Q. I am a retiree with a 100 percent disability rating. I have been getting all my medical care through the Veterans Affairs Department, but they're driving me crazy with delays. Plus, the nearest VA medical center is more than 200 miles away. How can I switch from VA care to Tricare?
A. The primary qualifying condition for a former uniformed service member to be eligible for Tricare is entitlement to retired, retainer or equivalent pay. Many retirees with service-connected disabilities opt for equivalent pay in the form of a pension from the Veterans Affairs Department in lieu of retired pay from their uniformed service. The amount of the VA pension is often greater.
To determine your Tricare eligibility, contact the Defense Enrollment Eligibility Reporting System support office at 800-538-9552. Be prepared to tell them all the appropriate dates and numbers.
My understanding of the rules regarding a transfer of your coverage from VA to Tricare is that it is an administrative matter you must resolve through VA. There may be special circumstances due to your 100 percent disability rating.
In essence, the rules say a beneficiary must choose whether to receive care through VA or Tricare, but not both, for the same medical condition.
Getting care under Tricare may be more expensive than under VA because of Tricare's deductible and cost shares. Unless you have a Tricare supplement, or qualify for Tricare For Life by virtue of being eligible for Medicare, those costs could run you up to $3,000 out of pocket each fiscal year.
Q. I am currently on active duty in the Army. Is it possible to put my sister on my Tricare? She lives with me, is 18 years old and currently still in high school.
A. Parents, brothers and sisters, or other family members other than spouses and children are not eligible for Tricare, even if totally dependent on the military member.
For official confirmation of the above, please call the Defense Enrollment Eligibility Reporting System at 800-538-9552.
Q. My husband and I have an insurance policy that will pay us $100 for each day we are in the hospital for cancer treatment. Do we have to report that to Tricare when we file claims?
A. Policies that pay a specified and fixed amount directly to the beneficiary for each day of hospitalization and don't specify that the payments are for medical bills are income protection policies. They are not health insurance and do not have to be reported to Tricare.
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