Tricare Help: Can I use up my coverage? - Getting out, military health issues - Navy Times

Tricare Help: Can I use up my coverage?

Q. I am a retired reservist with Tricare. I am being treated for non-Hodgkin lymphoma, which requires long-term, expensive therapy and sometimes weeks of hospitalization for adverse reactions. What happens if I use up my policy’s lifetime reserve?

A. You cannot “use up” your or your family’s Tricare benefits. That’s because Tricare is not a health insurance policy or insurance company — it is a federal health benefits program that exists to pay most of the costs of civilian medical care for active-duty family members, retirees, retiree families and survivors.

Unlike most commercial health insurance policies, and even Medicare, Tricare has no specific day/dollar/lifetime limits on any kind of medical care except drug and alcohol rehabilitation programs. Tricare most likely will pay for authorized medical services related to almost every illness as long as the services are:

• Determined to be medically necessary.

• Appropriate for the specific patient’s diagnosis, symptoms, and personal or family history.

• Consistent with what is considered to be good medical care in the U.S.

• Able to show progress toward certain therapeutic goals.

Q. I have Medicare Part A and Part B plus a Medicare supplement. When Medicare denied a claim because it was not a covered service, the supplement also denied it. What would Tricare do in such a case? Would I be better off using Tricare as my Medicare supplement?

A. You need to visit www.tricare.mil and learn about Tricare for Life.

Designed specifically for Tricare beneficiaries with Medicare, TFL combines the benefits of Medicare Parts A and B with the benefits of Tricare Standard, which is free.

When both Medicare and Tricare cover a particular medical service, Tricare Standard will pay whatever Medicare did not. Their combined payments will pay the balance on the Medicare claim and the doctor’s bill in full. On the vast majority of your claims under TFL, you will pay nothing.

If Medicare does not cover a particular service, but Tricare does, Tricare will process the claim as if it were your only health insurance. All Tricare claims-processing rules will apply, however, so that particular claim will be subject to Tricare Standard’s 25 percent cost share of the amount allowed, plus any portion of your $150 Tricare deductible not previously satisfied in that fiscal year.

If Medicare covers a service but Tricare cannot, Tricare will pay nothing and you will have to pay the Medicare deductible and co-payment yourself.

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