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TRICARE South BCAC and Communications Partnership Meeting February 16, 2011. TRO-South Customer Service Branch :. Toll-F ree Number: 800-554-2397 Mr. Greg Howard, Chief, Customer Service Branch Ms. Janet Hudson, Supervisor, Customer Service Section

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slide1

TRICARE South

BCAC and Communications Partnership Meeting

February 16, 2011

slide2

TRO-South Customer Service

Branch:

Toll-Free Number: 800-554-2397

Mr. Greg Howard, Chief, Customer Service Branch

Ms. Janet Hudson, Supervisor, Customer Service Section

Ms. Briana Flowers, Manager, Marketing and Communications

Ms. Karla Reese, Manager, Prime Travel Benefit Program

Ms. Sherry Steindel, BCAC/Reserve Component

Mr. Mac Sanders, BCAC/Reserve Component

Ms. Janet Bryant, BCAC/Prime Travel Coordinator

Mr. Joe Kinzler, BCAC/Prime Travel Coordinator

Mr. George Beeson, BCAC/Congressional Liaison

Mr. Bill Dennis, BCAC

Ms. Cris Becerra, BCAC

Ms. Birdie Moncivais, Admin Support

Ms. Kim Harper, Travel Program Assistant

Mr. Shane Gerry, Marketing Assistant

medicare

Medicare

ANNE E. BRESLIN

TRICARE Management Activity

TRICARE Policy & Benefits Division

January 2011

while i can explain the meaning of life i don t dare try to explain how the medicare system works
“While I can explain the meaning of life, I don’t dare try to explain how the Medicare system works.”
medicare part a
Medicare Part A
  • Hospital Insurance (HI)
    • Hospice, Inpatient SNF, Home Health
  • Financed through payment of the Hospital Insurance (HI) portion of the FICA tax
federal state local government employees
Federal/State/Local Government Employees
  • Although many are not eligible for Social Security benefits, they may be eligible for Medicare if they worked and paid Hospital Insurance (HI) portion of FICA taxes.
  • Feds began paying HI portion of FICA taxes in January 1983
  • State and Local began paying for HI in April 1986
  • Individuals otherwise not eligible & over 65 may purchase Part A. 2011: $ 461.00/month
medicare part b
Medicare Part B
  • Supplementary Medical Insurance
    • Doctors and other practitioners services, Home Health Care, DME, Outpatient Services
  • Financed through monthly premiums paid by the beneficiary
  • Beneficiaries that aren’t receiving Social Security, Railroad Retirement are billed quarterly
  • 2011 Standard Part B Premium: $115.40/month
medicare part c
Medicare Part C
  • Medicare Advantage
    • Extra benefits, lower co-payments, provider network
      • Medicare HMOs (out of network for emergencies only)
        • Medicare HMO’s may offer Medicare Part D
        • Enrollees cannot join a separate Part D plan
      • Medicare PPOs (extra cost for out of network)
        • Medicare PPOs may offer Medicare Part D
        • Enrollee cannot join a separate Part D plan
      • Medicare Special Needs Plans
        • Residents of LTC facilities, Dual-eligible Medicare/Medicaid beneficiaries, certain chronic conditions (e.g., diabetes)
        • Must provide Medicare prescription drugs
      • Medicare Private FFS
        • Any Medicare approved doctor/hospital that accepts the term of your plan’s payment
        • May offer extra benefits
        • Private company determines it’s payment and yours
        • May offer Medicare prescription drug coverage, if not you may join a Medicare PDP
medicare part c coverage
Medicare Part C Coverage
  • MA plans provide all Part A and Part B benefits
  • MA plans cover all Medicare benefits with the exception of hospice
    • Original Medicare covers hospice even for MA enrollees
  • MA plans may offer additional coverage (vision, hearing, dental, wellness programs).
