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Tricare Help: Retiree asks why he's billed for VA care

Jun. 21, 2012 - 01:54PM   |   Last Updated: Jun. 21, 2012 - 01:54PM  |  
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Q. I am a retiree enrolled in Medicare Parts A and B, and I also have Tricare For Life. I do not use Medicare; instead, I use a VA Medical Center near my home. I am in VA enrollment Category 8, the lowest priority, so I am billed co-payments for my visits. The VA hospital will not bill TFL and as a result, I'm not receiving any benefits from my TFL, even though I am paying $100 a month in premiums for Medicare Part B. I don't think it's fair that I have these co-pays.

A. It's not entirely true that you're getting no benefit from TFL. While you may have co-pays, those charges are far lower than the actual costs of the medical services you receive through your Veterans Affairs Department facility.

However, those co-pays are a matter of law. According to the Veterans Health Administration Handbook, TFL-eligible beneficiaries using VA medical facilities may receive all Tricare-covered services, but VA services provided through TFL are always subject to cost-sharing requirements, such as applicable annual deductibles and cost shares.

What you're not getting any benefit from is Medicare, for which you are paying $100 a month in Part B premiums.

Because you are in VA's lowest-priority category for care and are already paying for Medicare Part B, you may want to consider simply using Tricare For Life. To do that, you need to find a Medicare provider: http://www.medicare.gov/find-a-doctor/provider-search.aspx">click here to find one.

Under TFL, in most cases, Tricare will pay for whatever Medicare does not, fully covering your medical costs on the vast majority of your claims.

Clarification

The June 4 Tricare Help column stated that parents and siblings are not eligible for Tricare. A reader correctly noted that this isn't completely accurate. Dependent parents and parents-in-law of Tricare sponsors are eligible for Tricare Plus, a program that may offer primary care through local military treatment facilities if space and resources are available.

Dependent parents and parents-in-law are not eligible for Tricare Prime, Standard or Extra; Tricare for Life; Tricare Reserve Select; or Tricare Retired Reserve. Siblings are ineligible for all Tricare programs.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com?subject=Tricare%20Help:%20Retiree%20asks%20why%20hes%20billed%20for%20VA%20care">click here and send us an email. In email, include the word "Tricare" in the subject line and do not attach files. Get Tricare advice anytime http://www.militarytimes.com/tricarehelp">on our blog.

Answers by RallyPoint

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