Tricare Help: Will Tricare cover nursing home care? - Getting out, military health issues - Navy Times

Tricare Help: Will Tricare cover nursing home care?

Answering your questions on Tricare.

Q. My father is retired from the military, and my mother is developing dementia and needs to go to a nursing home. Will Tricare and Medicare pay for her stay?

A. Neither Medicare nor Tricare, unfortunately, can pay for nursing home care — commonly known in the insurance agency as custodial care. That is a matter governed by federal law and is not subject to appeal.

Although her residence in a nursing home cannot be covered, your mother will continue to have the other medical benefits of Medicare and Tricare. That means they will help pay for doctor visits, surgery, medically necessary hospital care, prescription drugs and the like.

You, or another responsible adult, must keep her registration in the Defense Enrollment Eligibility Reporting System and her military ID card up to date, and ensure that claims for her medical care are filed properly.

Although I am not a lawyer, it seems to me that someone should be appointed by a court to be responsible for your mother’s care and to do for her the things she cannot do for herself. You should seek advice from a lawyer about such matters.

If the cost of legal assistance is a problem, I suggest you contact your city’s Legal Aid office or the local lawyer referral service to see about getting lower-cost help.

Q. If an unmarried, active-duty father acknowledges paternity of a child, is the child eligible for Tricare without a paternity test? A paternity test can be difficult when the service member is deployed. Also, is the father’s name on the birth certificate enough to establish paternity?

A. Tricare’s rules and procedures are governed by federal law and regulation. In the case of a birth outside of wedlock, the law specifies that paternity must be established by judicial determination — that is, a court must issue a statement certifying that the presumed father is, indeed, the child’s biological parent.

Merely naming the “father” on the birth certificate is not enough.

However, I am not an attorney, and your question has legal implications, so you may want to consult a lawyer. I also suggest you call the Defense Enrollment Eligibility Reporting System support office at 800-538-9552 for official information regarding the matter.

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