TRICARE is the United States Military health care program for military members and their families, providing worldwide, comprehensive healthcare coverage including health plans that meet the minimum requirements of the Affordable Care Act, plus prescriptions, dental plans, and special plans tailored for certain types of medical conditions or coverage requirements. The TRICARE system is managed by the Defense Health Agency.
TRICARE requires certain co-pays and there may be health expenses not covered by a particular plan; that is where TRICARE supplemental insurance can help. But supplemental insurance should not be confused with TRICARE itself. The supplemental plan a servicemember and family might choose will not be affiliated with TRICARE but with another agency.
What Kinds Of Out-Of-Pocket Costs Might Require TRICARE Supplemental Insurance?
A service member’s individual out-of-pocket expenses under TRICARE will vary depending on the medical condition and the type of TRICARE plan the service member chooses. There are a variety of coverage options that have varying degrees of out-of-pocket costs.
TRICARE Coverage Options
- TRICARE Prime (including Prime, Prime Remote, Prime Overseas, and Prime Remote Overseas
- TRICARE Select
- TRICARE Select Overseas
- TRICARE For Life
- TRICARE Reserve Select
- TRICARE Retired Reserve
- TRICARE Young Adult
- US Family Health Plan
Active duty military members who choose one of the TRICARE PRIME options have no out-of-pocket expenses, no enrollment fees, no network co-pays, and no point-of-service fees. Once the active duty military member starts adding family members, the potential for co-pays and out-of-pocket expenses begins.
Retirees, family members of military retirees, and other beneficiaries are subject to enrollment fees, co-pays, and point-of-service fees.
The non-Prime TRICARE options include more deductibles, co-pays, and other potential cost-sharing expenses. Active duty members typically pay less than other groups eligible for coverage for co-pays, deductibles, etc.
For those enrolled in certain programs such as TRICARE For Life, no enrollment fees apply but the veteran must be covered by Medicare Part A and Medicare Part B.
Not all plans feature the same requirements, co-pays, or deductibles, but it’s clear that once you move down from TRICARE Prime, additional expenses will apply that may make it worthwhile to explore TRICARE supplemental insurance options.
TRICARE Policy Changes May Affect Your Coverages
Some who started out not interested in TRICARE supplemental insurance may, due to policy changes and other factors, wind up needed supplemental coverage. A good example of this was the 2013 TRICARE policy changes that resulted in certain military retirees losing access to TRICARE Prime and needing to switch to TRICARE Standard.
That policy change affected military retirees, their dependents, surviving dependents, and TRICARE Young Adult members who live outside a reasonable commuting distance to the nearest military medical facility or base closure site.
The switch to TRICARE Standard in those cases resulted in changes to co-pays and other expenses, and likely sent some former TRICARE Prime enrollees affected by that change in search of supplemental insurance.
TRICARE reserves the right to change its’ policies in the future, so knowing your options for additional covered if and when needed is definitely a good idea if future medical expenses are anticipated for chronic conditions, recurring issues, etc.
How Does TRICARE Supplemental Insurance Work?
The first thing to know about TRICARE supplemental insurance is that it is not associated with TRICARE at all, but rather provided by a third party. The U.S. government weighs in on supplemental insurance on the TRICARE official site, stating:
“Many military associations and private companies offer supplemental insurance policies. Unlike other health insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance, which pays first, supplemental insurance pays after TRICARE pays its’ portion of the bill.”
The TRICARE official site warns its’ insured clients to consider supplemental insurance carefully since the cost of the additional plan may exceed the actual out-of-pocket expenses the plan is designed to offset (depending on circumstances).
Does TRICARE Supplemental Insurance Count As “Other Insurance” Under TRICARE Policies?
The TRICARE official site describes a situation where the military member may carry “other insurance” and have TRICARE pay claims following those providers’ payments. TRICARE is required by law to pay after all other health insurance, except for the following plans:
- TRICARE supplements
- State Victims of Crime Compensation Programs
- Other Federal Government Programs identified by the Director, Defense Health Agency (i.e. Indian Health Service)
Any “other health insurance” claims will be processed first, then TRICARE. Notice that TRICARE supplements are not considered “other insurance” for these purposes.
