Tricare Help: Losing Tricare Prime eligibility - Marine Corps Health Issues | Marine Corps Times

Tricare Help: Losing Tricare Prime eligibility

Q. I have just become eligible for Social Security disability, and I understand that after two years I will become eligible for Medicare. When that happens, I’ll have to enroll in Medicare Part B and pay the premium, and I will lose my Tricare Prime eligibility. I don’t want any of those things to happen. I just want to draw my disability pay and continue with my Tricare Prime doctors, whom I trust greatly. Is there any way to do that?

A. I don’t believe that a person drawing disability pay for two years is required to enroll in Medicare at that time. I think that is an option. But you need to call Social Security for clarification.

If you’re required to enroll in Medicare Part A in two years, then the things you want to avoid will be forced upon you.

If you are required to enroll in Medicare Part A, federal law requires you to enroll also in Medicare Part B and pay its monthly premium to avoid losing your Tricare eligibility.

If you enroll in Medicare Part A and Part B, you become eligible for the program called Tricare for Life even if it is against your will.

In that case, you will no longer be eligible for Tricare Prime. You’ll have to get all your medical care from Medicare providers. You’ll be automatically switched from Tricare Prime to Tricare Standard, which will act as last payer to your Medicare claims.

Q. Why won’t Tricare pay my claims? What can I do about it?

A. Every time Tricare processes a claim, it sends the patient a form called an explanation of benefits. The EOB explains every action Tricare took with the charges on the claim. If payment is denied on a claim, or a portion of the claim, the reason is always reported on the EOB. That is the issue you must fix, if possible, for the claim to be paid.

As a general rule, any time a charge or a claim is denied, the patient should file an appeal within 90 days. The appeal must be in writing, state the specific matter in dispute, and include a copy of the EOB showing the denial. Send it to the office that processed the claim. For further information about appeals, call your Tricare Service Center.

If the denial reason mentions eligibility or the Defense Enrollment Eligibility Reporting Service, call the DEERS Support Office at 800-538-9552. Always contact DEERS first for help with any problems or questions concerning Tricare eligibility.

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Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or e-mail us. In e-mail, include the word “Tricare” in the subject line.