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Does coverage switch when daughter visits father?

Sep. 20, 2012 - 03:27PM   |   Last Updated: Sep. 20, 2012 - 03:27PM  |  
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Q. My husband and I divorced, and I have primary custody of our daughter, although she visits him for a few months in the summer. Per the divorce decree, I provide for her health insurance, but my ex-husband, who is in the Coast Guard, decided he also wants her covered by his Tricare. Tricare has always told me that they will be second payer to the insurance that I provide her. However, my ex says if she stays with him for more than 30 days, Tricare will become primary, and then it will switch back when she comes home. Is this true?

A. Your ex-husband is incorrect. As you are the official custodial parent, your health insurance is first payer for your daughter and Tricare remains second payer, even when your daughter is staying with your ex. Tricare is always second payer to any other available health coverage.

Q. My wife and I have Tricare Prime. Before my wife turned 65 in November, we received a letter telling her to apply for Medicare. She enrolled in Part B with its monthly premium. However, Tricare Prime continues to bill us at the family rate of $460 per year. I will not turn 65 until 2017. I am getting conflicting information about what program we should be under — Tricare Prime, Tricare for Life or Tricare Plus. What are our options?

A. Since your wife is now 65 and is enrolled in Medicare Part B, she is covered under Tricare for Life. As you probably know, you will not be eligible for TFL until you turn 65. Until then, you will remain under Tricare Prime.

However, you should not still be paying the family rate for Prime, since only you are now using that option. You should contact the managed-care contractor for your region.

Under Tricare Plus, beneficiaries who normally can get care at a military treatment facility only on a space-available basis can access primary care at the MTF the same as beneficiaries enrolled in a Tricare Prime option.

For example, if Plus is available at their local MTF, retirees and retiree family members using Tricare for Life can enroll in Tricare Plus and be guaranteed a routine appointment within one week, the same access standard as beneficiaries enrolled in a Prime option.

Tricare Plus is available only at certain MTFs, and local MTF commanders may limit enrollment to specific categories of beneficiaries. Tricare beneficiaries enrolled in Prime are not eligible to enroll in Tricare Plus, so in your case, this option would be available only to your wife.

The patient administration office at your local MTF can give you more information on the availability of Tricare Plus at that facility.

Answers by RallyPoint

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