Starting October 1, 2013, there will be higher outpatient costs at VA hospitals and clinics for retirees eligible for TRICARE for Life (TFL). These costs will be for those conditions that are not rated as service-connected. Though this will obviously save TRICARE some money (approximately $1 million per year), this change comes because regulations do not actually allow TRICARE to foot the entire bill for the health problems not associated with service.
What is TRICARE for Life?
TFL is a supplement for retirees 65 and older. It is designed to pick up the tab after Medicare is billed the initial 80%, and then after any secondary insurance is billed. Since a VA facility is not Medicare certified and thus cannot bill Medicare for a retiree’s non-service connected condition (the service-connected conditions are covered by the VA), TRICARE has been paying the 20% they are allowed to pay, and then paying the rest that could not be billed to Medicare.
Which Veterans Are Affected by the TFL Billing Changes?
Because TRICARE’s payments to VA for non-service connected thus aren’t legally correct, effective October 1, the beneficiary would have to pay out-of-pocket the portion that cannot be billed to Medicare. It is estimated that about 12,000 TFL retirees were notified of the changes. Although this problem was discovered in the spring, the changes do not take effect until October 1 so that those who are currently going to the VA for non-service related conditions can find a private doctor who will take Medicare initially. This way TRICARE will pay no more than 20%. This should only affect those veterans that have no other insurance besides TRICARE, or those who simply do not want to seek care outside of a VA facility.