What insurance do medically separated permanent disability soldiers get?

soldieradvocate

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I am trying to help soldier who is rated 70% military disabled and 100% VA permanent disability. He is still active duty but will separate in Sept. When he is out, what medical will he quality for? I assume he will have a transition appointment with VA about their benefits but will he also qualify for Tricare for Life? Will he have to apply for it and will there be a cost? He has been working with VA liason for transition and healthcare at his current post but due to his disability, it is difficult for him to keep track of what he is supposed to do upon separation. We will start with VA and DEERS appointments but not sure about how to apply forTricare. Timing is critical because he has been on monthly IV treatments and must continue with them in September. His SSDI claim is pending.
 

chaplaincharlie

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If he is 70% military disabled, he will be retired. Retired members are entitled to TriCare Prime. There is a small premium for Prime. He can set up the premium as a draft. TFL does not kick in until you are Medicare eligible.

He will also be eligible for VA healthcare including medications on the VA formulary. The VA will mail his prescriptions.

DoD also has a mail order pharmacy. Some medications may be free others will have a small copay.

I suggest he talks to the TriCare people as soon as he gets his retirement orders.

Each service has a wounded warriors program that includes members who are injure or ill, qualifications varies by service. I suggest he put the number in his phone 877-393-9058.

Is any part of his Army disability due to combat? If so he should apply for CRSC (Combat Related Special Compensation)
 

RonG

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Excellent summary by Chaplaincharlie.

Ron
 

oddpedestrian

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Hes got four months to opt into VGLI from SGLI after that he probably will not qualify for life insurance again unless its really low like 10k. VGLI waives the proof of good health during that short time frame.
 

Pagemaster500

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If he is 70% military disabled, he will be retired. Retired members are entitled to TriCare Prime. There is a small premium for Prime. He can set up the premium as a draft. TFL does not kick in until you are Medicare eligible.

He will also be eligible for VA healthcare including medications on the VA formulary. The VA will mail his prescriptions.

DoD also has a mail order pharmacy. Some medications may be free others will have a small copay.

I suggest he talks to the TriCare people as soon as he gets his retirement orders.

Each service has a wounded warriors program that includes members who are injure or ill, qualifications varies by service. I suggest he put the number in his phone 877-393-9058.

Is any part of his Army disability due to combat? If so he should apply for CRSC (Combat Related Special Compensation)

To add to this, while he will be able to get TRICARE prime/select upon medical retirement, because he is/will be on SSDI, he will need to track his 2 year point of receiving SSDI benefits. After 24 months he will become eligible for Medicare and MUST enroll in Part B at that time (which also enrolls him in Tricare For Life) or he will lose Tricare coverage.
 

chaplaincharlie

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To add to this, while he will be able to get TRICARE prime/select upon medical retirement, because he is/will be on SSDI, he will need to track his 2 year point of receiving SSDI benefits. After 24 months he will become eligible for Medicare and MUST enroll in Part B at that time (which also enrolls him in Tricare For Life) or he will lose Tricare coverage.
Great add. BTW Medicare will send your friend all the information about Medicare when that time comes.
 

soldieradvocate

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Thank you for this info. When does his active duty tricare officially end? His ETS date is July 27 and his retirement date is Sept 10th. Does Tricare abruptly end on ETS date or is there a grace period? When does he apply for Tricare Prime? Does he have to wait until after ETS date? He has some serious medical procedures that he has to have monthly.
 

RonG

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Thank you for this info. When does his active duty tricare officially end? His ETS date is July 27 and his retirement date is Sept 10th. Does Tricare abruptly end on ETS date or is there a grace period? When does he apply for Tricare Prime? Does he have to wait until after ETS date? He has some serious medical procedures that he has to have monthly.
Hello,

ETS generally stands for “expiration – term of service” and is contained in each service member’s contract. On the ETS date, a service member’s current contract has expired and the service member is free to leave the military or sign a re-enlistment contract.

Has his contract been extended?

Retirements normally occur the day following the member's separation date. A retirement date two months post-separation is unlikely.

Ron
 

soldieradvocate

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Hello,

ETS generally stands for “expiration – term of service” and is contained in each service member’s contract. On the ETS date, a service member’s current contract has expired and the service member is free to leave the military or sign a re-enlistment contract.

Has his contract been extended?

Retirements normally occur the day following the member's separation date. A retirement date two months post-separation is unlikely.

Ron
Sorry, I meant his ETS date is August 27th and medical retirement date is Sept 10th. So does this mean his Tricare coverage ends on August 27th?
 

RonG

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Sorry, I meant his ETS date is August 27th and medical retirement date is Sept 10th. So does this mean his Tricare coverage ends on August 27th?
The same info I provided earlier applies.

Unless his ETS is extended, it is unlikely he will retire 10 September.

There are some features of this case missing. Let me put it stark terms: The military will not discharge a service member on 27 August and retire him on 10 September.

Either the info you have been given has been misunderstood or his ETS has been extended . Perhaps you are confusing terminal leave
with ETS...

Regards,
Ron
cc: @chaplaincharlie @tony292 @oddpedestrian
 

soldieradvocate

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The same info I provided earlier applies.

