Q. My father is an 82-year-old Korean War veteran and military retiree. He is in a skilled nursing home but has exhausted his Medicare coverage. He's very ill, with four compression fractures, liver cancer and dementia. He is currently on the waiting list for a state veterans hospital. The problem is that he is about to exhaust his skilled nursing home benefits under Medicare. My mother, also 82, recently had cervical stenosis surgery, and I am attending to her at home as well as visiting my dad at the home. What do I do?
A. Under Tricare for Life, Medicare is the primary payer and Tricare acts as a backup secondary payer. Assuming your father is enrolled in Medicare Part B and properly registered in the Defense Eligibility Enrollment Reporting System, the Tricare portion of his Tricare for Life benefit may well kick in and cover him after he exhausts his Medicare benefits for skilled nursing home care.
However, while Tricare does cover skilled nursing facility care, certain conditions apply. Tricare covers skilled nursing facility care when the beneficiary:
■ Is treated in a hospital for at least three consecutive days, not including the day of discharge, and;
■ Enters the skilled nursing facility within 30 days of hospital discharge.
Covered skilled nursing services include a semi-private room; regular nursing services; meals (including special diets); physical, occupational and speech therapy; medications provided by the facility; and necessary medical supplies and appliances. There's no time limit as long as the care is medically necessary. Beneficiaries are responsible for applicable deductibles and cost shares.
The Tricare for Life contractor, Wisconsin Physician Services, can help you get started. The WPS toll-free customer service number is 866-773-0404.
You should also check your father's DEERS status to make sure the information that is on file for him is current and accurate. Contact the main DEERS support office in California toll free at 800-538-9552.
Much more information on Tricare for Life, including the TFL Handbook, can be found online here: www.tricare.mil/Plans/HealthPlans/TFL.aspx.
By the way, your mother, as the spouse of a military retiree, is also eligible for Tricare for Life and all the same benefits as your father, assuming she is also enrolled in Medicare Parts A and B and properly registered in DEERS under your father's sponsorship.
Q. I have Tricare benefits as the widow of a military retiree. I have read that if I remarry after age 57, I am eligible to continue to receive Dependency and Indemnification Compensation payments from VA. Does that same rule apply to Tricare benefits?
A. You're correct about the DIC. But a surviving widow of a military retiree who remarries at any age loses eligibility for continued Tricare coverage as of the date of remarriage.
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