  • Most include prescription drug coverage (Part D)
medicare advantage costs
Medicare Advantage Costs
  • In addition to your Part B premium you pay a monthly MA premium.
  • Each MA plan determines their cost shares and rules for obtaining care (referrals, network providers etc.).
  • Rules and costs may change each year
who may join an ma plan
Who May Join an MA Plan?
  • You have Part A and Part B
  • You live in the service area of the plan
  • You don’t have ESRD
esrd and medicare advantage
ESRD and Medicare Advantage
  • Beneficiaries with ESRD cannot join an MA plan.
  • If you are in an MA plan before you develop ESRD you may stay in the plan.
  • If the MA plan ends its participation with Medicare you may enroll in another MA plan or use original Medicare
tricare for life and ma
TRICARE for Life and MA?
  • TFL
    • No enrollment
    • No premiums
    • Any provider
    • Available worldwide
    • No cost shares
      • when covered by Medicare and TRICARE
    • No OHI – No claims to file
  • MA
    • Enrollment periods
    • Premiums
    • Network providers
    • Plan service area
    • Cost shares
    • File claims for TFL reimbursement of cost shares – must have itemized bill, diagnosis code, complete DD2642
medicare part d
Medicare Part D
  • Medicare Prescription Drug Coverage Began Jan 2006
  • Available to beneficiaries with Medicare (Part A, Part B, or Parts A&B) and who live in the service area
  • Annual open enrollment: Nov. 15th through Dec. 31st
  • Join by Dec. 31, 2010 for Jan. 2011 effective date
  • Premiums vary by Prescription Drug Plan
  • Low income beneficiaries who do not enroll in Part D are automatically enrolled by CMS
  • No advantage to TRICARE beneficiaries unless they meet the Low Income Subsidy (LIS) requirements
  • Premium increases by 1% for every month that you wait to join, unless you have Creditable Coverage
tricare and medicare
TRICARE and Medicare
  • P.L. 102-190, Sect. 704 Dec. 1991
    • Requires beneficiaries entitled to premium free Medicare Part A to have Medicare Part B coverage to retain TRICARE coverage.
    • Applicable to the under 65 population (Disabled, ESRD)
  • P.L. 106-398, Sect. 712 October 2000
    • Extended TRICARE benefits to beneficiaries age 65 and older who are entitled to premium free Medicare Part A and have Medicare Part B coverage.
65 no medicare coverage
>65 No Medicare Coverage
  • >65 not eligible for premium-free Medicare Part A, remain eligible for TRICARE Prime, Extra, Standard
  • Apply for Medicare Part A on own record and spouses record
  • Those not eligible will get a Letter of Disallowance (LoD) /Disapproved Claim
  • Share LoD with ID card facility to retain TRICARE benefits beyond 65th birthday. Medicare Part B not required.
medicare entitlement age 65
Medicare Entitlement – Age 65
  • Application for Social Security Retirement Payments is also an application for Medicare (Reduced benefits available at age 62.In 2011 Full SS retirement benefits payable at 65 years and 10 months. FRA increases to 67 in 2025)
  • Can file a separate application for Medicare benefits payable at age 65 (Medicare eligibility age not changing)
  • Insured status 40 quarters (can use own earnings or those of a spouse)
initial enrollment period iep
Initial Enrollment Period (IEP)
  • 7 month period: begins 3 months prior to the month you turn 65 and ends 3 months after.
    • Eligible month you turn 65 (Birthday other than the 1st).
  • 7 month period: begins 4 months prior to the month you turn 65 and ends 2 months after.
    • Eligible the month before you turn 65 (Birthday on the 1st.)
iep example based on attaining age 65
IEP Example Based on Attaining Age 65
  • 65 on May 2, IEP = Feb. 1 –Aug. 31

