Page 23 - Medicare Benefit Policy Manual

3. Medicare-TRICARE/CHAMPVA Relationship

If a TRICARE/CHAMPVA beneficiary also has Medicare coverage, TRICARE/
CHAMPVA reduces its liability in all cases by the amount payable by Medicare, i.e.,
Medicare is the primary payer and TRICARE/CHAMPVA supplements Medicare by
paying the Medicare deductible and coinsurance amounts and portions of the bill not
covered by Medicare. Thus, dually entitled individuals may be reimbursed up to 100
percent of expenses for items and services covered by both programs.

TRICARE/CHAMPVA has established policies and procedures which provide for (a) the
identification of claimants who have coverage under both TRICARE/CHAMPVA and
Medicare and (b) the detection of duplicate payments under both programs. If
TRICARE/CHAMPVA inadvertently pays amounts which duplicate Medicare payments
for the same items or services, TRICARE/CHAMPVA will take steps to recover the
incorrect TRICARE/CHAMPVA payments.

50.5 - Active Duty Members of Uniformed Services
(Rev. 1, 10-01-03)
A3-3153.3.E, HO-260.3.G

In limited circumstances, active duty members of the Uniformed Services may have care
in civilian facilities paid for by the Army, Navy, Air Force, Marine Corps, or other
appropriate uniformed service. Except for emergency services, prior approval is
generally required before such payment can be made. Services furnished pursuant to
such approval and services paid for or expected to be paid for by the Uniformed Services
are not reimbursable under Medicare.

60 - Services Not Provided Within United States
(Rev. 102; Issued: 02-13-09; Effective/Implementation Date: 03-13-09)

Items and services furnished outside the United States are excluded from coverage except
for the following services, and certain services rendered on board a ship:

• Emergency inpatient hospital services where the emergency occurred:

o While the beneficiary was physically present in the United States; or

o In Canada while the beneficiary was traveling without reasonable delay and
by the most direct route between Alaska and another State. See Pub. 100-04,
Medicare Claims Processing Manual Chapter 3, Inpatient Hospital Billing,
Section 110 for a description of claims processing procedures.

• Emergency or nonemergency inpatient hospital services furnished by a hospital
located outside the United States, if the hospital was closer to, or substantially
more accessible from, the beneficiary’s United States residence than the nearest
participating United States hospital which was adequately equipped to deal with