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Tricare Help: Can service member's adult brother be put on Tricare?

Oct. 31, 2013 - 07:24PM   |  
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Q. My husband is an active-duty soldier. He and his brother recently lost their mother, and the brother lost the health insurance coverage he had under his mother’s sponsorship. Can we add his brother — 23 years old, deaf and working — to our Tricare Standard?

A. The chances are virtually nil that your husband could have his brother added to his Tricare coverage; siblings generally are not eligible for Tricare. The only way it could possibly happen is if your husband became his brother’s legal guardian, and even then the chances are remote, particularly in this case, since you indicate that your brother-in-law is an adult and is self-supporting.

Tricare itself does not make eligibility determinations; only the military services may do that. The mechanism they use is the Defense Enrollment Eligibility Reporting System, the Defense Department’s eligibility portal for Tricare. You can engage with DEERS by visiting the ID Card/DEERS office on any military installation or by calling the main DEERS support office toll-free at 800-538-9552.

But again, you probably should not get your hopes up.

Q. My mother was married to a retired Air Force pilot and never remarried after he died, so she retained Tricare for Life coverage. She now suffers from Alzheimer’s and was hospitalized in June after a stroke, and she needs care in a skilled nursing facility. Her Medicare coverage for this will end after 100 days. Will Tricare for Life pick up the costs from there?

A. Tricare covers care in skilled nursing facilities that provide skilled nursing, rehabilitation, and other care, including medications. Skilled nursing facilities are not nursing homes or intermediate facilities.

However, skilled nursing facility care is only covered when the beneficiary:

■ Is treated in a hospital for at least three consecutive days, not including the day of discharge, and

■ Enters the skilled nursing facility within 30 days of the hospital discharge.

Covered skilled nursing services include:

■ A semi-private room.

■ Regular nursing services.

■ Meals (including special diets).

■ Physical, occupational and speech therapy.

■ Medications provided by the facility.

■ Necessary medical supplies and appliances.

There is no day limit as long as the care is medically necessary. Beneficiaries are responsible for applicable deductibles and cost shares.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com. In email, include the word “Tricare” in the subject line and do not attach files. Get Tricare advice any time at http://blogs.militarytimes.com/tricarehelp/.

Answers by RallyPoint

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