Q. I have a 6-month-old daughter, but I need a paternity test to prove she is mine before I can register her in the Defense Enrollment Eligibility Reporting System. Does Tricare cover paternity tests?
A. Tricare covers most inpatient and outpatient care that is medically necessary. Paternity tests may be legally necessary in any number of scenarios, but they are not medically necessary. As such, Tricare does not cover them.
Q. I'll be 65 in October. I will apply for Medicare only and delay receiving Social Security benefits until I am 66, my full retirement age. Medicare will pay for up to 20 "hospital" days per benefit incident or up to 100 "skilled nursing home" days. If an individual requires more than 20 hospital days or more than 100 skilled nursing home days, will Tricare for Life pay the full cost after those days are used up?
A. For hospitalization, Tricare for Life will cover 100 percent of Medicare Part A deductibles and co-pays for covered services, through Day 150. If the hospitalization lasts longer than that, TFL beneficiaries must begin paying daily co-pays as well as cost shares, which vary depending on whether they are in a network or non-network hospital.
For skilled nursing care, eligibility starts with a requirement that the beneficiary must have had a medical condition that needed to be treated in a hospital for at least three consecutive days. Admission to a skilled nursing facility is covered as long as the beneficiary is admitted within 30 days of discharge from the hospital, with some exceptions for medical reasons. Prior authorization is required, and the beneficiary's doctor must certify that the skilled nursing home care is medically necessary.
Assuming all those boxes are checked, TFL will cover skilled nursing facility care for an unlimited number of days that a beneficiary requires skilled services that meet the criteria for continuing coverage — that is, skilled services that are directed by a doctor and can only be provided by professionals.
Under this benefit, TFL will cover medically necessary skilled nursing care and rehabilitative (physical, occupational and speech) therapies, room and board, prescribed drugs, lab work, supplies, appliances and medical equipment.
After day 100 of skilled nursing care, however, Tricare cost shares and deductibles apply. Beneficiaries are responsible for daily co-pays as well as cost shares, which again vary depending on whether they are in a network or non-network facility.
Tricare for Life does not cover long-term care, also known as custodial care, either in a home setting or a nursing home.
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