Tag Archives: TRICARE

Navigating the Healthcare Crossroad: Active Duty to Reserves

crossroads-ad-to-reservesRecently, my spouse separated from active duty and transitioned to the Reserves. Healthcare was a major concern for us. While he was on terminal leave, we were eligible for TRICARE Prime, but we had to change service regions and find new doctors for any non-urgent treatment.

We were unsure about what would happen upon his separation date.

He had an assignment to a Reserve unit that processed him in the day after he separated from active duty, preventing a break in service. This made us eligible for the Transition Assistance Management Program (TAMP).

TAMP provides continuation of TRICARE coverage for 180 days.
We applied for TAMP through the Defense Enrollment Eligibility Reporting System (DEERS). If your dependents are not enrolled in TRICARE Prime upon separation, you will have to submit a new enrollment. This means there will be a waiting period before benefits can begin.

In the meantime, you will have TRICARE Standard coverage. If you were previously enrolled in TRICARE Prime, you can have your TRICARE Prime enrollment backdated to the last day of active duty service. It is important to submit a DD Form 2876 to your regional or local TRICARE office, because it cannot be backdated through web enrollment.

As a Reserve family, we are enrolled in TRICARE Dental and pay premiums. When called to active duty, my husband’s premium is suspended until his activation period is over, and he is covered under TRICARE Active Duty Dental Program. Dependents will continue to pay premiums for dental coverage during the activation.

Whenever we had questions, calling TRICARE or Military OneSource usually resolved things, but there were some paperwork headaches. The websites are pretty thorough and easy to navigate, even when we felt overwhelmed by all of the new changes.

Have you or your service member made this transition? Share your tips for transitioning from active duty to reserves in the comments below! 

brookePosted by Brooke Goldberg, Government Relations Deputy Director

Back to School: TRICARE options for college students

collegeboyYou’ve spent the summer months searching for the perfect dorm room essentials: mini-fridge, extra-long twin sheets, and the perfect papasan chair. But what are your college student’s TRICARE options?

Dependent children are eligible for regular TRICARE benefits while in college full time until their 23 birthday or until graduation, whichever comes first. After that, children may qualify to purchase TRICARE Young Adult.

The service member must update the dependent child’s “student status” in the Defense Enrollment Eligibility Reporting System (DEERS) to maintain the student’s TRICARE eligibility past age 21.

Before sending a son or daughter to college, it is important for military families to review their child’s health care options because some TRICARE options will work better than others. Here are some tips to consider:

Location. Where is the school located? Is it in a Prime Service Area? Contact the regional contractor for the TRICARE region where the school is located to determine if the school is in a Prime Service Area.

Transportation. Will your son or daughter have a car at school? Will your child be able to get to his or her assigned Primary Care Manager (PCM)? If enrolled in Prime, your child will need to see his or her PCM or additional fees will apply.

Cost. TRICARE plans have different cost sharing components and your student may need a split-enrollment in order to receive care while at college. A split enrollment allows some members of the family to be enrolled under one plan and other members of the family to be enrolled under another type of plan. For example, the family may be enrolled in TRICARE Prime, but the college-age student may be enrolled in TRICARE Standard. Or the college student may disenroll from Prime at his or her home location and re-enroll for Prime at the school location. Please review disenrollment options carefully. Students may be subject to a one-year lock-out if disenrolling from Prime and will not be able to re-enroll in Prime at their home location when returning for the summer. Families should check with their TRICARE contractor for more details.

On Campus Options. Many colleges and universities offer student health plans. Student health plans are considered other insurance, so TRICARE will be the secondary payer to any student health plan. TRICARE Standard and Extra work best with student health plans.

Visit our website for additional information about TRICARE options for college age kids.

KatiePosted by Katie Savant, Government Relations Information Manager

TRICARE Standard: Is it right for you?

flag-stethoscopeAs a new spouse, or even a seasoned spouse, the difference between TRICARE Standard and TRICARE Prime can be somewhat confusing. I remember how overwhelming it felt when I was faced with the decision on whether I wanted “Prime” or “Standard”. After reading through the literature available, as well as on TRICARE’s website, I decided TRICARE Standard was the best for me. If you are considering TRICARE Standard for your family, here are some points to consider:

TRICARE Standard is an option which allows you to choose your own doctor. You are able to see any type of doctor, from a specialist to a primary care physician. To search for the type of doctor you need, go to TRICARE’s “Find a Doctor” feature. If you choose a network provider, you end up paying less of a cost share . The cost share depends on what care you get at that particular appointment, whether or not you use a network or non-network doctor, or whether you are an active duty family member, retiree, or retiree family member.

