Definition
Provided by the U.S. Department of Defense (DoD), TRICARE is a regionally managed health insurance and care program for active or retired members and family of all seven uniformed services. This includes the Army, Navy, Air Force, Marine Corps, Coast Guard, Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA) and the Commissioned Corps of the Public Health Services. A retired member of the military is someone who has 20 years of service. All military retirees are veterans, but not all veterans are military retirees. Therefore, not all veterans are eligible for TRICARE.
TRICARE for Life (TFL) is an extension of TRICARE for seniors enrolled in Medicare. TFL serves as the secondary payer to minimize the military retiree’s out-of-pocket expenses by covering Medicare’s co-insurance and deductibles. A network of both military and civilian health professionals provides care.
TRICARE for Life was formerly called the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).
Long Term Care Coverage Overview
Like Medicare Supplemental Insurance, TRICARE for Life (TFL) picks up where Medicare leaves off. TFL will pay the co-insurance and deductibles but does not pay for the monthly Medicare Part B premium. What follows is an overview of TFL’s benefits that are relevant to caring for an aging individual.
Assisted Living / Senior Living
TFL does not pay for long term care or custodial care as defined by assistance with the activities of daily living such as bathing, dressing, feeding or supervision of the cognitively impaired. This type of care is not covered by TRICARE for Life regardless of the participant’s place of residence, be that at home or in assisted living.
Skilled Nursing Homes
TFL will pay for skilled nursing care to an extent. Like Medicare, there must be a medical condition that was treated in a hospital for three consecutive days, and the senior must be admitted to a skilled nursing facility within 30 days following discharge from the hospital. Medicare has a 100-day limit on skilled nursing, and TFL will be the primary payer after that 100-day limit, but it will not cover the full amount. TFL does not limit the number of days they will assist in covering the cost of skilled nursing facility care, given the care is medically necessary. Make note, pre-authorization is required. A co-payment from the insurance holder in the amount up to $250 / day should be expected.
Home Health Care
For persons confined to their homes who are unable to visit a medical facility without extensive assistance, TFL will cover home health visits for medical purposes but not to provide personal care. Prior authorization is required.
Adult Day Care
TFL does not pay for either medical care or supervision in adult day care centers.
Hospice
TFL covers hospice care but it is offered as an alternative to further medical treatment. Prior authorization is required.
Qualifications
Age
Veterans or their family members must be at least 65 years of age to be eligible for TRICARE for Life. However, there is an exception for younger individuals if they are enrolled in Medicare already as a result of a disability.
Disabilities / Health Requirements
A senior veteran’s disability status, service-connected or otherwise does not affect their eligibility for TRICARE for Life.
Family Status
Family or marital status does not play a role in TRICARE for Life eligibility. One exception is surviving spouses that have re-married, which means they are no longer eligible. Divorce or death of the new spouse does not enable them to re-gain their eligibility as it does with the CHAMPVA for Life program.
Financial Requirements
Applicants and / or their surviving spouses with any level of financial resources and income are eligible for TRICARE for Life.
Veteran Status
One cannot have been dishonorably discharged.
Other Requirements
Military retirees and / or their spouses must be enrolled in Medicare Part A, which is Medicare’s hospital insurance, and Medicare Part B, which is Medicare’s medical insurance, to be eligible for TRICARE for Life.
Benefits
The types of care covered by TRICARE for Life are discussed in the Overview section above. In addition to care, TFL provides for durable medical equipment (DME) provided the items are 1) medically necessary and 2) prescribed by a physician. One can find greater details about the program’s DME policy here.
Benefits payments are made directly to the medical providers. At no point do veterans receive cash or checks from TRICARE for Life.
Costs
There are no enrollment fees or monthly premiums for TFL. However, military retirees and/or their spouses must purchase Medicare Part B and pay those monthly premiums in order to be eligible for TFL.
How to Apply
Participants manage their TRICARE enrollment through the Defense Enrollment Eligibility Reporting System known as DEERS, which can be done on their website. To enroll in TRICARE for Life, a veteran must confirm that their Medicare Part B status is current in DEERS. Their record will then show they are “eligible for TRICARE for Life.” To learn more about TRICARE for Life, click here.
