Tricare For Life- question

[Tailgate]

I've posted several questions recently concerning my DM's upcoming move to independent living and responses have been extremely beneficial. It's reassuring to hear other's experience with similar situations. To me, this is the true value of being an active member of this forum.

Now comes a question about an unforeseen medical event down the road. She is 87, healthy (no chronic ailments) and has survivor benefits from Tricare For Life. I'm just now beginning to get up to speed on these benefits. I understand that they kick in after Medicare pays and is very good at paying.

Her finances are pretty tight and my question is what medical related expenses might we be on the hook for if something happens (fall, serious illness) beyond what Medicare and TFL would pay. The answer will tell me what she will be able to afford in housing.

Has anyone had a similar experience with your DH or DW? Are we safe to use her assets for housing and not worry about major medical that is not covered? Thanks in advance for any advice.

 

[wmc1000]

check out this link on tricare - Health Plans - TRICARE For Life | TRICARE

 

[MBSC]

TFL is basically a combination of Medigap Plan F and a Part D drug plan. This PDF document explains your costs after Medicare and TFL pay.

http://www.tricare.mil/~/media/Files/TRICARE/Publications/PubsNotOnPubsPage/TFL_cost_matrix_2016.pdf

 

[Tailgate]

check out this link on tricare - Health Plans - TRICARE For Life | TRICARE

thanks... very helpful link..

TFL is basically a combination of Medigap Plan F and a Part D drug plan. This PDF document explains your costs after Medicare and TFL pay.

http://www.tricare.mil/~/media/Files/TRICARE/Publications/PubsNotOnPubsPage/TFL_cost_matrix_2016.pdf

perfect...exactly what I needed...

Sounds like TFL is great coverage for survivors of military spouses... in lieu of a very lengthy illness, it doesn't look like any realistic scenario where we would be liable for large medical bills.

 

[samclem]

Sounds like TFL is great coverage for survivors of military spouses... in lieu of a very lengthy illness, it doesn't look like any realistic scenario where we would be liable for large medical bills.

True. Still, no significant coverage for long-term care (nursing home etc), so that's something her assets would potentially need to cover.

 

[mickeyd]

DW and I have been on TFL for 5+ years and all medical costs are covered so far. All we pay out of pocket is the monthly Medicare Part B that is deducted from the monthly SS income stream.


When we were treated by civilian doc for a few years, we received EOB from Medicare and Tricare showing how each was paid in full, but now that we receive care directly from a military clinic, no papers arrive at all any more. I assume that the military and Medicare work it out between them.

 

[braumeister]

TFL is amazingly good coverage. In fact I can't get over how good it is.
Since I have the numbers handy, I'll just point out the last few years for me.

2013: Billed $19,796, Medicare paid 4,689, TFL paid 1,770 and I paid $30.
2014: Billed $4,548, Medicare paid $1,138, TFL paid $525 and I paid $10.
2015: Billed $7,734, Medicare paid $2,112, TFL paid $716 and I paid $10.
2016 so far: Billed $13,767, Medicare paid $2,697, TFL paid $779 and I paid $0.

I won't get involved in a discussion of the rights or wrongs of the system and the billing amounts, but as you can see I'm incredibly happy with my coverage.

 

[friar1610]

I am 71, spouse almost 70. Since we went on Medicare the only out of pocket expenses we've had are copays for prescriptions. Between Medicare and TFL everything has been covered. I have no military treatment facility nearby but even if I did I would prefer the civilian system (although I would try to get scrips filled for free at the MTF.)

 

[braumeister]

Bottom line: If you're willing to spend a couple of decades allowing people to try to kill you (that's what TFL actually costs), then you won't find a better plan.

 

[mickeyd]

Bottom line: If you're willing to spend a couple of decades allowing people to try to kill you (that's what TFL actually costs), then you won't find a better plan.

A thoughtful, qualified comment.

 

[OAG]

Total gross billings this year (thus far) about $20K for 4 (what I call) major medical procedures. MEDICARE and TRICARE paid everything except 2 prescriptions (which I could have gotten from Triscripts (the TFL provider of prescriptions) but I needed them rather quickly and did not feel like driving out to Wright Patterson AFB where I could have gotten them free of cost also). Also in 2014 when my DW died they paid about $14K in gross billings for her last couple of hours.

