TRICARE to MEDICARE Transition

[friar1610]

I know we have a few military retirees here. Don't know if any are old enough to have left TRICARE (as primary insurance) at age 65 and transitioned to MEDICARE (with TRICARE For Life {TFL} as the secondary). I have a few years to go before that transition, but I was just wondering about it. Is it a seamless transition? Are there any things one needs to be aware of to avoid glitches? Is TFL all it's cracked up to be?

[Rustic23]

I turned 65 in August. I applied for Medicare three months before my birthday as they say you should. I used Tricare Prime and went to the same doctor in August. Have not seen any of the bills so I am not sure how smooth it will be. However, I do not expect any problems. I scheduled a colonoscophy for Sept, and the doctor's office did not flinch when I told them it was Medicare and Tricare. Interesting as the same doctor did not except Tricare by itself.

[WM]

Quote:

Originally Posted by Rustic23 Interesting as the same doctor did not except Tricare by itself.

As I understand it, Medicare reimbursement is low, but Tricare is even worse.

[friar1610]

Quote:

Originally Posted by WM As I understand it, Medicare reimbursement is low, but Tricare is even worse.

I'm not sure that's true. I think they work off pretty much the same reimbursement schedule. But, for whatever reasons, MEDICARE covers some things that TRICARE doesn't and vice-versa. Examples: you get prescription coverage with TRICARE; not so with MEDICARE unless you enroll (and pay for) Part D. MEDICARE doesn't cover anything when you're outside the country; TRICARE does. MEDICARE covers chiropractic care; TRICARE doesn't. I've done a bit more web research since I posted the first post in this string. I'm convinced that it's a really good deal to be covered by both.

[Gardnr]

Quote:

Originally Posted by friar1610 I'm convinced that it's a really good deal to be covered by both.

I'll second that!

[outtarentals]

On 8-31-2008 Friar 1610 posting in a separate thread, wrote:

"What worries me about TRICARE Standard (and also about MEDICARE as I get within spittin' distance of it) is this: It seems like every year there's a drill to reduce the fees paid to providers. At the eleventh hour they always seem to restore (or slightly increase) the fees and kick the decision into the next FY when even deeper reductions are proposed. The potential - and in some cases actual - problem: fewer and fewer civilian providers wanting to accept new patients under TRICARE/MEDICARE."


Friar, do you have an update on this? I have had Medicare/Tricare for Life for some time and have not one complaint about it. As far as I know, it is currently the best senior medical insurance available. (But - we earned it, didn't we?!)

I'd be concerned if I thought it would be hard to be accepted though.

One thing to be aware of - not a big deal - Medicare premiums are now means tested to a top level of around $250/month that will kick in if you sell highly appreciated assets and have a big capital gain - at least for that year.

[OAG]

Simple, simple. Been on TFL/MC for 3 years now. Even moved cross country. Found a local medical shop to take both of us (DW and I). Annual visits usually but referrals are "ask and thou shall receive", prescriptions written while we wait and filled via mail (prescriptions faxed to Express Scripts, usually cost is $3.00 for 90 days of medicine sometimes (DW stuff) it gets to $9 for 90 days). Usually get two pieces of paper for each visit. First one from MC saying there is a balance owing (but also says this is not a bill). Second is from TFL which ALWAYS has a bottom line of $0.00. Just file the paper away and clean out the file at tax time. No copays no nothiing to pay. We do not get enough dollars to worry about MEANS TESTING only pay the lowest rate for MC. Have not heard my Doctor complain about payment he is receiving. I do not worry about the Politics of this stuff just "go with the flow" on this program.

[friar1610]

Quote:

Originally Posted by OAG Have not heard my Doctor complain about payment he is receiving. I do not worry about the Politics of this stuff just "go with the flow" on this program.

That's probably a smart approach. I've personally never had a problem getting doctors to "accept" me but I have read about doctors not accepting new Medicare patients (although I believe most stick with you once you're in their system). And every year in the MOAA magazine I read about the Congressional drill.

[friar1610]

Quote:

Originally Posted by outtarentals On 8-31-2008 Friar 1610 posting in a separate thread, wrote: "What worries me about TRICARE Standard (and also about MEDICARE as I get within spittin' distance of it) is this: It seems like every year there's a drill to reduce the fees paid to providers. At the eleventh hour they always seem to restore (or slightly increase) the fees and kick the decision into the next FY when even deeper reductions are proposed. The potential - and in some cases actual - problem: fewer and fewer civilian providers wanting to accept new patients under TRICARE/MEDICARE." Friar, do you have an update on this? I have had Medicare/Tricare for Life for some time and have not one complaint about it. As far as I know, it is currently the best senior medical insurance available. (But - we earned it, didn't we?!) I'd be concerned if I thought it would be hard to be accepted though. One thing to be aware of - not a big deal - Medicare premiums are now means tested to a top level of around $250/month that will kick in if you sell highly appreciated assets and have a big capital gain - at least for that year.

Here is a MOAA "fact sheet" summarizing the current state of affairs:

MOAA: Military Officers Association of AmericaMedicare Improvements

[mickeyd]

Quote:

Originally Posted by OAG prescriptions written while we wait and filled via mail (prescriptions faxed to Express Scripts, usually cost is $3.00 for 90 days of medicine sometimes (DW stuff) it gets to $9 for 90 days).

I am under TCP now and about a year from MC/TFL. I receive care from a military facility so I have no cost. Even my RX are at no cost, and since I have about 10 Rx's it is a good savings. Do you know if, when I transition to MC/TFL, I will still be have access to the military pharmacy or will I need to find another source (mail order)?

[friar1610]

Quote:

Originally Posted by mickeyd I am under TCP now and about a year from MC/TFL. I receive care from a military facility so I have no cost. Even my RX are at no cost, and since I have about 10 Rx's it is a good savings. Do you know if, when I transition to MC/TFL, I will still be have access to the military pharmacy or will I need to find another source (mail order)?

I read some of this recently (on the web) but may be a little fuzzy on the details:
- I believe you can still get RX from the MTF on a space-available basis.
- Your worst case scenario would be that you would use the Tricare mail order plan where you get 90 days of scrips for $3 (generics); $9 (formulary brand names) or $22 (non-formulary brand names.)

Check these web sites:
myTRICARE.com (general Tricare Info)
https://www.tricare4u.com/apps-porta...ps-app/static/ (Tricare for life contractor)

[OAG]

Quote:

Originally Posted by mickeyd I am under TCP now and about a year from MC/TFL. I receive care from a military facility so I have no cost. Even my RX are at no cost, and since I have about 10 Rx's it is a good savings. Do you know if, when I transition to MC/TFL, I will still be have access to the military pharmacy or will I need to find another source (mail order)?

Yes you will have access to the on base pharmacies and MAY even be able to continue to get your health care from the military facility (I did until I left Florida). Not we could get prescriptions filled out a WPAFB (Dayton) but it is too far to travel (100 mile RT) so Express Scripts is our route.