2-14-2009 TRICARE for Life Overseas Program (TOP TFL)
TRICARE for Life is available for dual-eligible beneficiaries residing overseas. By statute to be eligible for TFL, Medicare-entitled beneficiaries must be enrolled in Medicare Part B. There are no enrollment fees for TFL; however, eligible Medicare-TRICARE beneficiaries must pay Medicare Part B monthly premiums. The Part B requirement applies whether you live in the United States or abroad. Beneficiaries must retain enrollment in Medicare Part B in order to qualify for TRICARE benefits. For more information about enrolling in Medicare Part B, please visit the Social Security Administration online at www.ssa.gov/foreign.
Because Medicare typically does not provide benefits for medical care received overseas, TRICARE is the primary source of health benefits. Beneficiaries may seek care from any host nation provider without a referral or prior authorization. TOP TFL provides the same coverage as Standard with the same cost shares and deductibles. The deductible is based on a fiscal year (October 1 through September 30). For more information on costs, visit http://www.tricare.mil/tfl/tflcostmatrix.html.
When seeking reimbursement for care provided by a qualified host nation provider, a claim must be submitted by using DD Form 2642 along with medical receipts and itemized bills to the TRICARE overseas claims processor. After the deductible has been satisfied, a reimbursement minus a 25% out patient cost share [up to the $3,000 annual maximum patient cost share] or appropriate inpatient cost share will be issued. Submit TFL overseas claims to:
Beneficiaries should confirm that their Medicare status is current in the Defense Eligibility Enrollment Reporting System (DEERS) by calling the DEERS Support Office at 1-800-538-9552. Beneficiaries may also visit the TRICARE DEERS web site at http://www.tricare.mil/deers/update-info.cfm to learn how to update personal information.
Contact: Sheri Pueblo
TRICARE Pacific Marketing Representative
TRICARE Program Office
DSN 736-9130; Comm 02-7916-9130 or 0505-736-9130
3-18-2007 Memorandum of Understanding (MOU) with Certain Hospitals in Korea Regarding the Use of TRICARE Standard for Retirees and their family members in Korea
The following information was provided by the Area IV (Daegu) Retiree Council and is provided for the information of all retirees.
RSO Note: At the Area IV (Daegu) Retiree Council meeting on Mar 10, 2007, several retirees recommended that TRICARE claims should be filed directly to Wisconsin Physican Services (WPS) since the reimbursement will arrive in weeks rather than the months of waiting that are the norm when filing through the TRICARE offices here.
5-16-2005 TRICARE Brochures
The following three brochures have been provided by the 121st Combat Support Hospital to give you more information on TRICARE as it applies to military retirees in the Pacific. Each brochure file consists of two pages and is designed to be printed back-to-back and then folded into thirds.
TRICARE Prime: This option is available only to active duty military and their dependents. It is not available to retirees living in Korea. However, for retirees with health care problems who travel to the U.S. frequently, TRICARE Prime coverage would ensure treatment at a military facility or TRICARE healthcare provider. This coverage costs $230 per year for an individual and $460 per year for a family.
TRICARE Extra: This option is not available in Korea.
TRICARE Standard: This is the only option available to retirees and their dependents under the age of 65. There is no signup required and it is free. With this option, a retiree or retiree dependent referred to a civilian hospital must pay the entire cost of care and then file with the local TRICARE office to be reimbursed. TRICARE Standard has an annual deductible of $150 for an individual and $300 for a family. After that, 75% of allowable expenses are reimbursed to the retiree up to the annual cap of $3,000. Once the retiree costs have reached $3,000 in a year, TRICARE reimburses 100% of allowable expenses for the remainder of that year (Oct 1- Sep 30). Whenever possible, retirees should check with the local TRICARE office in advance to verify that the treatment to be received is an allowed expense, and to get an estimate of what the retiree will be expected to pay. At Korean hospitals, where insurance information is not provided, payment must be made before treatment will be provided (for outpatient), or before the patient will be released (for inpatient). (Some longtime Korea retirees may remember when TRICARE guaranteed reimbursement so the retiree did not have to pay the hospital, but that is no longer the case.)
