Tricare & the VA - Financing Transplantation for Active Duty or Retired Military. OBJECTIVES. AWARENESS OF GOVERNMENT BENEFITS: Tricare Standard • Tricare for Life Tricare Extra • Champ V.A. Tricare Prime. TRICARE STANDARD
Tricare & the VA - Financing Transplantation for Active Duty or Retired Military
Government funding for family members of active duty, retired or deceased personnel may be available through Tricare.
Tricare also covers living donor kidney, liver and lung transplants.
Prior authorization by medical director required. Must meet Tricare Selection criteria.
Primary Care Manager
The Point of Service Option
Prime Pros and Cons
Tricare Cost Comparison
Active duty service personnel are automatically enrolled in Tricare Prime, THEY MUST COMPLETE AN ENROLLMENT FORM TO SELECT Prime as their coverage.
POSOption under Tricare Prime allows freedom to receive non-emergency health care from Civilian providers that may be in or out of the Tricare network.
No enrollment fee for active duty and family members.
Small fee to visit civilian providers - no fee for active duty member.
No balance billing.
Primary care manager supervises and coordinates care.
Point of Service option.
Reduced catastrophic cap for retirees ($7,500. Now decreased to $3,000.
Enrollment fee for retirees and families.
Provider choice limited.
Specialty care by referral only.
Not Universally available.
Plan for retirees generally 65 or older and their spouses that have Medicare A & B.
YOU MUST HAVE MEDICARE PART B to get Tricare for Life, if eligible.
October 2006 - Tricare will no longer reimburse Tricare for Life claims from providers who have opted out of Medicare.
TRICARE FOR LIFE members MUST ASK if provider accepts Medicare.
People eligible for Medicare A/B must take Medicare Part B in order to have Tricare Standard and/or Tricare for Life.
EXCEPTION: Active Duty military personnel and family members ARE NOT REQUIRED TO TAKE MEDICARE PART B.
People who have served honorably in the military and have met the criteria for eligibility can obtain benefits through the V.A.
V.A. has dedicated transplant centers, ie. McGuire.
Patients should be referred to V.A. Center and/or go on-line and complete the 10-10EZ. Application can be obtained by visiting, calling and/or writing V.A. Health Care Facility
1) DD-214 REQUIRED.
2) App sent to V.A. Eligibility Center in Atlanta.
3) Confirmation of enrollment, status and priority group.
4) Financial Assessment, ie. Must be under $80,000. in our area.
V.A. Benefits for EligibleVeterans
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health benefits program in which the Department of Veterans Affairs (V.A.) shares the cost of certain health care services and supplies with eligible beneficiaries.
Cannot be eligible for Tricare.
Spouse or child of a veteran permanently/totally disabled.
Surviving spouse or child of a veteran who died from VA-rated service connected disability.
Surviving spouse or child who at time of death rated permanently/totally disabled.
Surviving spouse or child of military who died in line of duty (most eligible for Tricare).
Divorce from Sponsor
Eligibility for Medicare or Tricare
All Changes Must Be Immediately Reported.
CHAMPVA always pays last to MEDICARE or any other health insurance.
ONLY EXCEPTION: Travel Overseas (When you return to U.S., does not pay Prime.)
Medicare and Tricare
Discussed: Tricare Standard
Tricare for Life
Most retired military understand their benefit, the ones you will try to identify are the folks that have served but were uninformed about their ability to access V.A. benefits. They can get 90 days worth of immunosuppressive drugs for a very small copayment.