TRICARE for Life and TRICARE Plus

1. TRICARE for Life and TRICARE Plus Presented by: Wendy Pritt TRIWEST Healthcare Alliance, Inc.

2. TRICARE Regional Contractors

3. DEERS • Medicare status • Current Uniformed services ID card • DEERS automatically notifies beneficiaries within 90 days of 65th birthday about changing benefits • How many of you have received this notification?

4. TRICARE for Life • National Defense Authorization Act for FY 2001 • Extended TRICARE eligibility • Combines TRICARE Standard with Medicare Parts A & B • Second payer to Medicare

5. TRICARE For Life Eligibility • All TRICARE beneficiaries entitled to Medicare, regardless of age or residence • May receive Space A Military Treatment Facility (MTF) care • Some beneficiaries may enroll in the Military Treatment Facilities “TRICARE Plus” program.

6. Medicare Eligibility • Health insurance not a benefit like TRICARE • Ages 65 and older • Under 65 with certain disabilities • Any age with end-stage renal disease or amyotrophic sclerosis (ALS); most commonly known as Lou Gehring’s disease

7. Medicare Overview • Medicare Part A • Hospital Insurance • Medicare Part B • Medical Insurance • Medicare Part C • Medicare + Choice Plan • Medicare Part D • Medicare Prescription Drug Plan

8. Shows your eligibility for Parts A & B and the effective dates of coverage. Medicare Card • No TRICARE For Life card • Just show this Medicare card along with your uniformed services ID card Call 1-800-MEDICARE or visit www.medicare.gov if you need a new card.

9. Medicare Part B Enrollment • Federal law mandates enrollment to remain TRICARE eligible • Medical entitled Active Duty Service Members (ADSM)/Active Duty Family Members (ADFM) are not required to enroll until retirement • These beneficiaries retain TRICARE eligibility • Active Duty Service Members (ADSM)/Active Duty Family Members (ADFM) must have Part B enrollment in effect on retirement date to avoid break in TRICARE coverage

10. TRICARE For Life Costs • Medicare Part A • No fee if beneficiary paid Medicare taxes while working • Medicare Part B • Monthly premium required for Medicare, no enrollment fee for TRICARE at that point • 2010 Medicare Part B Premium • Based on income • May change each year

11. 2010 Medicare Part B Premiums

12. Medicare TRICARE Medicare + TRICARE Standard = TFL Medicare Parts A and B along with TRICARE Standard as the second payer gives beneficiaries TRICARE For Life coverage

13. 1st Payer: Medicare 2nd Payer: OHI or Medicare supplement 3rd Payer: TRICARE 1st Payer: Employer-sponsored plan 2nd Payer: Medicare 3rd Payer: TRICARE Coordinating TRICARE For Life with Other Health Insurance (OHI) Order of payment depends on whether or not you have employer-sponsored health insurance. Other Health Insurance (not based on current employment) With Employer-Sponsored Health Insurance (based on current employment) TRICARE For Life will always pay last.

14. TRICARE For Life—How it Works • You visit your Medicare provider • Your provider files a claim with Medicare • Medicare pays its portion and sends the remaining amount to TRICARE • TRICARE pays remaining amount to your provider • You get an explanation of benefits from Medicare and TRICARE Contact Wisconsin Physicians Service-TFL 1-866-773-0404  www.tricare4u.com

15. TRICARE For Life—What You Pay

16. Medicare Advantage Plans • Health Plan options that are a part of: • HMOs • PPOs • Fee-for-service • Medicare Special Needs program • Covered services and copayments are reimbursed by TRICARE

17. Medicare Prescription Drug Benefit – Medicare Part D • Covers brand name and generic drugs at participating pharmacies • Enrollment window – every year between Nov 15 – Dec 31 • TRICARE Pharmacy Program (may be better option for beneficiaries)

18. Pharmacy Options and Costs *Non-formulary drugs are available at the formulary cost if medical necessity is established. Visit www.tricare.osd.mil/pharmacy for information.

19. TRICARE for Life (TFL) Overseas • No Medicare coverage overseas • TRICARE is primary payer • Except for U.S. overseas territories • No location restrictions • TRICARE Standard is a global benefit • Beneficiaries file their own claims • Submit claim (DD form 2642) to WPS • No Medicare summary required

20. TRICARE For Life Claims Processing • Wisconsin Physician Services (WPS) • TRICARE4u.com • Explanation of Benefits (EOB)

21. TRICARE for Life (TFL) Explanation of Benefit (EOB) • Detailed summary of claims for all medical care processed that month

22. TRICARE Plus • Primary care enrollment option • Available to beneficiaries not enrolled in TRICARE Prime or other HMO-like program • Offered at some MTFs* • Limited by MTF capacity • Not transferable from one MTF to another * Check with your local MTF for program availability and details.

23. Additional Information • TRICARE For Life (TFL) -www.tricare.mil/tfl • Defense Manpower Data Center (DMDC) Support Office - (800) 538-9552 • ID Cards - www.dmdc.osd.mil/rsl/ • Social Security Administration (SSA) - www.ssa.gov • TRICARE Fact Sheets - www.tricare.mil/factsheets/index.cfm • Centers for Medicare and Medicaid Services - www.medicare.gov

24. Questions?