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Old 01-22-2013, 03:38 AM   #1
RKassl
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Tricare vs Medicare Question

I am new on Tricare standard, had two surgeries in the last 90 days and reached the catastrophic cap of $3000.00. My question for anyone in this program and then went to Medicare does Medicare have a catastrophic cap like Tricare Standard does? All the reading I do regarding Medicare it talks about a yearly deductible is this the same?

Thanks for any info!
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Old 01-22-2013, 07:34 AM   #2
1retired06
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Medicare does not have a cap like Tricare provides. Having moved from Tricare Standard to Medicare/tricare for life, I have found that as long as you go to a Medicare Provider (ie someone who signed up to the medicare rates), tricare for life picks up the balance.

Political comment removed. CRAFT-Guy
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Old 01-22-2013, 07:47 AM   #3
CamillaMichael
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Political comment removed. CRAFT-Guy
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Old 01-22-2013, 08:59 AM   #4
Countryfolks
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This is the latest I've found so far. Don't know how accurate it is though.
http://militarytimes.com/blogs/trica...care-for-life/

This may help although I don't know how it would work with stnndard.
http://www.militaryauthority.com/ben...-medicare.html
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Old 01-22-2013, 02:40 PM   #5
RKassl
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I realize that Medicare does not have the catastrophic cap like Tricare has, but do you think the yearly deductible for Medicare acts the same way? For you folks on Medicare once you reach your maximum yearly deductible is that all you pay?
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Old 01-22-2013, 02:45 PM   #6
ols1932
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I agree with 1retired06. We have Medicare and Tricare 4 Life. It is yet to be seen exactly how Obamacare is going to affect us. All I'm hearing is a bunch of rumors and every day they are different.

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Old 01-25-2013, 03:04 AM   #7
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There is no clear discussion from DOD on Tricare4Life impacts.Whatever happens or announced be sure you immediately contact our representatives, senators and orgs like American Legion, VFW or DAV. Our history is to receive life care once service has been given.
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Old 01-28-2013, 11:07 AM   #8
fauch
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I just helped my brother in-law who is a Vietnam Navy Veteran with bone marrow cancer research this. here is what I found:

Individuals who are eligible for Medicare and otherwise eligible for TRICARE may enroll in
Medicare Part B and receive “wrap-around” TRICARE coverage through the TRICARE for Life
Program, which covers costs not paid by Medicare that would otherwise be incurred by the
beneficiary.

How Does PPACA Affect TRICARE?
In general, PPACA does not affect TRICARE administration, health care benefits, eligibility, or
cost to beneficiaries.
PPACA does open a special Medicare Part B enrollment window to enable certain individuals to
gain coverage under the TRICARE for Life program.21 TRICARE was extended to Medicare eligible
military retirees, their Medicare-eligible spouses and dependent children, and Medicareeligible
widow/widowers by the Floyd D. Spence National Defense Authorization Act of 2001
(P.L. 106-398). This law established the TRICARE For Life (TFL) program, which acts as a
secondary payer to Medicare and provides supplemental coverage to TRICARE-eligible
beneficiaries who are entitled to Medicare Part A based on age, disability, or end-stage renal
disease (ESRD). In order to participate in TFL, these TRICARE-eligible beneficiaries must enroll
in and pay premiums for Medicare Part B. TRICARE-eligible beneficiaries who are entitled to
Medicare Part A based on age, disability, or ESRD, but decline Part B, lose eligibility for
TRICARE benefits.22 In addition, individuals who choose not to enroll in Medicare Part B upon
becoming eligible may elect to do so later during an annual enrollment period; however, the
Medicare Part B late enrollment penalty would apply. PPACA also waives the Medicare Part B
late enrollment penalty during the 12-month special enrollment period (SEP) for military retirees,
their spouses (including widows/widowers), and dependent children who are otherwise eligible
for TRICARE and are entitled to Medicare Part A based on disability or ESRD, but have declined
Part B. The Secretary of Defense is required to identify and notify individuals of their eligibility
for the SEP; the Secretary of Health and Human Services (HHS) and the Commissioner for Social
Security must support these efforts. This section was amended by the Medicare and Medicaid
Extenders Act of 201023 to clarify that section 3110 applies to Medicare Part B elections made on
or after the date of enactment of PPACA. This is the only provision in PPACA that has an effect
on beneficiary eligibility under the TRICARE program.

At the risk of stirring the political emotions, I have folks in my family that have ended up in pretty good shape with some of the PPACA provisions. This B-I-L will be paying 80.00 a month vs 1000.00 for his portion of the 6500.00/mo. specialized medicine he will be taking. The other is a brother who is self employed. His premiums for himself and his wife with Blue Cross had gone to 1900.00/mo. He was able to get coverage through the state exchange for 700.00/mo. for he and his wife.

The above is an excerpt from this publication:
http://www.ncsl.org/documents/health...E&VA_PPACA.pdf
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Old 01-28-2013, 12:01 PM   #9
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It should be noted that TFL will only cover the remaining allowed charges. For example, Medicare does not pay for a PSA test (not allowed), TFL does not pay anything either because the PSA was not an allowed procedure under Medicare. One has to ask the question of a provider, lab, or whatever else: IS THIS A MEDICARE COVERED PROCEDURE? If not, buyer beware.....
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Old 01-28-2013, 04:23 PM   #10
fauch
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Prostate cancer screenings

How often is it covered?

Medicare Part B (Medical Insurance) covers:

Digital rectal exam: Once every 12 months
Prostate Specific Antigen (PSA) test: Once every 12 months
Who's eligible?

All men with Medicare are covered. Coverage begins the day after your 50th birthday.

Your costs in Original Medicare

Digital rectal exam: You pay 20% of the Medicare-approved amount and the Part B deductible applies for the exam. In a hospital outpatient setting, you pay a copayment
Prostate Specific Antigen (PSA) Test: You pay nothing for the test, and the Part B deductible doesn't apply
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Old 01-28-2013, 05:26 PM   #11
exav8tr
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I am 65 and have been on medicare for 7 years and have had two PSA tests in that period and Medicare declined to pay for each one. The point I was making, other than my PSA tests is the fact that you must determine what you are prescribed by your physician is, in fact, allowed under the Medicare program, otherwise you could have a surprise coming when the bills come in. nough said!
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Old 01-28-2013, 06:09 PM   #12
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http://www.medicare.gov/coverage/pro...creenings.html
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Old 01-29-2013, 02:43 AM   #13
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Interesting. Different for me. My experience, medicare covers one PSA in a 12 month period. A code for that is applicable that my regular doctor uses on the lab request. Medicare also covers another one every six months because deemed necessary by my urologist and different code is used.
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Old 02-04-2013, 12:45 PM   #14
richfaa
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We are not tricare but are on the Federal Employees BC/BS plan and medicare. Medicare is primary.There is a deductable on Medicare but do not remember what it is. between the two I have never had a bill/BC/BS does cover psa test and the prescriptions are very cheap.
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Old 02-14-2013, 07:15 AM   #15
mail2us
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For many military retirees that are MOC family here is a link that displays proposed fees and co-pays. It's provided as info as no co-pay structure has been enacted yet.

http://www.military.com/benefits/tri...e-changes.html
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Old 02-14-2013, 08:57 AM   #16
mainer
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Quote:
quote:Originally posted by mail2us

For many military retirees that are MOC family here is a link that displays proposed fees and co-pays. It's provided as info as no co-pay structure has been enacted yet.

http://www.military.com/benefits/tri...e-changes.html
Thanks Dennis for posting and sharing the link. We will definitely be looking at it.

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