TRICARE for Life: This option continues the TRICARE Standard coverage once a retiree or dependent of a retiree reaches age 65. It can only be obtained by enrolling in Medicare Part B. If you do not sign up for Medicare Part B when you reach age 65, you will not be reimbursed by TRICARE for any medical care received at a Korean hospital. To sign up for Medicare Part B, go to Applying for ... (at the left side of the screen) for the signup form and mailing address. A benefit of having Medicare Part B and TRICARE for Life is that the combined coverage will pay almost entirely for medical care received in the U.S. However, Medicare does not reimburse the costs of treatment received in Korea that are not covered by TRICARE for Life.
Retirees who fail to sign up for Medicare Part B within 3 months before and 3 months after their 65th birthday will have to wait until the next signup period Jan 1-Mar 31, with coverage starting on July 1. A 10% penalty is added to the premium cost for each year past the 65th birthday that Medicare Part B was not taken.
Retirees who reach age 65 starting in 2003 are affected by the delay in reaching full retirement age, the age when you are eligible to receive 100% of your social security retirement benefits. There is a briefing on Social Security that discusses this in detail that can be viewed by going to the U.S. Military Retirees Association sub-page from the home page and selecting "Briefings." Even with the delay in full retirement age, you must still sign up for Medicare Part B when you reach age 65. If you elect not to receive Social Security retirement benefits until you reach your full retirement age, then you must arrange a means to pay Social Security for the Medicare Part B coverage.
Korean citizen spouses and widows are eligible for Medicare Part B and each person must enroll individually. Spouses age 65 and over are not covered under the retiree's Medicare or TRICARE. Spouses who become eligible for Medicare Part B must sign up themselves in order to receive TRICARE for Life coverage.
TRICARE Plus: See the Health Matters page under the heading Military Medical Care in Korea for information on how TRICARE Plus is implemented for retirees in Korea.
Korean Medical Insurance
Korean insurance became available to foreigners in July 1999. Premiums are income-based, so higher income means higher premiums (one Korean millionaire pays over $7,000 per month). Retirees report average costs of about $40 per month. This insurance will cover up to 60% of medical costs and, in combination with TRICARE, will cover virtually all costs of treatment received in a Korean hospital. The downside is that if you have been a Korean resident for a long time, you will have to pay premiums back to when you became a resident, or July 1999 when the program became available if you have been here since that time or longer.
The insurance is available to those holding a permanent visa for residence or work (does not include A-3 SOFA and C-3 Tourist visa holders). For those who have held resident status prior to applying for the insurance, premiums must be paid back to when the insurance was first offered to foreigners, or to when the applicant first became eligible after the insurance became available. If you are eligible and want to calculate how much it would cost you to buy in, the monthly premium rates in Korean won (₩) are as follows: (calculate from the first month of eligibility to three months from the application date)
Jack's Experience: I obtained a Resident visa in July 2000 and applied for the insurance in March 2004. The total enrollment cost was ₩1,258,000, a bit over $1,000. Before obtaining this coverage, we had a hospital bill of more than $15,000 and our share hit the TRICARE catastrophic cap of $3,000, the maximum share you have to pay out of pocket in one year. If we had the Korean insurance before the hospitalization, our costs (over the initial enrollment cost) would have been half the catastrophic cap. The Korean medical insurance would have been first payer up to 60%, and TRICARE would have covered 75% of the rest. (The retiree newsletter Still Serving in Korea number 03-1, Jan-Mar 2003, discusses this in detail starting on page 2.)
12-17-08 Automatic Payments for Korean Health Insurance
Starting in October 2008, those enrolled in the Korea National Health Insurance are able to arrange automatic payment of the monthly premiums from a Korean bank. The information and instructions are contained in this bilingual information sheet. As a reminder the Korean insurance costs about ₩62,000 per month and includes long-term care that provides for caregiver visits to the home to relieve family caregivers for a few hours. This is in addition to covering up to 60% of medical care costs and medications.