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Understanding Military Medical Care

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For inpatient care, retirees and retiree family members pay the lesser of $401 per day, or 15 percent of the hospital bill and 25 percent of the professional fees; and the lesser of $149.00 per day or 25 percent of the institutional charges, plus 25 percent of the professional fees for inpatient mental health care.

A special note here. Under Tricare Extra, while you are normally responsible for paying anything over the Tricare authorized costs, if the medical provider fills out the claim forms for you (as many of them do) and receives direct payment from Tricare (vs. you filling out the claim forms yourself and being reimbursed by Tricare), the medical provider AGREES not to charge more than the Tricare Allowable Amount. This is true unless you sign a separate agreement with the medical provider which obligates you to pay the additional amounts. This is a little-known provision of the Tricare Standard Program. If the provider attempts to charge you more than the authorized amount (as happened to me recently), then you can contact your nearest Tricare Service Center and they will help arbitrate the dispute with the medical provider.

Guard and Reserve. Members of the Guard and Reserve (and their dependents) can use any of the above Tricare Options anytime the member is called to active duty for more than 30 days. Use of Tricare Prime is free, as it is with active duty family members. Health coverage is also provided up to 90 days prior to activation for servicemembers who receive a 'delayed-effective-date' order. The coverage lasts until 180 days following their activation. After that 180 day "transition" period, following activation, Guard and Reserve members can purchase special Health Care Coverage under the Tricare Reserve Select program, if they were activated for a contingency operation for 90 days or more.

Tricare for Life. Until recently, when a retiree or retiree family member reached the age of 65, they were no longer eligible for Tricare. Instead, they were expected to receive medical care under the provisions of Medicare. This changed this year (2001) with the introduction of "Tricare for Life." Again, there is no need to enroll in advance (except one must be enrolled in Medicare Part B). Additionally, the only charges for this program are the monthly Medicare Part B Premiums ($54.00 per month in 2002). Under this program, you see an authorized Medicare Provider and present your ID Card. Tricare then becomes the "second payer," and picks up any costs that Medicare doesn't cover.

Although Medicare doesn’t cover services provided outside of the continental United States, retirees residing in foreign countries can still take advantage of TFL because Tricare becomes the primary source of health benefits for them. Like those living in the United States, to be eligible overseas retirees must be enrolled in Medicare Part B. Tricare for Life will provide the same level of coverage afforded retirees under 65 and they will be responsible for the same Tricare cost shares and deductibles as the under 65 retirees. Since a great number of retirees living overseas did not enroll in Part B because Medicare didn’t cover medical care received in foreign countries, some of the military related organizations are pushing for a waiver of the Part B penalty which entails a 10 percent penalty for each year the individual was eligible for Part B but didn’t enroll. However, there is currently nothing in the works that indicates such a waiver is coming.

Tricare Plus. This is a brand new program, currently undergoing development. Basically, it will allow individuals to use Tricare Extra and Tricare for Life benefits at military medical facilities. Not all military medical facilities will offer this this option. Local commanders will determine whether or not they have the resources. Individuals will be required to enroll in the program at a participating medical facility, then must receive their primary care at that facility. There are no enrollment fees for this program. 

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