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Tricare Help: Tricare may pay other insurer's deductible

Dec. 12, 2013 - 01:44PM   |  
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Q. When Tricare Standard is used as secondary coverage to other health insurance, will Standard cover any of the OHI’s deductible if the OHI care is provided through a non-participating provider?

A. Tricare will pay the OHI’s deductible up to 115 percent of the Tricare allowable amount for the service or procedure in question. The Tricare allowable charge varies depending on the service or procedure, but it is the same regardless of whether or not the OHI provider participates.

Q. I’m a retiree with a dependent spouse and mother. My mother is approved as my dependent in DEERS. If I die before them, Tricare policy clearly states that my spouse’s eligibility will continue as my survivor, but my mother’s status is unclear. Would my mother retain her eligibility as a “survivor”?

A. For the purposes of Tricare coverage for survivors of deceased retirees, the term “survivor” covers all dependents listed in DEERS under a retiree’s sponsorship at the time of the retiree’s death. In your circumstance, that would include your mom, assuming she is properly registered in DEERS as your dependent.

Q. Does Tricare for Life cover long-term care, such as for Alzheimer’s patients, outside of the Medicare provisions for up to 120 days of acute nursing home care?

A. When people talk about “long-term care,” they often have in mind a nursing home environment where people go when they can no longer care for themselves. It’s a place where you can live, and be watched over and protected. Your meals are provided and, if you’re unable to “do” for yourself, you will be helped to eat, dress, bathe, attend to personal hygiene and so on. In insurance and medical vernacular, such care is usually referred to as “custodial care.”

It is very expensive to live in a place where you have nurses and aides of several kinds, and probably a doctor on call 24/7 to care for you and meet your needs with the “activities of daily living” (a technical term used in law.)

Tricare covers skilled nursing care, home health care and hospice care, but it generally does not cover long-term care, also known as custodial care, for patients with degenerative conditions such as Alzheimer’s. Exceptions or partial exceptions to the “no coverage” guidance may be discussed with the managed-care contractors for the various Tricare regions, but such exceptions are rare.

One potential option for service members and military retirees is the Federal Long Term Care Insurance Program, open to active-duty and Selected Reserve members and military retirees. However, FLTCIP eligibility and enrollment requirements are complex, and not everyone who applies will be approved. Full details can be found at www.ltcfeds.com.■;

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or http://tricarehelp@militarytimes.com. In email, include the word “Tricare” in the subject line and do not attach files. Get Tricare advice any time at http://blogs.militarytimes.com/tricarehelp/.

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