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Tricare Help: Tricare covers most surgeries

Nov. 18, 2012 - 02:14PM   |   Last Updated: Nov. 18, 2012 - 02:14PM  |  
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Q. After a 30-year Navy career, I have been diagnosed with mesothelioma. I will require surgery and follow up at a distant hospital. We will have to pay for lodging for my surgical recovery and subsequent radiation. Will Tricare Standard cover any of this, or am I on my own?

A. Tricare generally covers all medically necessary procedures for qualified beneficiaries, including those related to treatment for mesothelioma.

You should be aware that mesothelioma is a condition that may entitle individuals to premium-free Medicare Part A even if they are under age 65, the normal Medicare eligibility age. If you are eligible for Medicare because of your mesothelioma, you can enroll in Medicare Part B and qualify for Tricare for Life, even if you are under age 65.

In addition, assuming you can provide documentation that your condition is a result of your military service, another option for you would be Veterans Affairs Department health care.

Your first move should be to contact the managed-health care contractor for the Tricare region where you live. It can give you more information and guidance.

Q. I have a good friend who is retired military, but I recently found out that he has not been covered by Tricare all these years; he has used his company's health insurance. Now, he is about to turn 65 and is considering Tricare for Life. Can he get enrolled if he has never been covered by Tricare?

A. The most basic thing your friend must do is register in the Defense Enrollment Eligibility Reporting System. DEERS is the Defense Department's eligibility portal for Tricare. The toll-free number for the DEERS support office is 800-538-9552. If he is married, he should register his spouse; she will be eligible for Tricare coverage as well.

Once he is properly registered in DEERS, to use Tricare for Life he must enroll in Medicare parts A and B when he turns 65. Enrollment in Part B is critical without it, you cannot use TFL. Part B requires payment of monthly premiums, currently about $100 a month.

When he is properly registered in DEERS and fully enrolled in Medicare, he may visit any Tricare-authorized health care provider for his medical needs. The provider will file your friend's health care claims first with Medicare; then, if there are any charges left outstanding, Medicare will automatically forward the claim to Tricare. That combination will cover 100 percent of the costs on the vast majority of claims.

Under TFL, your friend also will have access to the Tricare Pharmacy Program. He will be able to use retail pharmacies in the Tricare network or Tricare's mail-order pharmacy program, which has smaller drug co-payments.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com. In email, include the word "Tricare" in the subject line and do not attach files. Get Tricare advice anytime at www.militarytimes.com/tricarehelp.

Answers by RallyPoint

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