Tricare Help: Who’s responsible for illegal Tricare use? - Military Health, Tricare programs - Military Times

Tricare Help: Who’s responsible for illegal Tricare use?

Answering your questions on Tricare.

Q. My active-duty husband and I have guardianship over his teenage sister and got her enrolled in the Defense Enrollment Eligibility Reporting System and in Tricare Prime with the rest of our family. Eight months ago, she got married — and is still using her Tricare benefits. We were unaware of this since we weren’t on speaking terms; we only found out because of an explanation of benefits form we received about a prescription she recently filled. Is this a lawsuit, or should we just pay for the marriage certificate and let Tricare deal with her? They were notified the month she was married and have it on file, but they never canceled it.

Your sister-in-law lost her Tricare eligibility on the day she married. By law, children are eligible for Tricare until they marry or reach age 21, whichever comes first.

I strongly suggest that you contact the DEERS support office for guidance. The toll-free number is 800-538-9552. DEERS is a federal agency under the Defense Department that is responsible for official information regarding Tricare eligibility.

It is illegal for your sister-in-law to use Tricare if she is not eligible — though it is likely she does not know that and has used Tricare through ignorance of the law. I am not a lawyer, but in my experience with Tricare, it is likely that Tricare will demand repayment of all amounts paid in error since her wedding day.

Although it’s not a “hanging offense,” you may want to contact a lawyer if Tricare starts billing you for erroneous payments. You may need legal advice to learn who is legally responsible for repayment, if it comes to that.

Q. I am marrying my fiance as soon as he returns from Afghanistan. Does Tricare cover pre-existing injuries? A car accident three years ago left me with many broken bones, and I was in a coma and on life support for three months.

When you get married and become eligible for Tricare, you’ll have no penalties or limitations for pre-existing conditions. You will have the same coverage as any other Tricare beneficiary.

There will be no limitations if you continue to need medical care for your injuries.

Q. I’m over 65 and am enrolled in Tricare for Life. My wife is 63 and enrolled in Tricare Prime. If I decide to drop TFL and go with a private carrier supplement, can my wife continue to be enrolled in Tricare Prime until she’s 65?

Yes. Regardless of what you do, your wife can retain her Tricare Prime coverage until she becomes entitled to Medicare and Tricare for Life, probably at age 65.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or e-mail us. In e-mail, include the word “Tricare” in the subject line and do not attach files. Get Tricare advice anytime on our blog.