Tricare Help: Am I required to enroll in employer’s health plan? - Military Health, Tricare programs - Military Times

Tricare Help: Am I required to enroll in employer’s health plan?

Q. If I work for a company that sponsors a health insurance plan for employees, will Tricare require me to enroll in that plan and pay the additional insurance premium? If I do, how will it affect my Tricare coverage? Can I file claims with Tricare for the premiums as a medical expense?

A. Tricare will not require you to enroll in your employer’s health insurance plan.

A health insurance premium does not pay for medical care; it pays only to protect the beneficiary from paying the full costs of covered medical services. As such, it is not a covered medical expense under Tricare, and you may not file a Tricare claim for the plan’s premium.

If you choose to enroll in your employer-sponsored plan, federal law requires Tricare to be last payer. You must file all health care claims with your employer’s plan first. After that plan has completed its actions regarding the claim, including resolution of any appeals, and the plan issues to you an explanation of benefits, you may file a claim with Tricare as second payer on those charges.

To do that, complete a Tricare Claim Form DD 2642 and attach legible copies of the same bills that were sent to the primary plan (you may not use a “balance due” bill) and a copy of its EOB. Make copies for your records, and send the packet to your usual Tricare claims filing address.

Call your Tricare Service Center if you need help. You can find contact information at www.tricare.mil/contactus.

Q. Are retirees who get Medicare required to enroll in Medicare Part D, the Medicare Pharmacy Plan? I have heard it both ways.

A. A retiree, retiree family member or survivor of a deceased active-duty or retired member who becomes entitled to Medicare Part A at any age is required by law to enroll only in Medicare Part B. There is no requirement to enroll in the Medicare Pharmacy Plan, called Medicare Part D.

The Office of the Assistant Secretary of Defense for Health Affairs has said the only military retirees or family members likely to gain any financial advantage from Part D enrollment are those whose incomes are below the federal poverty line and who qualify to receive financial aid for payment of their Medicare premiums.

The Tricare Pharmacy program is automatically available for all Tricare beneficiaries. The exception is that beneficiaries who have other health insurance in addition to Tricare are not eligible to use the Tricare Mail Order Pharmacy Plan.

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