EnrollmentPart B Effective

Feb./ Mar./Apr. – May 1

May – June 1

June – August 1

July – October 1

August – November 1

general enrollment period gep
General Enrollment Period (GEP)
  • Jan 1 – March 31 each year (Applies to beneficiaries who did not enroll during IEP)
  • Part B/premium Part A effective July of year enrolled
  • Part B surcharge (10 % for each 12 month period that a beneficiary could have enrolled but didn’t.
  • Part A premium surcharge is 10% Example: 12 months late 10% surcharge paid for 2 years, 24 months late 10% surcharge is paid for 4 years
special enrollment period sep
Special Enrollment Period (SEP)
  • Group Health Plan coverage based on current employment
    • Enroll in Part B anytime while covered by GHP
    • Enroll during the 8- month period that begins the first full month after the employment or GHP coverage ends, whichever occurs first.
    • If you don’t enroll during the SEP, may only enroll during the GEP (may be subject to premium surcharge)
    • Although you don’t need Part B for GHP coverage (based on current employment), you must meet TRICARE Part B coverage requirements to retain TRICARE benefits.
  • SEP does not apply to: USFHP, TAMP, TRS, or TRR
  • SEP does not apply to beneficiaries with ESRD,
  • ESRD patients have the option to retroactively enroll in Part B with effective date coinciding with Medicare Part A entitlement date
sep example
SEP Example
  • Retire June 2010 SEP ends Feb 2011

EnrollPart B Effective

July or earlier Month of enrollment or any of the three months following month of enrollment

August September

September October

October November

Etc.

medicare entitlement esrd
Medicare Entitlement - ESRD
  • Once a beneficiary has filed for Medicare (based on ESRD) and meets the requirements for insured status (minimum 6 quarters out of the last 13 work quarters)–
    • Medicare begins 1st day of 4th month of renal dialysis or the first month of dialysis if participates in self-dialysis training.
    • Medicare begins the month admitted to a Medicare approved hospital for kidney transplant, provided that the surgery is that month or in the 2 following months
    • Medicare begins 2 months before transplant if transplant is delayed more than 2 months after admission to the hospital.
tricare and medicare esrd
TRICARE and Medicare (ESRD)
  • TRICARE beneficiaries with ESRD are eligible and required to file for Medicare entitlement.
  • Upon entitlement to Medicare Part A, TRICARE beneficiaries with ESRD must have Medicare Part B coverage to retain TRICARE benefits.
medicare entitlement disability
Medicare Entitlement - Disability
  • Individual must be disabled under the Social Security Act (Section 223).
    • Medicare entitlement begins after 24 months of Social Security Disability entitlement
    • 24 month waiting period does not apply to individuals with ALS
medicare entitlement disability1
Medicare Entitlement-Disability
  • Insured Status
    • Before age 24 (6 quarters)
    • Age 24-31 must have worked half the time between age 21 and the time you become disabled
      • e.g., Disabled at age 27 – need 3 years of work or 12 quarters.
    • Age 31 or older minimum of 20 quarters, maximum 40 quarters
insured status age 31
Insured Status Age 31+

