Disabled Tricare Enrollee Needs Help with Benefits


Dear Sgt. Shaft,

I have a question; let me give you a little background first. My wife has been covered by her work, my work and Tricare Prime, since 1996. In December of 2012 she was medically retired from her work. From an injury that occurred at her work. She did as she was told and went to Social Security and signed up for benefits, no mention of getting Medicare, as we thought she was covered well by Tricare and my work. About 8 months ago she was sent a form to apply for Medicare from SS. She made an appointment went in and had help filling out the paper work and was told that she met the minimum standard for coverage, little was said about Medicare being trash, that she needed part B also. So there was no discussion further and we were ignorant to the fact that this was needed. Question one: why isn't this needed coverage explained fully? If we would have known this we would have purchased it then. Question 2: Why even break them apart just say this is Medicare and your cost is? They can explain that the free part of Medicare is what people have been paying for out of their paychecks, and the charge is for the extra coverage that makes Medicare.

Now on with the story; my wife is a diabetic and lately was diagnosed with congestive heart failure, which she is under doctor’s care for so she can hopefully have gastric by-pass surgery this year to help aid the diabetes. Last month she had a doctor's appointment for her heart, was told even though she has the coverage above she was placed in standby status. We found out later because she did not have part B. She went to SS and after 4 hours put in an exception to policy to get part B, she was told that she may not be eligible until January 2015. With-in 15 days she got notice that she had been approved for part B, startup date Aug 1, 2014. This was speeded up because of her condition, far as I know there was no penalty the cost is 105 per month. But the problem is that Tricare will not give her medicines until Aug. We have used Tricare all these years, not Kaiser, so you can imagine trying to find doctor’s for her condition, even if for 1 month. Question 3; With all the coverage can this be done?

At the time she was working, with coverage from me, Kaiser and Tricare. From her Kaiser, she was considered triple covered. Now I am going to sound off; insurance coverage in the last 10 years has gone down the toilet, costs more and less coverage. This Obamacare is as much as trash as Medicare alone. Question 4; If something should happen to my wife with all this coverage she has before Aug 1, do I have any legal recourse? I am looking forward to your answers thanks.

Donald R Via the internet

Dear Donald,

I can’t speak for the quality of the counseling you received. However, a person on Social Security disability for two years is automatically placed in Medicare for health care regardless of age. This triggers a change in Tricare benefits. Once a Tricare member is placed in Medicare, Tricare has to switch the member to the Tricare for Life (TFL) program by law and the previous Tricare Prime or Standard coverage is cancelled. TFL is Medicare as your primary health plan coverage and Tricare as your Medicare supplement. To qualify for TFL coverage requires enrollment in both Medicare Parts A and B. If a member does not have Medicare Parts A and B, the Tricare portion of TFL is suspended until the member enrolls in both Medicare Parts, A and B. Also, no Tricare health care, no Tricare pharmacy. The HR contact at your employer will have to answer the questions about your employer health plan coverage.

Shaft Notes

• After the release of White House Deputy Chief of Staff Rob Nabors’ VA health care report to the president, Chairman Jeff Miller issued the following statement:

“It appears the White House has finally come to terms with the serious and systemic VA health care problems we’ve been investigating and documenting for years. While it’s extremely unfortunate President Obama did not heed our warnings about the very real and very deadly problems within the VA health care system sooner, we stand ready to work with stakeholders inside and outside the administration to institute VA reforms that will improve services to America’s veterans while bringing real accountability and efficiency to the department.”

• Representative Gus Bilirakis, Vice-Chairman of the House Committee on Veterans Affairs, today introduced the Creating Options for Veterans’ Expedited Recovery (COVER) Act, bipartisan legislation that will establish a commission to examine VA’s current therapy model and the potential benefits in incorporating complementary alternative therapies.

“It is vital that Veterans receive the care they need, but it is important to recognize that one size does not fit all when discussing treatments for Veterans and the invisible wounds endured from their service to our great nation. While many Veterans may thrive under evidence-based treatment plans, some may not be as responsive to this traditional medical care. As such, we need to provide them with choices and easy access to alternative forms of therapies that work best for them,” said Bilirakis.

“We must find the most effective ways to treat Veterans. The COVER Act will ascertain the viability of alternative treatments, providing a pathway forward that will eventually allow Veterans to have a range of options for mental health treatments such as outdoor sports therapy, hyperbaric oxygen therapy, accelerated resolution therapy, and service dog therapy.”

Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900, Washington, D.C. 20035-5900; fax 301/622-3330, call 202/257-5446 or email sgtshaft@bavf.org.

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