Legislative News Update: August 22, 2013 VA to Raise Fees for Some TRICARE for Life Beneficiaries. TRICARE officials have changed their guidance for TRICARE for Life (TFL) beneficiaries who use the VA for treatment of non-service connected conditions. The article issued last week along with a change to the wording of the TRICARE for Life Website reads: TRICARE For Life Beneficiaries May Have Higher Costs When Using VA Facilities for Care Not Related to Service Connected Disability 8/14/2013 FALLS CHURCH, Va. – Many TRICARE For Life (TFL) beneficiaries use Veterans Affairs (VA) facilities for care related to their service connected disabilities. But, as TFL is a comprehensive Medicare wraparound coverage, beneficiaries are reminded they run the risk of unexpected out-of-pocket costs if they use a VA facility for care not related to a service connected disability. By law, Medicare can’t pay for care at a government facility, such as the VA. When a TFL beneficiary chooses to obtain care from a provider that Medicare can’t pay, TRICARE can only pay up to 20 percent of the TRICARE-allowable charge. The TFL beneficiary is responsible for paying the VA the remainder. Beneficiaries who have been getting care at a VA facility that is not related to a service connected disability should talk to a VA representative about other VA options, including how VA can work with other health insurance (OHI) plans. As part of the intake process at VA facilities after October 1, 2013, TFL beneficiaries will be asked if they’re using their VA or TFL benefit or if they have other health insurance (OHI). When electing to use their TFL benefit at the VA, they will also be informed they must pay the remaining bill after TRICARE pays its portion of the TRICARE-allowable charge. They may be asked to sign a form indicating they understand their responsibility. TRICARE and the VA recommend getting care for service-connected disability at a VA facility. For other care, TFL beneficiaries may still consider using their VA benefit or they should use TFL with a Medicare-certified provider. When using Medicare providers, TFL beneficiaries typically have no out-of-pocket costs for services covered by both Medicare and TRICARE. For more information about TFL, beneficiaries may contact the TFL support contractor Wisconsin Physicians Service (WPS) at 1-866-773-0404 or visit tricare.mil/tfl to learn more about using TFL. To find Medicare-certified providers visit tricare.mil/ Find a provider. For more information about the VA, visit va.gov/health. Source: tricare.mil/CoveredServices/BenefitUpdates/Archives/8_14_13_TFLVA.aspx The TFL Website now has this basic explanation for the affected beneficiaries: Using TRICARE For Life at Veterans Affairs Facilities Veterans Affairs (VA) facilities, even if they are in the TRICARE network, are not Medicare-authorized providers. • By law, Medicare cannot pay for care at a government facility. When you use TRICARE For Life to receive care for a non-service-connected condition from a VA facility, even when the VA facility is in the TRICARE network, the VA cannot bill Medicare. • By law, when you seek care from a non-Medicare provider, such as the VA, TRICARE can pay only up to 20 percent of the TRICARE allowable charge. TRICARE and the VA recommend that you get care for your service-connected disability at a VA facility. For all of your other care, you should consider all of your options, including using a Medicare-certified provider. When using Medicare providers, you typically have no out-of-pocket costs for services covered by both Medicare and TRICARE. If you use your TRICARE for Life benefit at a VA facility and have no other VA benefit to cover those costs, you will have to pay the remaining balance after TRICARE pays its 20% of the TRICARE-allowable charge. You may wish to talk to your VA facility about your VA options, including how VA claims are processed if you are entitled to Medicare or have other health insurance. tricare.mil/tfl/ A Stars and Stripes article provides a column by journalist Tom Philpott who writes about this change. You can view that article at: stripes/news/us/vaoutpatient-costs-to-rise-for-some-retirees-using-tricare-for-life-1.236689
Posted on: Thu, 22 Aug 2013 21:22:23 +0000
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