Born after 1929

Become Disabled at AgeQuarters

31 through 42 20

44 22

46 24

48 26

50 28

52 30

54 32

56 34

58 36

60 38

62+ 40

ss disability trial work period
SS Disability Trial Work Period
  • Trial work period continues until beneficiary accumulates 9 months (does not have to be consecutive) in which he/she performs services within a rolling 60 month period.
  • Services- earning more than $720/month in 2011.
  • After the trial work period ends, benefits stop for months when earnings are:Substantial = $1000 (Non-Blind) $1,640 (Blind) in 2011.
  • Disability payment can be made for months in which earnings are not substantial for the 36 months following the end of the trial work period.
medicare entitlement continues after disability payments cease
Medicare Entitlement Continues After Disability Payments Cease
  • Medicare benefits continue for up to 8 ½ years after disability entitlement ends
  • Beneficiary will be billed quarterly for Part B
  • Part B coverage remains a requirement to retain TRICARE benefits.
tricare for life
TRICARE for Life
  • Eligibility:
    • Entitled to Medicare Part A and have Medicare Part B coverage regardless of age and place of residence
tricare pharmacy
TRICARE Pharmacy
  • Eligibility:
    • Beneficiaries that were 65 years of age prior to April 1, 2001 and entitled to Medicare Part A are not required to have Medicare Part B.
    • Beneficiaries that became 65 on/after April 1, 2001 are required to have Medicare Part A and Part B.
tricare prime extra standard
TRICARE Prime/Extra/Standard
  • Beneficiaries entitled to Medicare Part A and who have an AD sponsor are not required to have Part B coverage. (SEP applies)
  • Beneficiaries that are under 65, entitled to Medicare Part A and do not have an AD sponsor must have Medicare Part B coverage. TRICARE Prime enrollment fee is waived.
  • Beneficiaries 65 and over are not eligible for Prime/Extra/Standard with two exceptions”
    • not entitled to premium-free Medicare Part A or
    • have an active duty sponsor
prime enrollment fee waiver
Prime Enrollment Fee Waiver
  • 1 family member with Medicare Part B - $230 waived
  • More than 1 family member with Part B - $460 waived
usfhp
USFHP
  • USFHP beneficiaries entitled to Medicare Part A are not required to have Medicare Part B coverage.
  • USFHP Beneficiaries entitled to Medicare Part A are strongly encouraged to enroll in Medicare Part B when first eligible, in order to avoid paying the surcharge for late enrollment.
  • Beneficiaries entitled to Medicare Part A and who have an AD sponsor will have a SEP (see slide 14)
  • Enrollment fee is waived for USFHP beneficiaries with Part B coverage.
  • USFHP enrollees have in effect elected not to use Medicare. USFHP beneficiaries that receive benefits under Part A can be disenrolled from USFHP.
tricare plus
TRICARE Plus
  • Beneficiaries entitled to Medicare Part A are not required to have Medicare Part B to receive direct care.
  • Beneficiaries entitled to Medicare Part A only are responsible for the total cost of care received outside the direct care system.
tricare reserve select and tricare retired reserve
TRICARE Reserve Select andTRICARE Retired Reserve
  • Beneficiaries who are entitled to Part A are not required to have Medicare Part B coverage.
  • TRS/TRR beneficiaries entitled to Medicare Part A are strongly encouraged to enroll in Part B when first eligible, in order to avoid paying the surcharge for late enrollment.
  • Part B SEP does not apply.
2011 medicare part b premium 115 40
2011 Medicare Part B Premium$115.40*

You need Part B to keep TRICARE if:

  • You have premium free Medicare Part A and,
  • Your sponsor is retired

You do not need Part B to keep TRICARE if:

  • You are not entitled to premium free Medicare Part A
  • You have premium free Medicare Part A and
  • You have an active duty sponsor or
  • You are enrolled in:
    • USFHP (available in 6 locations)
    • TRICARE Reserve Select
    • TRICARE Retired Reserve
  • Even if Part B is not required by TRICARE, you may have higher Part B premiums if you delay enrollment

* Beneficiaries who earn more than $85,000 individually or $170,000 as a couple will pay more than $115.40 in 2011.

Before you decide, read the facts:

  • www.tricare.osd.mil
    • “Medicare and TRICARE”
    • TRICARE for Life
  • information provided to you by Medicare
    • “Welcome to Medicare”
    • “Medicare and You”
questions contact information
Questions/Contact Information
  • Anne.Breslin@tma.osd.mil
  • 703-681-0054
slide39

MARRIAGE COUNSELING AND TRICARE

Roxane Kissinger, ValueOptions

502-301-2055

Roxane.Kissinger@jax.valueoptions.com

February 16, 2011

marriage counseling and tricare
Marriage Counseling and TRICARE
  • Behavioral Health Services must be medically or psychologically necessary
  • Valid Behavioral Health Diagnosis
    • V-Codes
  • Family or Conjoint psychotherapy
    • Family member with valid diagnosed disorder
    • Self-Referral (not ADSMs)
    • Up to two sessions per week
marriage counseling and tricare1
Marriage Counseling and TRICARE
  • Provider Types
    • All TRICARE Authorized Providers can provide Family Counseling services
      • LMFT (Participation Agreement)
      • Counselors (Licensed Mental Health, Professional and Pastoral)
        • Letter of Referral required
  • Additional Resources
    • TRIAP
    • Military OneSource
    • Achieve Solutions
    • Local Military Resources
    • Community Based Services
tro south briefing for customer service partnership meeting february 16 2011