The “in network” doctors file the TRICARE claims for you so you do not have to deal with the paperwork of filing the claim yourself. Using a network doctor is called TRICARE Extra . Also, there is no pre-authorization required when you need lab work or testing done. Each fiscal year you have an annual deductible to meet, which varies based on your service member’s status. As an active duty spouse, I pay only 20% of any allowable charges after I have paid my deductible for the year. There is also a $1000 “catastrophic cap” for active duty families. This means your out of pocket expense will not exceed that cap.

TRICARE patients have the option to choose which pharmacy they would like to use. Using TRICARE retail pharmacies are especially convenient for patients using TRICARE Standard, but are the most expensive option. Major drug store chains such as RiteAid, CVS, Target, and Walmart are in-network pharmacies. By using an in-network pharmacy, you are responsible for a $5.00 copay for generic medications and a $17.00 copay for brand name medications. You can save money if you use the TRICARE Pharmacy Home Delivery to have your prescriptions mailed right to your home.

A common misconception of TRICARE Standard is the idea that patients are not able to use the military pharmacy because they are not seeing a doctor at a Military Treatment Facility (MTF). As a TRICARE Standard user, you have the option to use the MTF pharmacies, which may be the best value if the MTF stock your drugs. Personally, I have never used a MTF Pharmacy because they were not as convenient for me because I did not live on the Army Post. However, if you want to save money, using the MTF pharmacy is a great option because both generic and formulary drugs have no copay!

TRICARE Standard has been the best choice for me because I enjoy choosing my provider instead of being assigned one. I also enjoy the flexibility of changing providers if I am not happy with my current doctor. Unlike TRICARE Prime, TRICARE Standard does not require a referral to see a specialist. Because of these choices, I don’t mind paying to see a doctor when I am ill and can’t survive another day without an appointment! I feel I am in control of my healthcare experience with TRICARE Standard. I encourage you to read about the other differences between Prime and Standard in order to make the best decision for your family. I hope that by shedding some light on the sometimes confusing and often-misunderstood TRICARE Standard, your decision may come a little easier.

Stephanie-OSullivanBy Stephanie O’Sullivan, National Military Family Association Volunteer, Fort Bragg, NC

Turning 65: Another milestone known as Medicare

Turning 65: Another milestone known as MedicareRecently, I began the rite of passage for another milestone in my life: turning 65. (And thank you to all those muttering under your breath, “I didn’t think she was THAT old!”) Armed with advice from my high school classmates via our reunion Facebook page and our Association’s website, I sat down at my computer to enroll in Medicare.

I was surprised by how easy it was to enroll online. My application was approved by the end of the week (which I could check online by using my confirmation number) and my Medicare card arrived in the mail a week later. Along the way, I learned a thing or two:

  • Somehow the whole world has received notice that you are soon turning 65. Every insurance company you’ve heard of and those you haven’t will start sending you information and calling you about Medicare supplemental insurance plans. Military retirees, their spouses, and survivors shouldn’t need those policies because they qualify for Tricare for Life, which picks up the cost shares not paid by Medicare. But, remember—to be eligible for TRICARE for Life, you MUST sign up for Medicare Part B!
  • You want to sign up for Medicare before you turn 65. If you wait until afterwards, not only will you turn 65 anyway (it’s inevitable), but you may also need to pay a penalty. I signed up in May before my August birthday.
  • You will start using Medicare at the beginning of your birth month. So even though you are not yet technically 65, Medicare thinks you are for part of the month.
  • You will need to get a new military ID card. My ID card was expiring in June so I thought I could kill two birds with one stone. I took my new red, white, and blue Medicare card with me in June to renew my military ID card. But all they did at the ID card facility was laminate my Medicare card and renew my “old” military ID card. I have to go back in August when I’m officially on Medicare. Then I’ll get a military ID card that doesn’t expire (and hopefully has a better picture).
  • You will need to update DEERS too.
  • It took me a while to discover how I was supposed to pay for my new Medicare Part B. (You don’t pay a premium for Part A.) If you’re already receiving Social Security, they deduct it from your paycheck. Otherwise, they send you a bill.

