Retirees eligible for Tricare for Life will face higher outpatient costs at VA hospitals and clinics starting Oct. 1 if they continue to seek care there for conditions not rated as service-connected.
Tricare managers this spring discovered that, for more than a decade, Tricare was exceeding its legal authority by covering almost all outpatient costs that VA assessed on elderly retirees who were treated for ailments or injuries not linked to time in service.
On Oct. 1 that will end.
Tricare policy regarding TFL retirees and VA health care will “get back into sync” with statutory requirements, said Michael O’Bar, deputy chief of Tricare policy and operations.
Wisconsin Physicians Service, support contractor for the Tricare for Life program, sent letters this month to 12,000 TFL retirees, all of whom, over the past year or so, received VA care for conditions unrelated to service disabilities.
The law that established Tricare for Life as a prized supplement to Medicare for retirees 65 and older directs Tricare to cover the cost of TFL claims only after Medicare has paid its share, followed by any other health insurance that retirees might have to serve as second payer.
The VA does not actively recruit Tricare beneficiaries to its clinics and hospitals, officials said. But the VA is a Tricare network provider and will deliver care to Tricare beneficiaries as capacity allows. This usually is for specialty services, but some VA facilities also have primary care capacity.
More often, when the VA already is caring for a veteran with a service-connected condition, in order to care for the whole patient, the VA has offered veterans the option of using their Tricare benefit for routine care that falls outside their service-connected condition.
The hitch is that while VA facilities are Tricare-authorized providers, they are not Medicare-certified. So, the VA cannot bill Medicare for that care. That means Tricare can pay no more than 20 percent of Tricare-allowable charges. The beneficiary legally is responsible for the 80 percent Medicare won’t pay.
Tricare has been violating the law by covering the whole tab. O’Bar said that Tricare overpaid because it relied on a Memorandum of Understanding between the VA and the defense department on care reimbursements signed in 1995. The memo wasn’t updated to reflect the Tricare for Life law enacted in 2001.
A new memo is being drafted.
The 12,000 TFL retirees who received letters this month were identified from a review of TFL claims involving VA care of nonservice-connected ailments from April 2012 through May 2013. O’Bar acknowledged there could be more who use VA care infrequently. But the overall number still would be small compared with 2.1 million total TFL beneficiaries, he said.
Tricare estimates that it improperly covered only about $1 million of VA costs per year, or an average of $83 per retiree.To comment, write Military Update, P.O. Box 231111, Centreville, VA 20120, or email firstname.lastname@example.org. Twitter: @Military_Update.