TRO-SouthBriefing forCustomer Service Partnership MeetingFebruary 16, 2011

Mr. William (Bill) Prevo Program Operations DivisionTRICARE Regional Office-South

tricare young adult tya

TRICARE Young Adult (TYA)

  • TRICARE Standard/Extra and Prime benefit with applicable deductibles and cost shares
  • Full premium based program available worldwide
    • Current premium not yet established
  • Eligible for care in military treatment facilities (MTFs)
    • Same access priority as sponsor, PCM assigned for Prime enrollees
  • Not authorized for those eligible to enroll in employer sponsored health insurance plan
  • Phased implementation
    • TRICARE Standard/Extra 1 Apr retroactive to 1 Jan
    • TRICARE Prime summer 2011, not retroactive
    • USFHP not yet determined

44

william.prevo@tros.tma.osd.mil

January 31, 2011

tricare young adult tya1

TRICARE Young Adult (TYA)

  • Eligibility
    • Sponsor must be eligible for TRICARE benefit
    • Unmarried, under age 26
    • Not eligible for own employer sponsored coverage
    • Signed attestation on enrollment application
  • Purchasing coverage
    • Two months premiums for initial enrollment
    • Monthly charges paid by EFT or recurring credit card
    • Single coverage only, no family coverage
    • Individual and family deductibles and catastrophic caps apply
    • Premiums not credited towards deductibles or cap

45

william.prevo@tros.tma.osd.mil

2 Dec 10

tricare young adult tya2

TRICARE Young Adult (TYA)

  • May purchase continued coverage under CHCBP at age 26 for up to 36 months
  • Student Health Plans
    • TYA will be secondary payer
  • TRICARE Operations Manual (TOM)
    • Chapter 25
  • Military Identification card issued after enrollment begins