So now I’m waiting for August. 65!!! Yikes!

What milestone have you recently experienced in your journey as a military spouse? What advice do you have to share?

Susan-EversBy Susan Evers, Volunteer Services Coordinator, West Region

The Power of Volunteering

The power of volunteeringApril 21-27 is designated as National Volunteer Week and this year’s theme is “Celebrate Service.” The National Military Family Association is celebrating our volunteers, both past and present, who have made a profound contribution to the Association and the military families we serve. Today’s post is written by a volunteer about a volunteer, and is just one highlight of the great work all our volunteers do!

“Never be afraid to ask what you can do, because even if something seems really small, it can still help,” says Susan Reynolds, a military spouse and volunteer for the National Military Family Association. This philosophy, an unshakable optimism, and a genuine desire to contribute to her community keeps Susan fighting hard for military kids and families. She is committed to making sure that military kids, especially those with special needs, get the quality medical care they need and deserve.

Susan’s initiative started when her son was diagnosed with plagiocephaly, a condition defined by an asymmetrical distortion, or flattening, of one side of the skull. Her son needed a reshaping helmet, which she was told was not covered by TRICARE. The helmets can cost up to $5,000. Luckily, she and her husband were able to pay for it out of their savings account. However, she realized that not every military family could afford to do the same. “I don’t care what your rank is, that is a lot of money to come up with right away,” Susan says.

Even worse than the cost of the treatment was the uncertainty and delay Susan faced in getting her son properly diagnosed. “I was really given the runaround from the military treatment facility about TRICARE and what his course of treatment was,” Susan explains. Her experience convinced her that TRICARE and DoD can and must do better to ensure that military kids, especially those with special needs, are getting the care they need.

Susan soon became a tireless advocate for military kids and families. She worked closely with our Association’s Government Relations Department to understand TRICARE policy and how it should be changed. She founded support groups for military families with special needs children and met with Congressional staff members and other officials to share those families’ stories. During this time, while her husband deployed to Afghanistan, Susan’s home was hit by a tornado, but she never allowed herself to be distracted from her objective: to fight for military children.

Thanks in part to Susan’s efforts, Congress included a provision in the 2013 National Defense Authorization Act directing the Department of Defense to study TRICARE and its policies regarding care for kids. The provision, known as TRICARE for Kids, aims to develop and encourage health care practices addressing the specific needs of military children. “It was just so exciting to know that something I had worked on with the Association was passed,” Susan says. For her, knowing the President signed the bill that includes this provision is among her most rewarding and exciting achievements. She continues to work hard, however, to make sure that the results of the study reflect the real needs of military children and families.

To Susan, being a volunteer for the Association is her part time job. She enjoys reading, doing research, and keeping an eye on different issues happening in her local community and the greater military community. She never hesitates to talk about the Association and the people and organizations that she is involved with. She goes to key spouse meetings, to community blueprint meetings, talks to local nonprofits, and reports information associated with the military.

Susan will continue to work with the Association and to represent military families, as she wants to ensure people’s voices are being heard. She has received various awards and recognition  including one of the Air Force General’s coins. On more than one occasion, Susan was nominated as Air Force Spouse of the Year by different spouse magazines. Nevertheless, to her, knowing that she can make a difference and serve her community is the greatest reward.

Marlis Perez RiveraPosted by Marlis Perez Rivera, Volunteer with the National Military Family Association

Everything you need to know about the new TRICARE West Region Contractor, UnitedHealthcare Military & Veterans

Everything you need to know about the new TRICARE West Region ContractorThis month, the contractor managing the health care benefit in the TRICARE West Region changed from TriWest to UnitedHealthcare Military & Veterans (UnitedHealthcare). If you are enrolled in the TRICARE West Region, you should have received a welcome packet from UnitedHealthcare.

The TRICARE West Region includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding the Rock Island Arsenal area), Kansas, Minnesota, Missouri (excluding the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the southwestern corner, including El Paso), Utah, Washington, and Wyoming.

