Tricare & the VA - Financing Transplantation for Active Duty or Retired Military
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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

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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

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.


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TRICARE PRIME OVERVIEW or Retired Military

Primary Care Manager

The Point of Service Option

Prime Pros and Cons

Tricare Cost Comparison

NOTE

Active duty service personnel are automatically enrolled in Tricare Prime, THEY MUST COMPLETE AN ENROLLMENT FORM TO SELECT Prime as their coverage.


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POINT OF SERVICE or Retired Military

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.


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ADVANTAGES OF or Retired Military TRICARE PRIME

No enrollment fee for active duty and family members.

Small fee to visit civilian providers - no fee for active duty member.

No balance billing.

Guaranteed appointments.

Primary care manager supervises and coordinates care.

Point of Service option.

Reduced catastrophic cap for retirees ($7,500. Now decreased to $3,000.


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TRICARE PRIME or Retired Military ADVANTAGES

Enrollment fee for retirees and families.

Provider choice limited.

Specialty care by referral only.

Not Universally available.


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TRICARE FOR LIFE or Retired Military

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.


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MEDICARE A & B or Retired Military

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.


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VETERANS ADMINISTRATION or Retired Military BENEFITS

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


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ELIGIBILITY ASSESSMENT or Retired Military

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.


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COMMON PAYERS or Retired Military FOR TRANSPLANT

Health Insurance

COBRA

Medicare

Medicaid


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FORGOTTEN PAYERS or Retired Military

TRICARE

V.A. Benefits for EligibleVeterans

Charitable Organizations

Fund Raising


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CHAMPVA or Retired Military

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.


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CHAMPVA ELIGIBILITY or Retired Military

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).


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CHAMPVA CAN END or Retired Military WHEN THERE IS ...

Remarriage

Divorce from Sponsor

Eligibility for Medicare or Tricare

All Changes Must Be Immediately Reported.


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CHAMPVA AND MEDICARE or Retired Military

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.)


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SUMMARY or Retired Military

  • TRICARE:

  • Prime operates as an HMO; referral needed from PCM or specialist.

  • Standard operates as a PPO and no referrals are required.

  • Tricare for Life acts as a Medicare Supplement; no referral required.

  • All claims handled from Wisconsin and are approved if Medicare approves TDEFIC or Tricare Dual Eligibility applies when a beneficiary qualifies for Medicare before age 65. Patient may have Tricare Prime or Standard. Both will act as supplement to Medicare and Tricare will cover deductibles.


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SUMMARY (continued) or Retired Military

  • Authorization is always required for:

  • Active duty for all levels of service and DME

  • Non-network providers

  • No authorization is currently required for:

  • Standard in-patient stays except transplants.


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SUMMARY (continued) or Retired Military

Medicare and Tricare

  • All Tricare beneficiaries must carry Medicare A & B to retain their Tricare coverage.

  • Exceptions: Active duty military member and their dependents have the option not to take Part B.

Discussed: Tricare Standard

Tricare Extra

Tricare Prime

Tricare for Life

V.A. Benefits

CHAMPVA


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SUMMARY (continued) or Retired Military

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.

QUESTIONS ??


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