46

william.prevo@tros.tma.osd.mil

2 Dec 10

foreign force members

FOREIGN FORCE MEMBERS

RECIPROCAL HEALTH CARE AGREEMENTS; NATO SOFA; PFP SOFA

basis for eligibility
BASIS FOR ELIGIBILITY
  • Benefits determined by the agreement each country has established with the Department of Defense (DoD)
    • North Atlantic Treaty Organization (NATO)
    • Status of Forces Agreement (SOFA)
    • Partnership for Peace (PFP)
    • Reciprocal Health Care Agreement (RHCA)
  • Must be in the United States by official invitation or on official military business
eligibility for care
ELIGIBILITY FOR CARE
  • The sponsoring command’s administrative office issues a Form DD1172 (Application for ID Card)
    • Foreign Force Member (FFM)
    • All accompanying dependents (as stated on orders)
      • Spouse
      • Children under age 21
  • Take Form DD1172 to appropriate personnel/ID office for ID card issuance
    • Defense Enrollment Eligibility Reporting System (DEERS) updated
    • Foreign Identification Number (FIN) card should be issued to FFM and any dependents age 10 and older
medical registration process
MEDICAL REGISTRATION PROCESS
  • Can be registered into medical system (CHCS) at any military clinic once DEERS has updated system (usually within 24 hours)
    • Beneficiary Counseling and Assistance Coordinator (BCAC)
      • Need FIN Card, copy of official orders, OHI info
      • Demographics will be entered into system
        • Name, address, phone, date of birth
        • Patient category is determined
      • Receive counseling on locations and phone numbers of military clinics/HBA
    • Medical Records Department
      • Military medical record created
outpatient care for foreign force members
OUTPATIENT CARE FOR FOREIGN FORCE MEMBERS
  • Military Treatment Facility (MTF)
    • Recommend MTF closest to work location
    • Same access as U.S. Active Duty Service Member
    • Wide range of outpatient services available
      • Including Optometry and Behavioral Health services
    • Call clinic direct to schedule appointments
    • Care provided at no cost
  • Civilian outpatient care
    • Not a covered benefit
      • Unless referral is obtained/authorized (see BCAC to confirm)
    • FFM responsible for 100% of cost of care received
      • File to Other Health Insurance (OHI) plan
      • Submit bills to home country government
inpatient care for foreign force members
INPATIENT CARE FORFOREIGN FORCE MEMBERS
  • Military Treatment Facility
    • Cost to FFM
      • Determined by Health Care Agreement
        • RHCA – Admin/Subsistence Charges Only
        • W/o RHCA (NATO and PfP)- Reimbursable - FFM’s country must reimburse the United States for the cost of inpatient health care.
  • Civilian Inpatient Care
    • Cost of care not covered by United States
    • FFM responsible for 100% of cost of care received
      • File to Other Health Insurance (OHI) plan
      • Submit claims to home country government
mtf outpatient care for your dependents
MTF OUTPATIENT CARE FOR YOUR DEPENDENTS
  • Primary Care
    • May utilize any military clinic in the area
    • Call clinic direct for appointments
    • Same access to care as U.S. Active Duty Family Members
    • Wide range of outpatient services available
      • Includes Pharmacy, Laboratory, Radiology, Immunizations, Optometry, and OB/GYN services
    • Care provided at no cost
mtf outpatient care for your dependents cont d
MTF OUTPATIENT CARE FOR YOUR DEPENDENTS (cont’d)
  • Specialty care
    • Primary Care Doctor enters referral for specialty care into CHCS medical system
    • Patient to call specialty clinic 24 to 48 hours later to schedule specialty care
      • Obtain specialty clinic number from doctor or clinic staff prior to leaving clinic
    • Any difficulties in scheduling specialty care should be directed to the clinic nursing staff or a BCAC at your local clinic
civilian outpatient care for your dependents
CIVILIAN OUTPATIENT CARE FOR YOUR DEPENDENTS
  • Covers both primary and specialty care
    • Processes under TRICARE Standard/Extra
      • Annual deductible ($150 Ind/$300 Family)
      • Your portion of cost shares on balance
        • 20% of the allowable charge (Standard)
        • 15% of the allowable charge (Extra)
      • If Other Health Insurance (OHI) exists, OHI processes as primary and TRICARE pays secondary
    • Covers a wide range of medical services
    • Freedom to choose a civilian provider
inpatient care for your dependents
INPATIENT CARE FOR YOUR DEPENDENTS
  • Military Treatment Facility
    • Cost of care determined by HCA
      • RHCA – Admin/Subsistence Charge Only
      • W/o RHCA (NATO and PfP) - Reimbursable - FFM’s country must reimburse the United States for the cost of inpatient health care.
  • Civilian Inpatient Care
    • Cost of care not covered by United States
    • FFM responsible for 100% of cost of care received
      • File to Other Health Insurance (OHI) plan
      • Submit to home country government
dental care
DENTAL CARE
  • Military Dental Treatment Facility
    • Foreign Force Member
      • Access same as U.S. Active Duty Service Member
      • Call Dental Clinic for appointment scheduling
    • Dependents – space available
  • Civilian Dental Care
    • Foreign Force Member
      • Not covered without DoD DTF referral
    • Dependents
      • No coverage
upcoming meetings
Upcoming Meetings:

2011 Partnership Meetings:

April 20

June 22

August 17

October 19

December 14

Upcoming TRICARE Fundamentals Courses:

May 17-19 San Antonio, TX

July 19-21 Memphis, TN

October 18-21 San Antonio, TX

TIP Ad Hoc Training: None scheduled at this time. May possibly be going to an online training course. More to come.