Veteran seeks answers about wife's TRICARE For Life health benefits

May 21, 2013

Sgt. Shaft

Dear Sgt. Shaft:

Thank you for a most informative column. However, the more I read and the more I ask the question, I become more confused. So does my wife, in the matter of our health insurance cost after the age of 65.

My wife — who is currently eligible for benefits under TRICARE For Life (TCL) as a second payee after her employer-sponsored health insurance plan has paid and she has not reached the age of 65 — will turn 65 in June 2013 and therefore must enroll in Medicare Part A and Part B to continue with TCL benefits.

(TRICARE is the health care program serving uniformed service members, retirees and their families worldwide.)

She must continue to work in order to receive full Social Security benefits upon retirement when she reaches age 66.

She has received direction that to remain TCL eligible, she must enroll in Medicare Part B. But she continues to receive employer-sponsored health insurance plan coverage until her employment terminates.

Why then would she need to enroll in Medicare Part B with its cost to continue to receive TCL, while still enrolled in an employer-sponsored health insurance plan just so that a TCL supplemental plan would kick in?

Our income decreases and it appears that our cost increases. How do we avoid paying the additional Part B cost and still receive the benefits of TCL coverage after the employer-sponsored health insurance plan pays?

It seems that the employer-sponsored health insurance plan must pay before TCL under any condition, but that Medicare Part B must also be in place for the TCL to pay a remaining amount after she reaches age 65. However, she must remain in the employer-sponsored health insurance plan until reaching age 66 as a condition of her employment.

Why then should she need to enroll in Part B at age 65?

Thomas S.
USAF Master Sergeant (retired)

Dear Tom:

I asked Jim Schwartz from TRICARE for Life to contact you to contact you. Here is how he responded to my inquiry:

Here is what I know, Medicare allows individuals covered by group health plan coverage to delay their Part B enrollment and sign up during a special enrollment period. However, to remain TRICARE-eligible, all TRICARE beneficiaries (except for active duty family members) must purchase Part B, when first entitled to Medicare. TRICARE will not act as a secondary payer to your group health plan coverage. You will not be TRICARE-eligible until you purchase Part B.

If you wait to enroll in Part B because you or your spouse were still working and had group health plan coverage, you may sign up during a special enrollment period. If this applies to you, you can sign up for Part B:

Option 1: Anytime while you are still covered by the group health plan, through your or your spouse’s current employment status.

Option 2: During the eight months following the month the group health plan coverage ends, or the employment ends (whichever is first).

Enrollment in an employer-sponsored health care plan does not replace the need to enroll in Medicare Part B to retain TRICARE coverage.

Shaft notes

• The Department of Veterans Affairs has accelerated the effort to the elimination their disability compensation claims backlog with mandated overtime for claims processors in its 56 regional benefits offices.

This surge, which will be implemented through the end of fiscal year 2013, will be used to help eliminate the backlog with continued emphasis on high-priority claims for homeless veterans and those claiming financial hardship, the terminally ill, former Prisoners of War, Medal of Honor recipients and veterans filing Fully Developed Claims (FDC).

In Fully Developed Claims, veterans, service members and survivors submit all required records and documentation at the time they make their claim and certify that they have no further evidence, according the VA website.

“VA is dedicated to providing veterans with the care and benefits they have earned and deserve,” said VA Secretary Eric K. Shinseki. “This increased overtime initiative will provide more veterans with decisions on their claims and will help us achieve our goal of eliminating the claims backlog.”

This is the latest effort in support of the secretary’s plan to reduce the backlog. Last month, VA announced an initiative to expedite compensation claims decisions for veterans who have waited one year or longer.

On April 19, VA began prioritizing claims decisions for veterans who have been waiting the longest, by providing provisional decisions that allow eligible veterans to begin collecting compensation benefits quickly. With a provisional decision, a veteran has a year to submit additional information to support a claim before the decision becomes final.

“We’re committed to getting veterans decisions on their claims as quickly and accurately as possible,” Undersecretary for Benefits Allison A. Hickey said. “We need to surge our resources now to help those who have waited the longest and end the backlog.”

Claims for wounded warriors separating from the military for medical reasons will continue to be handled separately and on a priority basis with the Department of Defense through the Integrated Disability Evaluation System (IDES). On average, wounded warriors separating through IDES currently receive VA compensation benefits in two months following their separation from service.

Veterans can learn more about disability benefits on the joint Department of Defense-VA website portal eBenefits at http://www.ebenefits.va.gov.

More information about filing Fully Developed Claims is available at: http://www.benefits.va.gov/transformation/fastclaims/.

• In addition, the VA has launched a new hotline — 1-855-VA-WOMEN — to receive and respond to questions from veterans, their families and caregivers about the many VA services and resources available to women veterans. The service began accepting calls on March 27, 2013.

“Some women veterans may not know about high-quality VA care and services available to them,” Mr. Shinseki said. “The hotline will allow us to field their questions and provide critical information about the latest enhancements in VA services.”

The hotline is staffed by knowledgeable VA employees who can provide information about benefits including health care services for women. Callers can be linked to information on claims, education or health care appointments as well as information about VA cemeteries and memorial benefits.

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.