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Old 12-19-2018, 05:40 AM
 
368 posts, read 1,316,259 times
Reputation: 244

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Sounds like my experience. My husband is 65, pays the SS Parts A & B. When bills are submitted to Medicare, they pay and the balance is automatically transmitted to TFL who pays his balance. I am under 65 but am able to be Prime since there is a base nearby. My PCP sees me (for free) and refers me out. I make sure the referral is in-network so all I pay is my co-pay (and my monthly membership fee-about $25). For some reason, my husband occasionally gets the "we don't accept Tricare" but as long as they accept Medicare and TFL covers his 20% I couldn't care less (nor should they).
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Old 12-19-2018, 06:29 AM
 
Location: New Mexico U.S.A.
24,590 posts, read 39,825,655 times
Reputation: 28710
Quote:
Originally Posted by Dwatted Wabbit View Post
Or can get meds at VA.
Information at: https://www.va.gov/health-care/refil...prescriptions/
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Old 12-20-2018, 12:14 PM
 
18,797 posts, read 10,357,323 times
Reputation: 18569
I'm not clear on what might cover copays and what doesn't.

Currently, we have employer health insurance (what's called "other health insurance" or OHI in government parlance) and Tricare.

Tricare pays second and doesn't pay the copays of my employer insurance.

So, to illustrate by what just happened last week:

My doctor brings me in for a complaint-based examination. My employer insurance requires a copay, but covers all the rest of the examination, including a blood test. Tricare will not pay that copay.

So then my doctor sends to to get an MRI. My employer insurance has a an annual deductible for such things and the entire cost of the MRI is under what remains of my annual deductible, so they pay nothing.

Because I have OHI and the MRI is technically covered by the OHI (if I'd already met their deductible), Tricare requires them to pay something in order to trigger a Tricare payment for the rest. Because they will pay nothing, Tricare will pay nothing, so the complete cost of the MRI comes out of my pocket. That's how the Tricare rep explained it to me.

So in a few months, I'll be under Medicare and still potentially under employer OHI through my wife (it'll be another couple of years before she retires) as well as Tricare for Life.

What I read on this site appears to say that if a person has Medicare and Tricare, that between them there would be nothing to be paid: One or the other would cover everything, presuming it's a cost either of them would cover at all.

https://tricare.mil/Costs/HealthPlanCosts/TFL

So how will copays work then? It is actually disadvantageous for me to remain with OHI through my wife--would Medicare and Tricare actually cover copays and deductibles if I don't have an OHI?
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Old 12-20-2018, 01:56 PM
 
Location: Hawaii/Alabama
1,655 posts, read 3,049,371 times
Reputation: 4192
Ralf Kirk~

I will tell you my experience with medicare & TFL ( please either call TFL or if you are near a military installation stop by the medical facility and meet with someone in person to verify).

I have never had a co-pay (even with an extended hospital stay or very expensive dme); not even a penny. I will caution you and say that if the medical caretaker does not accept medicare then TFL most likely will not pay.
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Old 12-20-2018, 04:13 PM
 
Location: Alaska
239 posts, read 100,028 times
Reputation: 785
Quote:
Originally Posted by Ralph_Kirk View Post
I'm not clear on what might cover copays and what doesn't.

Currently, we have employer health insurance (what's called "other health insurance" or OHI in government parlance) and Tricare.

Tricare pays second and doesn't pay the copays of my employer insurance.

So, to illustrate by what just happened last week:

My doctor brings me in for a complaint-based examination. My employer insurance requires a copay, but covers all the rest of the examination, including a blood test. Tricare will not pay that copay.

So then my doctor sends to to get an MRI. My employer insurance has a an annual deductible for such things and the entire cost of the MRI is under what remains of my annual deductible, so they pay nothing.

Because I have OHI and the MRI is technically covered by the OHI (if I'd already met their deductible), Tricare requires them to pay something in order to trigger a Tricare payment for the rest. Because they will pay nothing, Tricare will pay nothing, so the complete cost of the MRI comes out of my pocket. That's how the Tricare rep explained it to me.

So in a few months, I'll be under Medicare and still potentially under employer OHI through my wife (it'll be another couple of years before she retires) as well as Tricare for Life.

What I read on this site appears to say that if a person has Medicare and Tricare, that between them there would be nothing to be paid: One or the other would cover everything, presuming it's a cost either of them would cover at all.

https://tricare.mil/Costs/HealthPlanCosts/TFL

So how will copays work then? It is actually disadvantageous for me to remain with OHI through my wife--would Medicare and Tricare actually cover copays and deductibles if I don't have an OHI?

