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Answering your questions on Tricare.
Q. My wife and I are going to Italy to visit relatives. Will Tricare for Life continue to provide the same coverage as it does at home?
Tricare for Life consists of full coverage by Medicare Part A and Part B plus full coverage by Tricare Standard. By federal law, Medicare may not pay for any medical care received outside the U.S. and its possessions. Tricare Standard, however, provides coverage worldwide. At the moment you leave U.S. airspace or waters, your only coverage will be Tricare Standard.
All Tricare claims will be processed as they were before you got Medicare and Tricare for Life. Medical services and payments will be subject to Tricare rules and must be provided by a physician or hospital properly licensed in that country.
Claims will be subject to the normal Tricare deductible and cost shares. Foreign providers are unlikely to recognize U.S. health insurance, however, so expect to be asked to pay up front.
Be sure to save a copy of every document relating to any care you receive. Each document must show the name and address of the provider, the name of the patient, and the date of each medical service.
Both of you will need proper documentation to file Tricare Standard claims for reimbursement after you return home. Claims for services not properly documented may be denied.
A beneficiary has 90 days to file an appeal of any claim or item for which Tricare denies payment. The Tricare Explanation of Benefits will always state the reason for denial, which is what must be "fixed" for the claim to be reconsidered.
Q. I understand that Medicare comes with my Tricare for Life benefit package when I am 65. What about my wife? Will she get TFL and Medicare in October when I do, or does she have to wait until next May when she is 65?
You have the sequence backward. To have Tricare for Life, you must get Medicare first. You must contact Social Security, apply for and become enrolled in free Medicare Part A, and enroll also in Medicare Part B.
Note that Medicare is under the control of the Social Security Administration. Tricare has no control over Medicare or vice versa.
After your enrollments in Medicare Part A and Part B are in effect, and your Defense Enrollment Eligibility Reporting System record has been updated to prove it, you will become eligible automatically for Tricare for Life.
Your transition to Tricare for Life will have no effect on your wife's Tricare eligibility or enrollment. Her eligibility will continue until she gets Medicare, probably when she turns 65 next May. Ë
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