TRICARE, formerly known as CHAMPUS, is the government health care program for military service families. This program was expanded to include military beneficiaries who are Medicare-eligible.
The cost of these programs is minimal, and we expect some of our customers to drop their current Medicare Supplement coverage.
For example, prescription drugs are $9 for a 90-day supply of brand-name and $3 for a 90-day supply of generic. We have developed these Questions and Answers to help with some common questions that we believe will be asked.
NOTE: We do not discuss TRICARE benefits with customers, however, we have provided phone numbers where you can refer them to obtain general information as well as benefit information.
| What is TRICARE? |
Formerly called CHAMPUS, TRICARE is the government health care program for military service families. It consists of three options: TRICARE Prime, TRICARE Extra and TRICARE standard.
| Is TRICARE going to be the secondary or tertiary payer after Medicare? |
A: According to a TRICARE representative we contacted on July 30, 2001, TRICARE will be the final payer if charges remain. Medicare Supplement coverage will be the secondary payer to Medicare. (Please note that this answer is based on updated information and may differ from that given at previous broker meetings.)
| What is the new benefit now being offered by the government? |
As a result of new legislation, access to military pharmacy benefits increased for military beneficiaries who are Medicare-eligible, effective April 1, 2001. Specific information is available to beneficiaries by calling the toll-free Defense Manpower Data Center Support Office Beneficiary line at 1-800-538-9552 for assistance, or by visiting the TRICARE web site at www.tricare.osd.mil/pharmacy/newsenior.htm.
| Who is eligible for TRICARE? |
TRICARE eligibility is determined by the various branches of the uniformed services. Clients who are unsure about their eligibility for this program may contact the toll-free Defense Manpower Data Center Support Office Beneficiary line at 1-800-538-9552 for assistance.
| Where can I direct clients for more information if they ask about TRICARE? |
They can usually get informational materials from the health benefits adviser at the nearest military medical facility, from the beneficiary counseling and assistance coordinator at their TRICARE region's lead agent office, or from the regional TRICARE contractor's local TRICARE service center. They'll also find information on the TRICARE web site: www.tricare.osd.mil.
| Who is the TRICARE contractor for Virginia? |
Anthem Alliance for Health, Inc., is the regional TRICARE service contractor for Region 2 (Mid-Atlantic), which includes most of Virginia, except for certain northern Virginia ZIP codes located near Washington, D.C. Here are some important numbers and addresses:
The toll-free number for general information is 1-800-931-9501
The toll-free number for claims information is 1-800-493-1613
| As a result of changes in military health care benefits, one of my clients is eligible for TRICARE benefits. What should I tell him about keeping Medicare Supplement/Select coverage with Anthem? |
For clients enrolled in a traditional (non-standardized) Medicare Supplement plan, be sure to point out that we can no longer sell the product they currently have. This means that, if they drop this coverage, they will not be able to return to the same plan and enjoy the same benefits at a later date. While we have several federally standardized Medicare supplemental plans that they may choose from, the benefits are different from what they currently have.
Regardless of which plan they had before, anyone who is older than age 65½, or who enrolled in Medicare Part B more than six months ago, would have to answer health questions and qualify medically for our federally standardized plans. This means they could be turned down for the plan of their choice.
Clients should carefully compare their supplemental and Medicare coverage versus TRICARE coverage. If they need more information about Medicare, they may visit the Medicare web site at www.medicare.gov, or call 1-800-633-4227.
| If my client decides to keep Anthem supplemental coverage, can he, as a military beneficiary, still use TRICARE's pharmacy benefit? |
Yes. If a beneficiary is enrolled in a Medicare supplemental plan that has a prescription drug benefit, the Medicare supplement coverage will be used first to cover costs of prescriptions. If the supplemental plan does not include a prescription drug benefit, then, as a military beneficiary, the person may use TRICARE's pharmacy benefit.
The TRICARE program will ask the person to furnish proof that the supplemental plan does not include prescription drug coverage. The person also will have to file his own drug claims. For more information about using TRICARE's pharmacy benefit with other health care coverage, beneficiaries may call Merck-Medco, the program's pharmacy contractor, at 1-800-903-4680.