VA has also recently provided me with my 3d set of Hearing Aids. These are the first ones I have had that are IPhone compatible - when I call or receive a call he audio goes directly to the HA. Pretty neat stuff. The VA also ordered me a Bluetooth compatible device which is plugged into the TV and the sound goes directly to my HA - no need to bother others with high volume on the TV. Going to pick that up on my next VA appointment next month.

 

[braumeister]

my 3d set of Hearing Aids. These are the first ones I have had that are IPhone compatible - when I call or receive a call he audio goes directly to the HA. Pretty neat stuff. The VA also ordered me a Bluetooth compatible device which is plugged into the TV and the sound goes directly to my HA

Awesome! I had no idea such things were available.

 

[OAG]

Awesome! I had no idea such things were available.

Google RESOUND HA and the Apple App RESOUND SMART.

 

[nash031]

Bottom line: If you're willing to spend a couple of decades allowing people to try to kill you (that's what TFL actually costs), then you won't find a better plan.

Ha! Definitely.

DW is often amazed at the level of coverage she gets from Tricare Standard right now (I'm still AD), particularly as we go through prenatal care and look at things like nursing pumps and such. Tricare/TFL is just a fantastic benefit.

We originally tried using her work coverage as primary with Tricare as "backup", but once she saw how great the coverage and options were, even paying a little bit out of pocket every year on Standard, she dropped her work coverage altogether and now she's only covered by Standard.

 

[friar1610]

VA has also recently provided me with my 3d set of Hearing Aids. These are the first ones I have had that are IPhone compatible - when I call or receive a call he audio goes directly to the HA. Pretty neat stuff. The VA also ordered me a Bluetooth compatible device which is plugged into the TV and the sound goes directly to my HA - no need to bother others with high volume on the TV. Going to pick that up on my next VA appointment next month.

I hope this doesn't take the original question too far off topic.

I assume you are retired military. Are you able to use the VA for hearing aids because you have a documented service-related hearing problem? Or can any military retiree get hearing aids from the VA?

I'm USN (Ret) and have neither a service-connected disability nor any kind of disability rating. Never tried to/needed to use the VA medical system but just curious if I could if my hearing goes south.

 

[Huston55]

I hope this doesn't take the original question too far off topic.

I assume you are retired military. Are you able to use the VA for hearing aids because you have a documented service-related hearing problem? Or can any military retiree get hearing aids from the VA?

I'm USN (Ret) and have neither a service-connected disability nor any kind of disability rating. Never tried to/needed to use the VA medical system but just curious if I could if my hearing goes south.

Friar-If you served, got a discharge that was not 'dishonorable', and have a medically diagnosed need for hearing aids, you should be eligible to get them from the VA; with or without any service-connected disability. Of course, this is after you complete the paperwork and application process. See link below.

Note that access to VA medical care is on a priority system, with eight groups. The VA website (www.va.gov) is an excellent resource.

Veterans Eligibility - Health Benefits

 

[ExFlyBoy5]

I hope this doesn't take the original question too far off topic.

I assume you are retired military. Are you able to use the VA for hearing aids because you have a documented service-related hearing problem? Or can any military retiree get hearing aids from the VA?

I'm USN (Ret) and have neither a service-connected disability nor any kind of disability rating. Never tried to/needed to use the VA medical system but just curious if I could if my hearing goes south.

Really depends on when you served. For the last 20 years or so, you would have to be service connected *and* damn near totally deaf. For the folks that served QUITE a while ago, I *think* it's a little easier, but you STILL have to have the service connection which getting that rating, well these days it can take a very long time depending on what regional office services your area. There is a forum out there that does a really good job in answering questions like these... VA Disability Compensation Claims

I hope that TFL will still be around when I switch over to Medicare. I can say, without a doubt, that my early retirement would not be possible without Tricare. When people ask about the costs of it as a retiree (w*rking age, still eligible for Tricare Prime) I am very hesitant to tell them how very inexpensive it is.

 

[friar1610]

Friar-If you served, got a discharge that was not 'dishonorable', and have a medically diagnosed need for hearing aids, you should be eligible to get them from the VA; with or without any service-connected disability. Of course, this is after you complete the paperwork and application process. See link below.

Note that access to VA medical care is on a priority system, with eight groups. The VA website (U.S. Department of Veterans Affairs) is an excellent resource.