Unless his ETS is extended, it is unlikely he will retire 10 September.

There are some features of this case missing. Let me put it stark terms: The military will not discharge a service member on 27 August and retire him on 10 September.

Either the info you have been given has been misunderstood or his ETS has been extended . Perhaps you are confusing terminal leave
with ETS...

Regards,
Ron
cc: @chaplaincharlie @tony292 @oddpedestrian
Since I have been getting this info second hand, it was inaccurate. Yes, he has terminal leave until Aug 27 and retires/separates on Sept 10th. (Does that mean Sept 10 is his ETS date?) If so, does Tricare end on Sept 11th or is there a grace period? Thanks for hanging in there with me.
 

RonG

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Normally terminal leave is taken and the retiree never returns to duty station. That is how it worked for me 30 years ago, but that was for a regular retirement, not medical.

Based on the changing info, it sounds like he is on active duty until 10 September. If he separates on that date, his retirement date would be 11 September (first day in retired status).

Another way to describe this (using your info) is that he will be on active duty thru 10 September; be separated on the 10th; and
enter into a retired status on 11 September. What happens between today and 10 September will be based on his processing requirements and possibly terminal leave.

Finally, he should know his own ETS. His PEBLEO should be helpful in this matter.

Regards,
Ron
 

chaplaincharlie

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Thank you for this info. When does his active duty tricare officially end? His ETS date is July 27 and his retirement date is Sept 10th. Does Tricare abruptly end on ETS date or is there a grace period? When does he apply for Tricare Prime? Does he have to wait until after ETS date? He has some serious medical procedures that he has to have monthly.
He should contact TriCare before his last day on AD. He can pay his premium and never have a lapse in coverage. There is a grace period, ask TriCare for details. The important thing is to act sooner rather than later.
 

tony292

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Warning about the VA and their “formulary”, it’s basically an ancient list of drugs you can be prescribed from the VA. If the drug you need isn’t on the list, you ain’t getting it.... period. VA likes to use older meds and generics to save money. They save money at your expense. Free isn’t always better. Tricare has express scripts and copays are very very low or non existent.

I’ve walked away from VA for the following conditions because they couldn’t/wouldn’t prescribe effective meds:

1. insomnia Severe enough of I don’t get meds I sleep zero to two hours per night. VA didn’t care. I got sick of not sleeping properly and for some bizarre reason they “couldn’t” prescribe me more than 20 lunesta 2mg tabs per 30 day month... so I just wasn’t sleeping a third of the time... the prescriber literally told me he could not prescribe 30 days of lunesta for a 30 day month.... bizzare stuff. Tricare is able to. Prescribe 3mg per night for all 30 days... go figure!
2. Depression: VA can’t prescribe anything new such as trintellix..It’s not in the formulary. tricare was able to prescribe trintellix with zero issues.
3. Anxiety
4. Borderline personality disorder or bipolar disorder depending on which psychiatrist you ask
5. Extremely high blood pressure as much as 179/121. VA simply told me if I lost ten pounds my BP would go down. 179/121 is enough to cause stroke. They didn’t care and refused to prescribe BP meds... period. Tricare prescribed the day I went and saw a civilian PCM... He was shocked at my BP numbers and VAs refusal to prescribe.
6. High cholesterol, again VA simply refused to prescribe. Tricare no problem...

Ive since switched over to tricare for all except neurology, which I’m in the process of switching. Everything listed above I now have meds for through tricare.

your results may vary. my situation is with the Boise VA. I gave them a fair chance... went there for 5 years. But if they are denying meds,
Or giving you crap 50 year old meds and refusing newer more expensive meds... you’ll know why.
 
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ljk1968

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I use both the VA and tricare for healthcare. I’m not sure how many of you have dealt with civilian health insurance, but these, even with the downsides, are far better. I used to pay $300 a month for a “good” family plan through my employer (this was 20 years ago) I still had to have referrals (in network), pay a $500 deductible per person per year. They only paid 80% of “approved” charges. If the provider did not write off the difference you owed that too. There was a co pay for prescriptions and they only paid for generic. I’m thankful everyday for tricare and the VA.
 

soldieradvocate

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Tricare sounds like the answer. Will I get it automatically if 100% medically retired or do I need to sign up? If I do need to sign up, do I wait until separation? Not sure when current Tricare officially ends. Separation date is Sept 10 but on Milconnect, it says Tricare ends in November. Also, do I need to go into DEERS now or do I wait until Separation date for new military card and update?
 

soldieradvocate

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Tricare sounds like the answer. Will I get it automatically if 100% medically retired or do I need to sign up? If I do need to sign up, do I wait until separation? Not sure when current Tricare officially ends. Separation date is Sept 10 but on Milconnect, it says Tricare ends in November. Also, do I need to go into DEERS now or do I wait until Separation date for new military card and update?
He should contact TriCare before his last day on AD. He can pay his premium and never have a lapse in coverage. There is a grace period, ask TriCare for details. The important thing is to act sooner rather than later.
Thanks, just saw this.
 
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