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● 61 to 90 days of hospital stay: All but $341 per day negotiated charges minus your share for institutional
each benefit period. TRICARE for Life pays the $341 and professional charges. You pay $250 per day or
per day not covered by Medicare Part A. You pay $0. 20% of total negotiated institutional charges, which-
● 91-150 days of hospital stay: All but $682 per day ever is less, plus 20% for separately billed negotiated
each benefit period. TRICARE for Life pays the $682 professional charges.
per day not covered by Medicare Part A. You pay $0. ● Non-Network Skilled Nursing Facility: TRICARE
● 151+ days of hospital stay: Medicare pays nothing. for Life pays an allowable amount minus your share
TRICARE Network hospital, TRICARE will pay for institutional and professional charges. You pay
negotiated charges minus your share for institutional 25% of Tricare allowable amount for institutional
and professional charges, if applicable. Network charges , plus 25% of TRICARE allowable amount
Hospital- You pay $250 per day or 25% of total for professional charges.
institutional negotiated charges, whichever is less,
plus 20% for separately billed negotiated professional Hospice Care
charges. Non-Network Hospital- TRICARE for Life Medicare covers 100% of care. TRICARE and you pay$0.
pays a Diagnosis Related Group (DRG) per diem
rate minus your share for institutional and profes- Medicare Part B:
sional charges. You pay $953 per day or 25% of billed As noted before Part B covers most ambulatory outpatient
charges for institutional charges, whichever is less, care and doctors/ provider visits. Medicare Part B almost
plus 25% of TRICARE allowable charges for sepa- always pays 80% of the allowable charges and TRICARE
rately billed professional services. for Life pays the remaining 20%. You typically pay $0.

Mental Health You will have to have a Medicare card with a Medicare
● Stays of 1 to 60 days, 61 to 90 days and 91 to 150 Beneficiary Identifier (MBI) and a newer DoD military
days have the same deductibles and payments as those retired ID card with a DoD Benefits Number on it to
under Medical and Surgical stays above. obtain services under under TRICARE for Life. If you
● Stays of 151+ days are not covered by Medicare. have an old military ID card with your Social Security
Network Hospital- TRICARE for Life will pay number on it you need to get a new ID card. The MBI
negotiated charges minus your share of institutional and the DoD Benefits are needed for billing, eligibility
and professional charges. You pay 20% of negoti- and claim status for Medicare and TRICARE.
ated institutional charges, plus 20% of separately
billed negotiated professional charges. Non-Network
Hospital- TRICARE for Life pays an amount minus I hope this is helpful
your share for institutional and professional charges. in some way in navigating the road to retirement health
You pay 25% of the TRICARE allowable amount for care coverage for our retired members. Although this is by
institutional charges, plus 25% of TRICARE allow- no means a complete rendering of everything available it
able amount for separately billed professional charges. does cover the key points.

Skilled Nursing Facility
Note: You must have a qualifying inpatient hospital stay of We in NERA continue to fight and push for continued
3 days in a row or more, starting with the day admitted, but quality and lower cost health care provided to our mem-
doesn't include the day of discharge. Skilled facilities must bers. A current example pertinent to this overview is our
be Medicare-certified and must participate with TRICARE. support and push for the TRICARE
● Stays of 1 to 20 days: Medicare pays 100% of allow-
able charges. TRICARE and you pay $0. Fairness For National Guard and Reserve Retirees Act ,
● Stays of 21-100 days: Medicare pays all but $170.50 S.829 and companion bill H.R.1997, which would allow
per day. TRICARE for Life pays the $107.50 not Guard and Reserve members under age 60 and draw-
covered by Medicare. You pay $0. ing retirement pay parity with other military retirees to
● Stays of 101+ days: No Medicare coverage. Network TRICARE plans other than the ultra high cost TRICARE
Skilled Nursing Facility- TRICARE for Life pays Retired Reserve plan.

The Naval Enlisted Reserve Association 15