Since 11-09-05
Fed program (FEHBP) may cost more than Tricare For Life
Since 11-09-05
From: Waspscpo@aol.com
Sent: Wednesday, November 09, 2005 1:31 PM
To: undisclosed-recipients:
Subject: Fed Program may cost more than TFL
Tricare Help
Fed program (FEHBP) may cost more than TFL
By James E. Hamby, Jr.
Special to Navy Times
14 November 2005 Issue
Q. I’m a military retiree and a federal employee. My wife and I are enrolled in
the Federal Employees Health Benefits Program, but she will be 65 in February
and eligible for Tricare for Life. I’m debating whether to continue her on the
FEHBP or switch her to Tricare for Life. I haven’t been able to find a clear
definition of the benefits under that program. Can you help?
A. Tricare for Life combines full Medicare (parts A and B) coverage with full
Tricare coverage.
A patient goes to the Medicare provider of his choice. The provider files a
Medicare claim. Medicare processes the claim, pays its share to the provider and
forwards the claim to Tricare. Tricare pays the amount Medicare did not pay on
the claim for every service that is a Tricare benefit.
In this way, the provider’s Medicare claim and the bill for the services are
paid in full in the majority of cases.
In the rare event that the patient receives a medical service covered by one of
the programs but not both, he must pay the provider the paying plan’s deductible
(if applicable on that claim) and its co-payment.
The only medical service covered by Medicare but not by Tricare is chiropractic.
Medicare has a limited chiropractic benefit. The chiropractor will file a
Medicare claim. Assuming the patient has satisfied the Medicare deductible,
Medicare will pay the provider 80 percent of the amount it approves on that
claim. Medicare will forward the claim, including a report of its processing,
called the Medicare summary notice. That is what Medicare calls the Explanation
of Benefits, or EOB.
Federal law forbids Tricare to pay for chiropractic. Thus, Tricare will deny the
claim and pay nothing. As Tricare did not pay the patient’s 20 percent Medicare
co-payment, it is the patient’s responsibility to pay that amount to the
chiropractor.
Tricare covers a number of services that Medicare does not.
As to your question about possibly removing your wife from your federal employee
coverage when she becomes eligible for Tricare for Life, only you know enough
about your family’s financial and medical situation to make that call.
If your wife were to continue her coverage under your employee plan, that plan,
not Tricare, would be second payer to Medicare. I have little doubt it would
also pay the balance on Medicare claims for every covered service, just as
Tricare would. But there is an important difference.
The Tricare portion of Tricare for Life is free. (You can’t count the monthly
premium for Part B of Medicare because even if you didn’t have Tricare, you
would have to pay for Part B.) But your federal employee coverage surely is not
free. So, in effect, you would be paying a commercial insurer to do for your
wife’s insurance coverage what Tricare would do without charge.
You didn’t mention children, but if more than two people are on your employee
plan, you’d gain nothing by removing your wife. Premiums for a “family” of two
or more are the same no matter how many family members are on it.
If you make that conversion, be sure to specify to your personnel office that
you want to remove your wife’s coverage with the understanding that she may
reinstate it during open season. If her policy is canceled, she can never get it
back, but if done properly, she can reinstate it in any year if she thinks
Tricare for Life is not meeting her needs or expectations.
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Contributed,
YNCS Don Harribine, USN(ret)