Tricare for Life Skilled Nursing Agreement: What You Need to Know
Tricare for Life (TFL) is a comprehensive health care coverage program for retired military personnel and their dependents. The program provides coverage for medical services, prescription drugs, and long-term care, among others. One aspect of TFL that beneficiaries should be aware of is its agreement with skilled nursing facilities (SNFs).
What is a Skilled Nursing Facility?
A skilled nursing facility is an institution that provides 24-hour nursing care to patients who require regular medical attention. These facilities provide rehabilitation therapy, wound care, medication administration, and other skilled nursing services. SNFs often cater to elderly patients, people with disabilities, and those with chronic illnesses.
Tricare for Life and Skilled Nursing Facilities
Under TFL, beneficiaries are entitled to skilled nursing care services in SNFs. However, TFL has an agreement with SNFs that outlines the conditions under which beneficiaries can receive services. According to the SNF agreement, TFL will only cover the cost of care if the beneficiary meets certain criteria.
Firstly, the beneficiary must have a qualifying hospital stay of at least three days. Secondly, the beneficiary must require daily skilled nursing care services that cannot be provided at home or on an outpatient basis. Finally, the beneficiary`s doctor must certify that skilled nursing care is medically necessary.
TFL will cover the cost of skilled nursing care services up to 100 days per benefit period. If the beneficiary requires care beyond the 100-day limit, they will be responsible for the cost of care. Additionally, TFL will only pay for services provided by SNFs that have a contract with Tricare.
What You Need to Know
If you are a TFL beneficiary, it is important to understand the agreement between TFL and SNFs. Before seeking skilled nursing care services, ensure that you meet the criteria outlined in the SNF agreement. You should also confirm that the SNF has a contract with Tricare to ensure that TFL will cover the cost of care.
If you require skilled nursing care beyond the 100-day limit, you will be responsible for the cost of care. In such a scenario, you may want to consider other options, such as home health care or hospice care, which TFL also covers.
In conclusion, Tricare for Life provides comprehensive health care coverage for retired military personnel and their dependents, including skilled nursing care services. To access these services, beneficiaries must meet certain criteria outlined in the SNF agreement and ensure that the SNF has a contract with Tricare. Understanding the SNF agreement can help you make informed decisions about your health care needs.