Ask the Doc

Q. I have Medicare and TRICARE. Can I see a doctor/supplier who doesn’t provide services through Medicare?

A. Yes, but your out-of-pocket expenses are higher. If you sign a private contract with your doctor/supplier:
• Medicare won’t pay any amount for the services you get from this doctor/supplier, even if it’s a Medicare-covered service;
• TRICARE processes the claim and only pays the amount it would have paid if Medicare processed the claim (normally 20% of the TRICARE-allowable charge); and
• You’re responsible for the remainder of the TRICARE-allowable charge.
For example, Mr. Jones sees a doctor for a Medicare and TRICARE covered service. The charge for the service is $1,000. Assume Mr. Jones already paid his Medicare Part B and TRICARE deductibles for the year.

Note: In areas where access to medical care is limited (i.e., underserved areas), TRICARE may waive the second-payer status and pay the claim as the primary payer.


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