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Tricare Help: Long-term care coverage is limited

May. 21, 2009 - 01:23PM   |   Last Updated: May. 21, 2009 - 01:23PM  |  
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A. If you're referring to what is commonly called nursing home care, Tricare's part is limited.

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Q. What are Tricare's provisions for long-term health care insurance?

A. If you're referring to what is commonly called nursing home care, Tricare's part is limited.

Nursing home care usually means residence in a protected and secure facility that provides general nursing services and assistance with the activities of daily living. The facility provides those services to residents more or less equally. It does not provide medical care with the goal of making the resident well.

Federal law and regulation do not allow Tricare to pay for those services by a long-term care facility or nursing home.

However, residents of long-term care facilities do retain all the Tricare benefits they'd be entitled to if they were living independently. Tricare will cover doctor visits, medically necessary and appropriate diagnostic testing, lab and X-ray services, prescription drugs, medically necessary admissions to an acute care hospital, and other Tricare-covered services.

It is the costs of the nursing home that Tricare may not cover. Unfortunately, those services are usually the most costly part of long-term care.

Q When I get my yearly exam, I prefer my doctor's female physician assistant to perform my Pap test. Will Tricare cover her services?

A. If your doctor is a Tricare-authorized provider and the physician assistant is an employee working under his supervision and direction, the doctor will bill for all the office's services. If Tricare covers the particular Pap test in your case, the fact that the physician assistant performs the procedure should make no difference in Tricare's ability to pay.

Write to James E. Hamby Jr. at Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159 or at tricarehelp@militarytimes.com">tricarehelp@militarytimes.com.

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