Changes Coming for TRICARE for Life Retirees

Starting October 1, 2013, there will be higher outpatient costs at VA hospitals and clinics for retirees eligible for TRICARE for Life (TFL). These costs will be for those conditions that are not rated as service-connected. Though this will obviously save TRICARE some money (approximately $1 million per year), this change comes because regulations do not actually allow TRICARE to foot the entire bill for the health problems not associated with service.

What is TRICARE for Life?

TFL is a supplement for retirees 65 and older. It is designed to pick up the tab after Medicare is billed the initial 80%, and then after any secondary insurance is billed. Since a VA facility is not Medicare certified and thus cannot bill Medicare for a retiree’s non-service connected condition (the service-connected conditions are covered by the VA), TRICARE has been paying the 20% they are allowed to pay, and then paying the rest that could not be billed to Medicare.

Which Veterans Are Affected by the TFL Billing Changes?

Because TRICARE’s payments to VA for non-service connected thus aren’t legally correct, effective October 1, the beneficiary would have to pay out-of-pocket the portion that cannot be billed to Medicare. It is estimated that about 12,000 TFL retirees were notified of the changes. Although this problem was discovered in the spring, the changes do not take effect until October 1 so that those who are currently going to the VA for non-service related conditions can find a private doctor who will take Medicare initially. This way TRICARE will pay no more than 20%. This should only affect those veterans that have no other insurance besides TRICARE, or those who simply do not want to seek care outside of a VA facility.

More News for Veterans

More Articles

Federal Court Addresses PTSD Stressors

A recent decision from the U.S. Court of Appeals for the Federal Circuit confirms that VA must apply a generous standard when evaluating the lay testimony of veterans suffering from PTSD concerning their combat experiences and PTSD stressors. Sanchez-Navarro v....

Permanent and Total VA Disability Ratings for PTSD

What is Post Traumatic Stress Disorder (PTSD)? Post-traumatic stress disorder (PTSD) is a mental health condition that develops in some people who have experienced a shocking, scary, or dangerous event. Symptoms of PTSD usually begin within three months of the...

Depression And Your VA Claim

Depression can negatively affect every aspect of your life: how you feel, think, sleep, function, and interact with others. According to the National Alliance on Mental Health Issues, about 14% of veterans suffer from depression. Depression is one of the most common...

Four Tips On How To Get The Highest PTSD Rating

If you have been fortunate enough to have been granted service connection for PTSD, then you have probably been given a disappointingly low rating.  This is a very common situation so you are not alone. The VA regularly underrates PTSD claims.  In the...

FREE CASE EVALUATION 

  • Hidden
  • Hidden
  • This field is for validation purposes and should be left unchanged.