TRICARE for Life and Long Term Care for the Elderly

Page Reviewed / Updated - Feb. 2014

Definition

Provided by the Department of Defense, TRICARE is a health insurance and care program for active or retired members and family of all seven uniformed services which includes the Army, Navy, Marine Corps, Air Force, Coast Guard, Public Health Service and NOAA.  A “retired” member of the military is someone who has 20 years of service. All military retirees are veterans but not all veterans are military retirees.

TRICARE for Life (TFL) is an extension of TRICARE for seniors enrolled in Medicare.  TFL serves as the secondary payer to minimize veteran seniors’ out-of-pocket expenses by covering the Medicare's coinsurance and deductible. Care is provided by a network of both military and civilian health professionals.

TRICARE for Life was formerly called the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).

 

Long Term Care Coverage Overview

Like Medicare Supplemental Insurance, TRICARE for Life (TFL) picks up where Medicare leaves off. TFL will pay the co-insurance and deductibles but does not pay for the monthly Medicare Part B premium.  Follows is an overview of TFL's benefits which are relevant to caring for an aging individual.

Assisted Living / Senior Living
TFL does not pay for long term care or custodial care as defined by assistance with activities of daily living such as bathing, dressing, feeding or supervision of the cognitively impaired.   This type of care is not covered regardless of the place of residence.

Skilled Nursing Homes
TFL will pay for skilled nursing care to an extent. Like Medicare, there must be a medical condition that was treated in a hospital for 3 consecutive days and the senior must be admitted to a skilled nursing facility within 30 days. Medicare has a 100 day limit on skilled nursing and TFL will be the primary payer after that 100 day limit, but will not cover the full amount and pre-authorization is now required. Co-payment from the insurance holder in the amount of $100-$200 / day should be expected.

Home Health Care
For persons confined to their homes, unable to visit a medical facility without extensive assistance, TFL will cover home health visits for medical purposes but not to provide personal care.

Adult Day Care
TFL does not pay for either medical care or supervision in adult day care centers.

Hospice
TFL covers hospice care but it is offered as an alternative to further medical treatment.

 Did You Know?
There are other benefit programs for aging Veterans that offer greater flexibility and benefits.  Read about the VA Aid & Attendance Benefit and the VD-HBCS program.

 

Qualifications

Age
Veterans or their family must be 65 to be eligible for TRICARE for Life. There is an exception for younger individuals if they are enrolled in Medicare already as a result of a disability.

Disabilities / Health Requirements
A senior veteran’s disability status, service-connected or otherwise does not affect their eligibility for TRICARE for Life.

Family Status
Family or marital status does not play a role in TRICARE for Life eligibility with the exception of surviving spouses that have re-married who are no longer eligible. Divorce or death of the new spouse does not enable them to re-gain their eligibility.

Financial Requirements
Veterans and / or their surviving spouses with any level of financial resources and income are eligible for TRICARE for Life.

Veteran Status
Veterans cannot have been dishonorably discharged.

Other Requirements
Veterans or their spouses must be enrolled in Medicare Part A & B to be eligible for TRICARE for Life.

 

Benefits

Benefits payments are made directly to the medical providers. Veterans at no point receive cash or checks from TRICARE for Life.

 

Costs

There are no enrollment fees or monthly premiums for TFL. However, veterans and/or their spouses must purchase Medicare Part B and pay those monthly premiums to be eligible for TFL.

 

How to Apply

Veterans manage their TRICARE enrollment through the Defense Enrollment Eligibility Reporting System known as DEERS, which can be done on their website.  To enroll in TRICARE for Life, a veteran must confirm that their Medicare Part B status is current in DEERS. Their record will then show they are “eligible for TRICARE For Life.”