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Medicare-Eligible TRICARE Beneficiaries under Age 65 Also Covered under TRICARE For Life
As part of the next generation of contracts, TRICARE Management Activity selected a single contractor to handle claims processing, customer service and administrative services for dual-eligible beneficiaries in the U.S., Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa and the Northern Mariana Islands.
Dual-eligible beneficiaries—TRICARE beneficiaries who are entitled to Medicare Part A based on age, disability or end-stage renal disease, and who are enrolled in Medicare Part B (see exception in the next section) and are paying the Part B monthly premium— will have their claims processed by the new contractor, Wisconsin Physicians Service (WPS).
Who Is Dual-Eligible?
Medicare-eligible retirees and their Medicare-eligible family members must enroll in Medicare Part B to remain eligible for TRICARE.
Active duty family members entitled to Medicare do not have to enroll in Part B to remain eligible for TRICARE. To remain TRICARE-eligible upon the active duty sponsor’s retirement, Medicare-eligible family members will need to purchase Medicare Part B during the eight-month special enrollment period that begins the month the active duty sponsor retires.
When Does WPS TFL Begin?
The contractor, WPS of Madison, Wis., is implementing WPS TRICARE For Life (TFL), location by location, over an eight-month period through November 2004. Once fully implemented, WPS TFL becomes the centralized claims processor for about 1.7 million dual-eligible beneficiaries. Previously, regional contractors processed TFL claims.
If you are a dual-eligible beneficiary, you are covered by the TFL benefit and WPS TFL becomes your TFL claims processor once it is activated in your state (see WPS TFL Rollout Schedule). At that time, you will receive additional information in the mail.
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WPS TFL Rollout Schedule
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| Region 11: |
April 1, 2004 |
| Regions 2/5: |
June 1, 2004 |
Regions 9/10
Alaska and Hawaii: |
July 1, 2004 |
| Regions 3/4: |
Aug. 1, 2004 |
| Region 1: |
Sept. 1, 2004 |
| Region 7/8: |
Oct. 1, 2004 |
| Region 6: |
Nov. 1, 2004 |
What Does WPS TFL Mean to Me?
If you are a dual-eligible beneficiary without other health insurance (OHI), when WPS TFL starts in your state, you should no longer have to file your own claims with TRICARE. Your provider (any TRICARE-authorized Medicare provider) files a claim with Medicare and your claim automatically transfers from Medicare to WPS TFL for processing (TRICARE is second payer). If you have OHI, Medicare pays first, your OHI pays second, and you file a paper claim with WPS TFL (P.O. Box 7890, Madison, WI 53707-7890) which pays last.
All dual-eligible beneficiaries, regardless of age, experience nationwide claims processing and improved customer service thanks to this new contract.
WPS TFL processes your claims no matter where you receive services in the U.S. As long as your doctor submits claims on your behalf to Medicare and you do not have OHI, you will not need to submit a paper claim to WPS TFL.
Beneficiaries may contact WPS TFL customer service staff toll-free at 1-866-773-0404 (TTY/TDD 1-866-773-0405) between 7 a.m. and 10 p.m. Central Standard Time, Monday–Friday. Confidential access to TFL claims, eligibility and out-of-pocket expenses can be accessed online, as well, at www.tricare4u.com.
Late Enrollment Surcharge Waiver for Medicare Part B
The “Medicare Prescription Drug Improvement and Modernization Act of 2003” relates to your TFL coverage by providing a special enrollment period so that you can enroll in Medicare Part B without a late enrollment premium surcharge. It also waives the late enrollment premium surcharge if you purchased Medicare Part B in 2001, 2002, 2003 or 2004.
Visit www.tricare.mil or www.medicare.gov for more information. |
