Tricare Help: Do I need Medicare Part C? - Getting out, military health issues - Navy Times

Tricare Help: Do I need Medicare Part C?

Q. I turned 65 in February and have enrolled in Medicare Parts A and B. I have also contacted Medicare about information on Part C, but it’s been three weeks and I have not heard back. Can you help?

A. I can’t help you get a reply from Medicare — that’s outside the scope of this column. But I can tell you that as a general rule, Tricare for Life beneficiaries do not need Medicare Part C coverage.

Medicare Advantage Plans under Part C are offered by private companies that are approved by Medicare. They may offer supplemental coverage beyond the standard Medicare Parts A and B, and most also offer Medicare Part D prescription drug coverage — all at additional out-of-pocket costs to beneficiaries beyond the monthly premiums required for Medicare Part B outpatient coverage.

Advantage plans, however, are designed for civilians who do not have your free Medicare supplement known as Tricare for Life. TFL offers the same supplemental coverage, along with its own prescription drug plan, at far less cost. While there has been talk of implementing an annual enrollment fee for TFL, at this time there are no enrollment costs for that program.

In addition, prescription drug costs through TFL are lower than under Medicare Part D. In fact, the Pentagon advises that the only people who may benefit from Part D coverage are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums.

Moreover, enrollment in Part D would preclude your use of the Tricare Mail Order Pharmacy program, under which you can get a 90-day supply of drugs for what you’d pay for a 30-day supply at a local retail pharmacy.

To sum up, you are already covered by two full-service, stand-alone, health insurance plans — Medicare and Tricare for Life —for the cost of the monthly premium for Medicare Part B.

Q. My father is retired Air Force and just recently had retinal reattachment surgery. He has Medicare, as well as Tricare for Life, so I don’t understand why he received a bill from the hospital for more than $300. Does Tricare not cover the surgery?

A. Ordinarily, there should be no unpaid balance under Tricare for Life; the combination of payments by Medicare (primary coverage) plus those by Tricare should have paid the Medicare claim and all providers’ bills in full. The balance most likely results from an error in the way the Medicare claim was filed or processed.

Your father will need to compare the itemized bills for the balance with the explanation of benefits forms that Medicare and Tricare should have sent to him. He can find contact information for help by clicking here.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or click here to send an email. In email, include the word “Tricare” in the subject line and do not attach files. Get Tricare advice anytime on our blog.