Tricare Help - Help spread the word about health benefits

Since 01-05-06

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Subject: Tricare Help: Help spread the word about health benefits

January 09, 2006
Army Times

Tricare Help: Help spread the word about health benefits

By James E. Hamby Jr.
Special to the Times

I’ve seen many changes in CHAMPUS/Tricare in the past 25 years. And I have also seen some persistent problems that have defied remedy, despite the efforts of the Defense Department’s Office of Health Affairs.

The problem that has troubled me most is not one of program management or program operation. Rather, it occurs at the other end — with the consumer, the Tricare beneficiary.

The problem concerns beneficiaries and potential beneficiaries who know little or nothing about Tricare, and have no idea who to contact for the information they need.

Beyond those, the saddest situation is the potential beneficiary who is in great need of medical care but is totally ignorant about Tricare. He doesn’t consider asking because it doesn’t occur to him he might be eligible.

This isn’t about laying blame. It concerns those who, because of certain personal histories, life choices or circumstances that existed at crucial times in their lives, have lost touch with the military community.

The beneficiary doesn’t know about Tricare or his eligibility because Tricare or Health Affairs has been unable to reach him.

I still see that those who are most in need of information about Tricare are often the least likely to get it. Not only do they not know how to get the information, many do not even know of Tricare or are not aware they might be eligible.

Some retirees are still unaware of the 4-year-old Tricare for Life program. Some elderly retirees, especially those living far from other military retirees, may lack information of many kinds, including Tricare information that could be vital to their well-being. They’re unlikely to subscribe to service-related publications, and might not have access to computers.

Others who were drafted, or who enlisted late in World War II or in the immediate period following that war, retired before CHAMPUS/Tricare was created. They were not advised about CHAMPUS when they retired because it didn’t exist.

Elderly widows, or the children of divorce and/or remarriage, are particularly disposed to being lost to the system.

Word of mouth is the only way many of these folks can be reached. And word of mouth is amazingly effective, especially if we adopt an “everyone tell two” policy.

Tell friends and relatives (and urge them to do the same); put announcements in bulletins at your place of worship; advise elder-housing, hospice, nursing home and home health care workers and aides; tell adult day-care, association and club personnel and the like that Tricare for Life coverage may be available for their members, patients and clients.

And don’t forget social service agencies, focus groups and the Red Cross. Advise doctors, nurses, hospital and clinic administrators. In short, tell everybody, and ask everybody you tell to pass it on.

Tricare eligibility is set by federal law for designated categories of people. But Tricare cannot make determinations on eligibility.

Only the uniformed services have authority to determine whether a given person meets legal criteria for Tricare eligibility, to register that person in the Defense Enrollment Eligibility Reporting System and to issue an appropriate ID card.

Beneficiaries and potential beneficiaries need to be put in touch with an official source for Tricare information and help. The Pass and ID Card Section at a military facility is the definitive place for eligibility help. But most counties have a Veterans Service Office, and all U.S. cities — and even many small towns — have military recruiting and National Guard/Reserve components that should be able to provide some guidance for making initial contact.

Health Affairs told me the best place to begin to establish one’s Tricare eligibility is DEERS. The nationwide toll-free telephone number for the DEERS Support Office is (800) 538-9552.

Please note that the DEERS office is not the place to ask about claims, nor is it the place to register for Tricare. It’s important to make that clear to those getting the office number; otherwise, the lines will be tied up with questions that cannot be answered. But, according to Health Affairs, it is a place that potential beneficiaries can use as a starting point to learn how to contact Tricare and then apply for the program.

Q. When I took my daughter for her new ID card, we had her university registrar’s certificate proving she would be enrolled as a full-time student through Dec. 9, 2005, when the quarter ends. The post’s ID card section would certify her Tricare eligibility only through Dec. 9. It was only two weeks more until her 23rd birthday, on Dec. 23, and I know she will lose her Tricare eligibility then. Why was Tricare so picky about only two more weeks?

A. First, let me say I am not a lawyer. I can tell you what the law says, or you can read it yourself, but I’m not qualified to tell you what the law means or how it applies in a particular case. For legal advice, you need to see a lawyer.

Tricare eligibility is established by federal law for designated categories of people. Tricare, however, does not have authority to make Tricare eligibility determinations.
That authority belongs solely to the uniformed services. Only the services may interpret and apply Tricare eligibility laws and regulations.

The reason the Pass and ID Card Section at your post was “picky” and refused to issue an ID card certifying Tricare eligibility for “only two more weeks” is that, very likely, it would have been in violation of federal law.
By law, Tricare eligibility for children is limited to those who are unmarried and under age 21. If the unmarried child is a full-time college student, however, eligibility may be extended until their 23rd birthday.

Although your daughter is not 23 years old, the full-time student status that qualifies her for Tricare eligibility stopped Dec. 9, when the academic quarter ended.

Because she will be over age 21 and no longer a full-time college student after Dec. 9, she would not meet legal criteria for Tricare eligibility. Her eligibility ends when her full-time student status ends, not when she turns 23.
I believe the Pass and ID Card Section at your Army post issued her ID Card correctly.

James E. Hamby Jr. may be reached by writing to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or by sending e-mail to tricarehelp@atpco.com . In e-mail, please include the word Tricare in the subject line and do not attach files to your message. Attachments will not be opened.

Any man or woman who may be asked in this century what they did to make life worthwhile in their lifetime....can respond with a great deal of pride and satisfaction, "I served a career in the United States Navy."