Other insurance options are not permitted for active duty military members, but for all others, these rules may apply. Fortunately, “other insurance” does not include TRICARE supplemental insurance.
Those who do choose to carry other health insurance are urged to complete a form to notify TRICARE it will be the second payer on any health insurance claim.
TRICARE Supplemental Insurance: Not All Plans Are Created Equal
Because TRICARE supplemental insurance is provided by third parties and not subject to regulation under the TRICARE program itself, borrowers need to use caution when approaching supplemental insurance providers.
There are ways you can protect yourself when searching for supplemental insurance. Knowing specific details of the supplemental insurance plan can go a long way toward knowing if a specific program is right for you.
Ask the TRICARE supplemental insurance provider if the plan will cover medical expenses above and beyond what TRICARE permits, and whether certain medical conditions are excluded from coverage. Is there a set timeline or time limit for filing claims? Is the policy effective overseas?
You should also ask how much supplemental premiums cost, how often they must be paid, what the penalties are for late or delayed payments, etc.
You will also need to ask about policies which may be much different under TRICARE than they are with a private insurer-for example, is age a factor in determining the payments for your supplemental coverage?
Are pre-existing conditions a problem? What are the limits of coverage over the lifetime of the policy?
Under the supplemental policy, are you penalized or do you have your coverage altered if your military status changes? Some will need to know whether the policy will eventually convert to a Medicare supplement policy and how long it takes for that to happen. Smokers should definitely ask up front about how smoking may affect rates, coverages, etc.
Does Everyone Need Tricare Supplemental Insurance Coverage?
The short answer is no. Active duty members are fully covered under TRICARE Prime options, and those with special circumstances may not necessarily need to resort to additional coverage thanks to a set of special TRICARE programs such as the Extended Care Health Option (ECHO).
The Extended Healthcare Option is open to TRICARE beneficiaries diagnosed “with moderate or severe intellectual disability, a serious physical disability, or an extraordinary physical or psychological condition” according to the TRICARE official site. Those beneficiaries include:
- Active duty family members;
- Family members of activated or ordered to active duty service for more than 30 days in a row including the Army National Guard, Army Reserve, Navy Reserve, Marine Corps Reserve, Air National Guard, Air Force Reserve, U.S. Coast Guard Reserve;
- Family members who are covered under the Transitional Assistance Management Program
Children or spouses of former service members who are victims of abuse and qualify for the
- Transitional Compensation Program
- Family members of deceased active duty sponsors (while still considered “transitional survivors.”)
What ECHO Does And How To Qualify
ECHO is designed to provide financial help to the above qualifying beneficiaries to provide “an integrated set of services and supplies”. To qualify for ECHO, TRICARE beneficiaries must be enrolled in the service member’s branch of service Exceptional Family Member Program and register for ECHO in the applicable TRICARE service region.
There may be a waiver for the Exceptional Family Member Requirement in cases “when the sponsor’s branch of service does not provide the EFMP” and in situations where the person receiving ECHO financial assistance stays with a parent who is not the active duty military member. Such exceptions may be handled on a case-by-case basis.
In any case, ECHO financial assistance is dependent on the beneficiary being registered in DEERS.
Other TRICARE Special Programs
There are too many TRICARE Special Programs to discuss comprehensively here, but you can ask a TRICARE representative about the following special programs as an alternative to TRICARE Supplemental Insurance or as a program enhancement to your existing TRICARE coverage:
- Autism Care
- Cancer Clinical Trials
- Chiropractic Health Care Program
- Combat-Related Special Compensation Travel Benefit
- Computer/Electronic Accommodations Program
- Continued Health Care Benefit Program
- Provisional Coverage Program
- Transitional Assistance Management Program
- TRICARE Plus
These programs all have individual requirements, restrictions, and provisions. Many are situation-specific and don’t provide assistance or coverage for other conditions or issues that fall outside the bounds of that program.
Others are designed to help transitioning service members retain health care coverage while leaving military service. Contact a TRICARE representative to learn what options may be open to you depending on circumstances, eligibility, and other factors.
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