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Tricare Help: Will Tricare cover diabetes care?

Feb. 16, 2012 - 12:21PM   |   Last Updated: Feb. 16, 2012 - 12:21PM  |  
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Q. My fiancé is active-duty military. I am diabetic and am on the insulin pump. I have been told that once I get married and go on Tricare, my care will not be what I'm used to. I have seen the same doctor for 17 years, and I heard Tricare won't let me pick my doctor. I have also been told I may have to give up my insulin pump and go back to shots. Is that true? Also, when we get married, do I have to wait for an open enrollment date for Tricare, or is there a way that coverage can start right away?

A. First of all, if medically necessary and appropriate for the diagnosis, symptoms and history of the particular beneficiary, an insulin pump can be covered by Tricare.

A problem could arise in your choice of providers. Tricare is not an insurance policy; it's a federal health benefits program. Tricare requires that you receive all civilian medical care from Tricare-authorized providers. Tricare may not pay for any medical services you receive from an unauthorized provider.

To retain your same providers, they would have to be willing to become Tricare-authorized. They can learn how to do that http://www.tricare.mil/providers">by visiting this webpage.

There is no open enrollment period for Tricare. You will become legally entitled to Tricare the moment you are married.

For you to use Tricare, your military sponsor (your husband) must contact his personnel office to register you in the Defense Enrollment Eligibility Reporting System and secure for you a uniformed service identification card. Your coverage will be retroactive to the moment of your marriage.

Q. My wife and I just qualified for Medicare and Tricare for Life. We were both enrolled in Tricare Prime. We are also enrolled in Tricare Prime Plus at a military treatment facility. Do we need to continue paying the annual enrollment fee to use Tricare Prime Plus?

A. Beneficiaries who are enrolled in Tricare Prime when they become eligible for Medicare and Tricare for Life have their Prime enrollment terminated.

On the effective date of Medicare coverage, their Prime coverage is automatically changed to Tricare Standard, which becomes a free supplement to Medicare, and they are no longer eligible for Tricare Prime.

They also no longer have priority access to free care at a military hospital, and any Tricare Prime enrollment fees paid in advance are lost; they cannot be refunded.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com?subject=Tricare%20Help:%20Will%20Tricare%20cover%20diabetes%20care?">click here to send an email. In an email, include the word "Tricare" in the subject line and do not attach files. Get Tricare advice anytime http://www.militarytimes.com/tricarehelp">on our blog.

Answers by RallyPoint

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