TRICARE Your Military Health Plan TRICARE for Life

TRICARE Your Military Health Plan TRICARE for Life and TRICARE Plus Presented by: Wendy Pritt TRIWEST Healthcare Alliance, Inc. 1

TRICARE Regional Contractors North Region Health Net 1 -800 -555 -2605 www. healthnetfederalservices. com South Region Humana Military 1 -800 -444 -5445 www. humana-military. com West Region Tri. West 1 -888 -TRIWEST (1 -888 -874 -9378) www. triwest. com 2

DEERS • Medicare status • Current Uniformed services ID card • DEERS automatically notifies beneficiaries within 90 days of 65 th birthday about changing benefits Ø How many of you have received this notification? 3

TRICARE for Life • National Defense Authorization Act for FY 2001 Ø Extended TRICARE eligibility Ø Combines TRICARE Standard with Medicare Parts A & B Ø Second payer to Medicare 4

TRICARE For Life Eligibility • All TRICARE beneficiaries entitled to Medicare, regardless of age or residence • May receive Space A Military Treatment Facility (MTF) care • Some beneficiaries may enroll in the Military Treatment Facilities “TRICARE Plus” program. 5

Medicare Eligibility • Health insurance not a benefit like TRICARE • Ages 65 and older • Under 65 with certain disabilities • Any age with end-stage renal disease or amyotrophic sclerosis (ALS); most commonly known as Lou Gehring’s disease 6

Medicare Overview • Medicare Part A Ø Hospital Insurance • Medicare Part B Ø Medical Insurance • Medicare Part C Ø Medicare + Choice Plan • Medicare Part D Ø Medicare Prescription Drug Plan 7

Medicare Card • No TRICARE For Life card • Just show this Medicare card along with your uniformed services ID card Shows your eligibility for Parts A & B and the effective dates of coverage. Call 1 -800 -MEDICARE or visit www. medicare. gov if you need a new card. 8

Medicare Part B Enrollment • Federal law mandates enrollment to remain TRICARE eligible • Medical entitled Active Duty Service Members (ADSM)/Active Duty Family Members (ADFM) are not required to enroll until retirement Ø These beneficiaries retain TRICARE eligibility • Active Duty Service Members (ADSM)/Active Duty Family Members (ADFM) must have Part B enrollment in effect on retirement date to avoid break in TRICARE coverage 9

TRICARE For Life Costs • Medicare Part A Ø No fee if beneficiary paid Medicare taxes while working • Medicare Part B Ø Monthly premium required for Medicare, no enrollment fee for TRICARE at that point • 2010 Medicare Part B Premium Ø Based on income Ø May change each year 10

2010 Medicare Part B Premiums Beneficiary Pays Beneficiary’s Yearly Income Beneficiary files individual tax return File joint tax return $96. 40 if beneficiary has SSA withhold in 2009 $110. 50 for all others $85, 000 or below $170, 000 or below $154. 70 $85, 001–$107, 000 $170, 001–$214, 000 $221. 00 $107, 001 –$160, 000 $214, 001–$320, 000 $287. 30 $160, 001–$214, 000 $320, 001–$428, 000 $353. 60 Above $214, 000 Above $428, 000 11

Medicare + TRICARE Standard = TFL Medicare TRICARE Medicare Parts A and B along with TRICARE Standard as the second payer gives beneficiaries TRICARE For Life coverage 12

Coordinating TRICARE For Life with Other Health Insurance (OHI) Order of payment depends on whether or not you have employer-sponsored health insurance. Other Health Insurance (not based on current employment) • 1 st Payer: Medicare • 2 nd Payer: OHI or Medicare supplement • 3 rd Payer: TRICARE With Employer-Sponsored Health Insurance (based on current employment) • 1 st Payer: Employersponsored plan • 2 nd Payer: Medicare • 3 rd Payer: TRICARE For Life will always pay last. 13

TRICARE For Life—How it Works • You visit your Medicare provider • Your provider files a claim with Medicare • Medicare pays its portion and sends the remaining amount to TRICARE • TRICARE pays remaining amount to your provider • You get an explanation of benefits from Medicare and TRICARE Contact Wisconsin Physicians Service-TFL 1 -866 -773 -0404 www. tricare 4 u. com 14

TRICARE For Life—What You Pay Type of Service Covered by TRICARE and Medicare Covered by Medicare but not TRICARE Covered by TRICARE but not Medicare Not covered by TRICARE or Medicare What TRICARE What You Pays Medicare’s authorized amount Remaining amount Nothing TRICARE’s authorized amount Nothing Medicare deductible and cost-share TRICARE deductible and cost-share Total amount charged 15

Medicare Advantage Plans • Health Plan options that are a part of: Ø HMOs Ø PPOs Ø Fee-for-service Ø Medicare Special Needs program • Covered services and copayments are reimbursed by TRICARE 16

Medicare Prescription Drug Benefit – Medicare Part D • Covers brand name and generic drugs at participating pharmacies • Enrollment window – every year between Nov 15 – Dec 31 • TRICARE Pharmacy Program (may be better option for beneficiaries) 17

Pharmacy Options and Costs Type of Pharmacy Formulary Generic Brand Name (Tier 1) Non-Formulary (Tier 3) (Tier 2) MTF $0 $0 Not available Mail order $3 $9 $22* Network $3 $9 $22* Non-network Prime: POS fees will apply TFL: $9 or 20%, whichever is more. Must meet deductible (up to 90 -day supply) (up to 30 -day supply) Prime: POS fees will apply TFL: $22 or 20%, whichever is more. Must meet deductible *Non-formulary drugs are available at the formulary cost if medical necessity is established. Visit www. tricare. osd. mil/pharmacy for information. 18

TRICARE for Life (TFL) Overseas • No Medicare coverage overseas Ø TRICARE is primary payer Ø Except for U. S. overseas territories • No location restrictions Ø TRICARE Standard is a global benefit • Beneficiaries file their own claims Ø Submit claim (DD form 2642) to WPS Ø No Medicare summary required 19

TRICARE For Life Claims Processing • Wisconsin Physician Services (WPS) • TRICARE 4 u. com • Explanation of Benefits (EOB) 20

TRICARE for Life (TFL) Explanation of Benefit (EOB) • Detailed summary of claims for all medical care processed that month 21

TRICARE Plus • Primary care enrollment option • Available to beneficiaries not enrolled in TRICARE Prime or other HMO-like program • Offered at some MTFs* Ø Limited by MTF capacity Ø Not transferable from one MTF to another * Check with your local MTF for program availability and details. 22

Additional Information • TRICARE For Life (TFL) - www. tricare. mil/tfl • Defense Manpower Data Center (DMDC) Support Office - (800) 538 -9552 • ID Cards - www. dmdc. osd. mil/rsl/ • Social Security Administration (SSA) www. ssa. gov • TRICARE Fact Sheets www. tricare. mil/factsheets/index. cfm • Centers for Medicare and Medicaid Services www. medicare. gov 23

Questions? 24