Military Medical - Part 2

About.com said military retirees or veterans cannot get free medical care from the Veterans Administration (VA) unless they have over 180 days of military service, an honorable discharge and either a service-connected illness, injury or disability or fall into a certain range of poverty. Retirees (under age 65) and their family members if they don’t qualify for VA benefits can enroll in any of the Tricare programs. Until 2001 when a retiree or retiree family member reached the age of 65 they were no longer eligible for Tricare. Instead, they were expected to receive medical care under the provisions of Medicare. With the introduction of "Tricare for Life" (TFL) there is no need to enroll in advance (except one must be enrolled in Medicare Part B). The only charges for this program are the monthly Medicare Part B Premiums. Under this program the member sees an authorized Medicare Provider and presents an ID Card; Tricare becomes the "second payer" and picks up any costs that Medicare doesn't cover. Although Medicare doesn’t cover services provided outside of the continental US, retirees residing in foreign countries can still take advantage of TFL because Tricare becomes the primary source of health benefits for them. Like those living in the US, to be eligible overseas retirees must be enrolled in Medicare Part B. TFL will provide the same level of coverage afforded retirees under 65 and they will be responsible for the same Tricare cost shares and deductibles as the under 65 retirees. Since a great number of retirees living overseas did not enroll in Part B because Medicare didn’t cover medical care received in foreign countries, some of the military related organizations are pushing for a waiver of the Part B penalty (entails a 10% penalty for each year the individual was eligible for Part B but didn’t enroll). There is nothing in the works that indicates such a waiver is coming.

Tricare Plus is a new program undergoing development. Basically it will allow individuals to use Tricare Extra and Tricare for Life benefits at military medical facilities. Not all military medical facilities will offer this option. Local commanders will determine whether or not they have the resources. Individuals will be required to enroll in the program at a participating medical facility then receive their primary care at that facility. There are no enrollment fees for this program. 

There are basically three ways to receive medications:

Military treatment facility (MTF) pharmacies-prescriptions up to a 90-day supply for most medications may be filled free of charge (not all medications are available). Each facility is required to have the medications listed in the basic core formally (BCF). The MTF through their local Pharmacy & Therapeutics Committee may add other medications to their local formally based on the scope of care at that MTF.

Tricare Mail Order Pharmacy (TMOP) allows ordering medications online or through the mail; for most medications up to a 90 day supply.

If a civilian pharmacy is part of the Tricare Pharmacy Network the cost is the same as the Mail Order Pharmacy. If your pharmacy is not part of the Network, Tricare will reimburse you $9 or 20% of total cost (whichever is greater). For users of Tricare Prime who use a commercial non-network pharmacy there is an annual per person/family deductible; the annual deductible for Tricare Standard users of a non-network pharmacy is part of the Tricare Standard annual deductible. Effective 1 April 2001, retirees/family members over the age of 65 are also eligible for the above pharmacy benefits, but like TFL they must be enrolled in Medicare Part B to participate. Cost-share is the same as shown above.

Dental Care for active duty is free through the Military Dental Clinic. Tricare does, however, offer optional dental plans for family members of active duty, and members of the Guard/Reserves and their family members. These programs require a monthly premium. The programs pay the total cost of some dental care, plus cost-share for other dental care. As of April 2012 the monthly premium rates will be:

Active duty - One family member $12.69 per month; two or more family members $31.72 per month.

Selected Reserves - Military member $12.69 per month; one family member $31.72 per month; more than one family member $79.29 per month and the military member and his/her family $91.98 per month.

Individual Ready Reserves (IRR) - For the military member, $12.69 per month; one family member, $31.72 per month; more than one family member, $79.29 per month; for the military member and his/her family, $91.98 per month.

Tricare offers a separate dental program for military retirees and their family members; premiums depend upon where the member lives and number of family members and the coverage is the same as the other programs.