Continuity of care remains a top TRICARE priority, and UnitedHealthcare officials have pledged to the National Military Family Association and other beneficiary groups that it will make every effort to conduct a smooth transition. Here are some tips to help ensure your family has a smooth transition:

Keep Contact Information Handy
UnitedHealthcare Military & Veterans
1.877.988.WEST (1.877.988.9378)
www.uhcmilitarywest.com

Review your Primary Care Manager (PCM)
UnitedHealthcare has recruited more than 90% of the PCMs in TriWest’s network to be in their network. A searchable online directory is available on UnitedHealthcare’s website. If you do not see your current PCM listed in the directory, do not be alarmed. UnitedHealthcare is will continue to add more providers. It is recommended your ask if your provider is part of UnitedHealthcare’s network before you seek services.

Explore Enhanced Benefits
UnitedHealthcare will provide new benefits including Convenience Care Clinics, Urgent Care Centers, Centers of Excellence, and Telemedicine services. Keep checking the UnitedHealthcare website for more information about the enhanced benefits.

The National Military Family Association welcomes UnitedHealthcare to the TRICARE community. We look forward to continuing our ongoing dialogue about how to best meet the health care needs of military families in the West Region.

katiePosted by Katie Savant, Government Relations Information Manager at the National Military Family Association

We fight for military families: the Association’s 2013 priorities, Part 3

We fight for military families: the Association’s 2013 priorities, Part 3This is Part 3 of a series explaining the National Military Family Association’s legislative priorities for 2013. Read Part 1 and Part 2 here.

Some issues affecting military families can only be taken care of through Congressional action. We see most of the work on these issues being addressed through the House and Senate Armed Services Committees in the National Defense Authorization Act (NDAA), which sets the laws and regulations for Department of Defense (DoD) and the Services to follow. The funding of this legislation comes through the House and Senate Appropriations Committees with the Defense Appropriations bill and the Military Construction and Veterans Affairs Appropriations bill.

Congress did not pass the Appropriations bills for Fiscal Year 2013 (FY13), which began on October 1, 2012. They passed a Continuing Resolution or CR, which forced DoD to work on 2013 missions, projects, and programs with 2012 levels of funding. The current Continuing Resolution will expire March 27. While military paychecks are protected for 2013, essential services could shut down if the CR is allowed to expire. This isn’t the first year we have had the threat of a government shutdown.

Pass the NDAA FY14

This is why our first “ask” for Congress is to pass the National Defense Authorization Act for FY14 and the bills that fund this legislation by October 1 in order to eliminate the uncertainty faced by the military community.

Increase Impact Aid

If you have children attending public schools, you should be aware of how important Impact Aid funding is to local school districts that educate large numbers of military children. We’re asking Congress to increase the level of Department of Education Impact Aid funding to meet the Federal obligation to support school districts educating military children and continue to fund the DoD supplemental impact aid and grant program. Impact Aid funding has not kept pace with rising education costs.

Protect surviving spouses

Survivors of service members who have died on active duty or from a service-connected disability are unfairly penalized by having their Survivor Benefit Plan (SBP) annuity offset by the Department of Veterans Affairs Dependency and Indemnity Compensation (DIC) payment. Under current law, survivors who are eligible for both SBP and DIC must forfeit a dollar of their SBP annuity for every dollar of DIC received. Often the offset eliminates the SBP annuity altogether. We ask Congress to end the DIC dollar for dollar offset of SBP payments for surviving spouses. For more details on this issue, visit the Survivors section on our website.

Ease transitions for the whole family

DoD does not always need Congressional approval to improve or change policies. We are asking DoD to address the informational needs of military families transitioning out of the military by expanding the opportunity for spouses to attend transition classes with service members and tailor information to address family transition issues.

Support families with special needs

It can often take DoD a long time to implement programs mandated by Congress. In the NDAA FY13, Congress charged DoD to start a pilot program to provide therapy for some families with special needs. We want DoD to implement the new pilot program to provide Applied Behavior Analysis to ALL eligible TRICARE beneficiaries.

If you have questions about our priorities for 2013 or would like to provide us with information about how these issues will affect you and your family, please leave a comment below. As I mentioned in the beginning of this blog series, we are sharing your stories, your experiences, and your suggestions to improve the quality of life for military families.

These are not the only issues we will be advocating for. When a new challenge surfaces that affects military families, we will make sure it is brought to the attention of the policymakers who can make a difference. We are listening to you and for you. We are your voice.

kathyPosted by Kathleen Moakler, Government Relations Director at the National Military Family Association