My experience so far
I currently have OHI as well, mine is Blue Cross Blue Shield through my employer and Tricare prime,
The Tricare Prime cost $49/month and comes out of my retirement paycheck, the BCBS is free from my employer. Past 4 years had I have had three ER visits, Ortho surgeries, follow ups, physical therapy, etc.. and have had no out of pocket expense though my body is a little worse for the wear.
I have received the copay bill once and I called back to the surgeons office and they resubmitted to Tricare and it was subsequently paid. I see a physician on base for routine primary care and that base hospital is allowed to bill OHI and recoup some $$, still no cost to me.
Also Tricare has picked up these copays even though I did not have referrals from my on post physician.
My wife has just dependent Tricare, everything off post needs a referral and has varying copays. They vary quite a bit, a 65dollar allergy shot had $12 copay now $30 I think. A $6500 neupogen shot I think...had no copay. She went through cancer treatment with great results.


PreApproval is always a good idea for non emergent stuff
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Old 12-22-2018, 07:40 PM
 
Location: Colorado
767 posts, read 398,415 times
Reputation: 872
Quote:
Originally Posted by Ralph_Kirk View Post
I'm not clear on what might cover copays and what doesn't.

Currently, we have employer health insurance (what's called "other health insurance" or OHI in government parlance) and Tricare.

Tricare pays second and doesn't pay the copays of my employer insurance.

So, to illustrate by what just happened last week:

My doctor brings me in for a complaint-based examination. My employer insurance requires a copay, but covers all the rest of the examination, including a blood test. Tricare will not pay that copay.

So then my doctor sends to to get an MRI. My employer insurance has a an annual deductible for such things and the entire cost of the MRI is under what remains of my annual deductible, so they pay nothing.

Because I have OHI and the MRI is technically covered by the OHI (if I'd already met their deductible), Tricare requires them to pay something in order to trigger a Tricare payment for the rest. Because they will pay nothing, Tricare will pay nothing, so the complete cost of the MRI comes out of my pocket. That's how the Tricare rep explained it to me.

So in a few months, I'll be under Medicare and still potentially under employer OHI through my wife (it'll be another couple of years before she retires) as well as Tricare for Life.

What I read on this site appears to say that if a person has Medicare and Tricare, that between them there would be nothing to be paid: One or the other would cover everything, presuming it's a cost either of them would cover at all.

https://tricare.mil/Costs/HealthPlanCosts/TFL

So how will copays work then? It is actually disadvantageous for me to remain with OHI through my wife--would Medicare and Tricare actually cover copays and deductibles if I don't have an OHI?
If you have Tricare prime, you really donít need, and are wasting money on any other private insurance.
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Old 01-24-2019, 02:38 PM
 
18,797 posts, read 10,357,323 times
Reputation: 18569
In my case, I don't have Tricare Prime.

I need some back surgery--fusing a couple of vertebrae. I'm also two months away from qualifying for Medicare and TFL.

I have BC/BS through my employer, but it's the beginning of the year so the full $2,500 deductible will apply, and BC/BS will cover only 90% of surgical and hospital costs. TriCare has told me explicitly in a couple of different calls that they won't cover the deductible, but they will cover the remaining 10%.

Right now I'm trying to decide if I'm willing to deal with two more months of Ibuprofen and Lyrica to save $2,500.
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Old 01-26-2019, 01:30 PM
 
350 posts, read 306,694 times
Reputation: 449
Further information:
Medicare Part A&B and TFL
Use Express Scripts for medication, co-pay is now in affect. We pay $7 for 90 day supply.
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Old Yesterday, 10:04 AM
 
Location: New Mexico U.S.A.
24,590 posts, read 39,825,655 times
Reputation: 28710
Quote:
Originally Posted by zed42 View Post
Further information:
Medicare Part A&B and TFL
Use Express Scripts for medication, co-pay is now in affect. We pay $7 for 90 day supply.
I just asked my wife (who does the paperwork). We use Express Scripts for our prescriptions which average from $7 to $24 for a 90 day supply.

Their website is at:
https://www.express-scripts.com/
and
https://www.express-scripts.com/TRICARE/index.shtml
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Old Yesterday, 01:57 PM
PFM
 
Location: Endicott, NY
114 posts, read 108,537 times
Reputation: 254
I am under Tricare Retired Reserve and use Express Scripts, and assume I will switch to Prime at age 60 and TFL at 65. I just signed up for FEDVIP for vision and dental - I assume I will have to keep it until the day I die?
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