Veterans Eligibility - Health Benefits

Really depends on when you served. For the last 20 years or so, you would have to be service connected *and* damn near totally deaf. For the folks that served QUITE a while ago, I *think* it's a little easier, but you STILL have to have the service connection which getting that rating, well these days it can take a very long time depending on what regional office services your area. There is a forum out there that does a really good job in answering questions like these... VA Disability Compensation Claims

Thanks to both. I would have a VA priority toward the bottom of the list (deservedly so) as I served on ships in the Tonkin Gulf but have no scars to show for it (thankfully so). My service goes back to 1967 (through 1996). Given the strain on the VA system and the number of men and women who really need the care they offer, there's really no need for me to be cluttering up the system. When I was more active in the American Legion I used to hear guys talk about getting hearing aids there but never asked about the details. I suspect most of them qualified under the last priority (income level).

 

[braumeister]

Given the strain on the VA system and the number of men and women who really need the care they offer, there's really no need for me to be cluttering up the system.

A common misperception.
I used to think the same way, and felt a bit guilty about going in for my annual checkup at the VA (I just do it to stay active in their system as a backup).

But whenever I mentioned my feeling to the VA doctors or nurses, they always quickly corrected me. They want us to use the system if we're eligible, because their funding is based partly on how many enrolled customers they have.

I've had nothing but great service from the VA, and I've been using it (lightly) for 25 years. They have been efficient, caring and most helpful. I read about locations where they have big problems, but I haven't encountered any.

 

[friar1610]

A common misperception.
I used to think the same way, and felt a bit guilty about going in for my annual checkup at the VA (I just do it to stay active in their system as a backup).

But whenever I mentioned my feeling to the VA doctors or nurses, they always quickly corrected me. They want us to use the system if we're eligible, because their funding is based partly on how many enrolled customers they have.

I've had nothing but great service from the VA, and I've been using it (lightly) for 25 years. They have been efficient, caring and most helpful. I read about locations where they have big problems, but I haven't encountered any.

Point taken. Not sure if you're retired military or a non-retiree vet. I'm the former and between Medicare and TFL I'm more than adequately covered.

 

[braumeister]

Point taken. Not sure if you're retired military or a non-retiree vet. I'm the former and between Medicare and TFL I'm more than adequately covered.

I'm retired military as well.
Like you, I am quite happy with Medicare/TFL, but it just seems prudent to avail myself of an alternate source of healthcare. As long as you're eligible for VA coverage, why not? I've found it to be good care, and they assure me I'm not using resources that should go to someone more deserving or needy.

 

[jimnjana]

... receive care directly from a military clinic, no papers arrive at all any more. I assume that the military and Medicare work it out between them.

Are you required to use the MTF or is it your decision? DW is counting the days til she reaches medicare eligibility so she can have a civilian doctor. We live very close to a Military base and a few years back we directed to use the MTF and lost our civilian primary care doctor.

 

[ExFlyBoy5]

Are you required to use the MTF or is it your decision? DW is counting the days til she reaches medicare eligibility so she can have a civilian doctor. We live very close to a Military base and a few years back we directed to use the MTF and lost our civilian primary care doctor.

You *should* be able to see a civilian PCM. Best way to find out for sure is to go on the tricare.mil site and do a provider search...should take less than 5 minutes and you aren't required to log on.

Sent via mobile device. Please excuse any grammatical errors.

 

[Huston55]

Are you required to use the MTF or is it your decision? DW is counting the days til she reaches medicare eligibility so she can have a civilian doctor. We live very close to a Military base and a few years back we directed to use the MTF and lost our civilian primary care doctor.

Jim&Jana-I'm guessing you're close to Patrick AFB, FL.

You *should* be able to see a civilian PCM. Best way to find out for sure is to go on the tricare.mil site and do a provider search...should take less than 5 minutes and you aren't required to log on.

If you don't get the answer you want on the Tricare.mil site, you could always switch to Tricare Standard/Extra. It's different than Tricare Prime (has a co-pay) BUT, no premiums & you choose your primary care doctor...and pretty much every other specialist you want as well.

 

[nash031]

Jim&Jana-I'm guessing you're close to Patrick AFB, FL.



If you don't get the answer you want on the Tricare.mil site, you could always switch to Tricare Standard/Extra. It's different than Tricare Prime (has a co-pay) BUT, no premiums & you choose your primary care doctor...and pretty much every other specialist you want as well.

Standard is definitely the way to go for provider choice, and what you pay out of pocket is really limited. I doubt we will ever use Prime. The counselor we spoke to basically said Prime is for folks who can't cover several hundred dollars in an unplanned expense. Standard is more choice if you don't mind covering up to $1000 in a year. Was a no brainier for us.