Is a TRICARE Supplement right for you?

Many members call us to ask whether they still need a TRICARE Supplement now that the annual catastrophic cap went from $7,500 to $3,000. Some of these calls were generated because the member was informed that his current insurer (e.g., USAA) was getting out of the TRICARE Supplement business altogether. As always the decision to insure your family against risk is a personal one that each person should make based on his or her own financial situation. However, here are some facts that you need to consider when you are making your decision about a TRICARE Supplement:

Not all expenses can be used to satisfy the annual catastrophic cap. The cap applies only to the amount of money required to meet your family's annual TRICARE deductibles and cost-shares based on TRICARE Standard allowable charges for covered medical care.

You still have to pay any charges in excess of those that TRICARE determines to be reasonable (or allowable) for covered care even if you do satisfy the catastrophic cap.

Alzheimer's Coverage Updated:

The Centers for Medicare & Medicaid Services (CMS) has clarified the coverage for Alzheimer's disease to clarify how Medicare processes claims for patients with Alzheimer's disease. On September 1, 2001 Medicare contractors were informed they could no longer automatically deny claims based solely on the Alzheimer's diagnosis. This did not guarantee that all claims for Alzheimer's patients will be paid. Instead, Medicare

 

 

contractors are instructed to review these claims based on the beneficiary's overall medical condition. This means that Medicare may pay for speech, occupational and rehabilitation therapies for people with Alzheimer's, including mental health services. The instructions given to Medicare contractors about Alzheimer's disease reflects the Center for Medicare & Medicaid Services commitment to ensure that people with Medicare receive the benefits they are entitled to under the program.

Uniform Formulary Rules Proposed:

On April 12, the Defense Department announced a proposal to set up new rules for a uniform formulary for TRICARE pharmacy programs. The uniform formulary is the list of pharmaceuticals covered by the TRICARE pharmacy standard co-payments of $3 (generic) or $9 (brand name). The DoD plan envisions establishing a third co-payment tier for drugs deemed by a special DoD committee to be less clinically effective or less cost-effective than other drugs in the same therapeutic class. "Non-formulary" pharmaceuticals would have a $22 co-payment vs. the current co-payments of $3 (generic) or $9 (brand name).

For medications in the uniform formulary, beneficiary co-pays would remain at $3 (generic) and $9 (brand name). For medications not included in the uniform formulary, beneficiaries would see higher co-pays:

*TRICARE Retail Pharmacies: $22 for a 30-day supply;

*Mail-Order Pharmacy: $22 for a 90-day supply;

*Non-Network Retail pharmacies: $22 or 20 percent of the cost, whichever is greater.

 

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Tom & Grace Carmody Donald Forsyth Frank & Eileen Taylor