From the Tricare Advisor: Taking a closer look at Tricare retiree benefits
Col. Alexander Alex, Air Force Reserve Command health benefits manager.
Posted 9/27/2012 Updated 9/27/2012
by Lt. Col. Alexander Alex
Headquarters Air Force Reserve Command
9/27/2012 - Citizen Airman/Oct. 2012 -- As my retirement from the Air Force Reserve approached, I began thinking about all of the things I needed to take care of before I left the service. Of course, health care is a big issue, and I will continue to have coverage under Tricare. However, the cost of this benefit will change due to my change in status, as it does for every military member who retires. In this, my final, article, I thought it fitting to summarize Tricare retiree benefits.
Health Benefit Eligibility Rule
If you are retiring from an active Guard and Reserve or active-duty position with a minimum 20 years of service (based on total accumulated points), you are eligible for full health benefits upon retirement, regardless of age.
Those who earn a reserve retirement do not become eligible for Tricare until they reach age 60. Even if you are eligible to receive retired pay before reaching age 60, based upon participation, your eligibility for Tricare does not change. It remains at age 60.
The Tricare Retiree Dental Benefit is available to all retiring active-duty and Reserve members upon the first day of retirement. Therefore, it is not contingent upon age.
Programs and Services
Following is a list of programs and services military members and their families can access upon retirement:
* Tricare Prime
* Tricare Standard and Extra
* Tricare Plus
* Tricare Retired Reserve
* Tricare Young Adult
* Tricare for Life
* Tricare Pharmacy
* Tricare Delta Dental
* Tricare Overseas Program Standard
* Outpatient visits
* Clinical preventive services
* Hospitalization/emergency services
* Ambulatory surgery
* Inpatient/outpatient behavioral health
* Inpatient skilled nursing
To obtain Tricare Prime coverage when you retire, you must enroll as a retiree and enroll eligible family members as retiree dependents and pay the appropriate single or family enrollment fee. If your retirement date is on the first of the month, you must submit your enrollment application to your regional contractor before that date. If you retire on another day of the month, you must submit your enrollment application within 30 days after that date. However, don't panic. From day one of your retirement, you and your eligible family members are covered by Tricare Standard and Tricare Extra (if your status is accurately reflected in the Defense Eligibility Enrollment Reporting System) until your Tricare Prime coverage resumes.
Please note that Tricare Prime is not available everywhere. Contact the regional contractor for your location. And if you are moving, contact the Tricare regional provider for that area and ask about Tricare Prime availability.
Tricare Prime Remote coverage options are not available after retirement. If you are enrolled in either of these options, you will be covered by Tricare Standard and Tricare Extra after retirement. Tricare Overseas Program Prime is not available to retirees.
However, if you plan to live overseas, Tricare Overseas Standard will be your choice of coverage.
If enrolled in Tricare Prime, your primary care manager will handle routine care and provide specialty care referrals. You may select a PCM at a military treatment facility when space permits (active-duty service members and their families have priority). If there is no space for retirees and retiree dependents to enroll in Tricare Prime at an MTF, you may need to change to a Tricare civilian network PCM. Enrollees in the Tricare Prime civilian network who live within an MTF prime service area may be referred to an MTF for specialty care based on the MTF's "right of first refusal" to deliver Tricare Prime specialty care within the prime service area.
If you were on active duty and used the Prime benefit, you and your family did not experience any additional fees. However, Retiree Prime benefits are different relative to cost. There is an annual Tricare Prime enrollment fee, and copayments will apply for civilian Tricare network provider care. Point-of-service fees will apply if you receive care from a network or non-network Tricare-authorized provider without a referral from your PCM or prior authorization from your regional contractor.
Additionally, if you have other health insurance, it is considered your primary insurance and pays before Tricare. For details, visit www.tricare.mil/costs, as these premiums and co-pay amounts can change from year to year.
Tricare Prime enrollment is portable, meaning you can transfer your coverage to another region if you move, if Prime is available. Retirees traveling for extended periods of time should transfer their Tricare Prime enrollment when they will be out of the area for more than 60 days. Your regional contractor can help you make this transition. You should not disenroll from Tricare before you move or leave your area for 60 days or more until you consult with your regional contactor. Retirees and their dependents are limited to two enrollment transfers each enrollment year.
Tricare Standard and Tricare Extra
When not enrolled in Tricare Prime, you are automatically covered by Tricare Standard and Tricare Extra, if DEERS shows you as eligible. Enrollment and referrals are not required, but some services may require prior authorization. Military treatment facility care is on a space-available basis only. You may see any Tricare-authorized provider, but the provider's Tricare network status determines your out-of-pocket costs. With Tricare Extra, you use a Tricare network provider, which reduces your costs. Under Tricare Standard, you may see any non-network Tricare-authorized provider, but your costs will be higher. For more details on costs under Tricare Standard and Tricare Extra, visit www.tricare.mil/costs.
Tricare Plus is a program that allows beneficiaries who normally are only able to get military treatment facility care on a space-available basis to enroll and receive primary care appointments at the MTF within the same primary care access standards as beneficiaries enrolled in a Tricare Prime option. Beneficiaries should contact their local MTFs to determine if they may participate in Tricare Plus.
Enrollment in Tricare Plus at one MTF does not automatically extend Tricare Plus enrollment to another facility. The treatment facility is not responsible for any costs when a Tricare Plus enrollee is referred outside the MTF for additional civilian care.
Tricare Retired Reserve
Tricare Retired Reserve is a premium-based health plan that members of the Retired Reserve may qualify to purchase until reaching age 60. TRR provides comprehensive health care coverage and patient cost-shares and deductibles similar to Tricare Standard and Tricare Extra, but TRR beneficiaries must pay monthly premiums. TRR beneficiaries may access care from any Tricare-authorized provider, unless overseas restrictions apply. Retiree cost-shares and annual deductibles apply. For TRR details, visit www.tricare.mil/trr.
U.S. Family Health Plan
The U.S. Family Health Plan is a Tricare Prime option available through networks of community-based, not-for-profit health care systems in six areas of the United States. When you enroll in the USFHP, you receive care through the health care systems offering the program, and you may not use services within the military health system, including military treatment facility care, except in emergencies. Additionally, your prescription drug coverage is offered through your USFHP provider, not the Tricare Pharmacy Program. For USFHP details and service areas, visit www.usfhp.com.
Tricare Pharmacy Program
The Tricare Pharmacy Program is available to Tricare Prime, Tricare Standard, Tricare Extra, Tricare for Life and Tricare Retired Reserve beneficiaries. Prescriptions may be filled through a military treatment facility pharmacy, Tricare Pharmacy Home Delivery, a Tricare retail network pharmacy or a non-network pharmacy. For Tricare Pharmacy Program details and cost information, visit www.tricare.mil/pharmacy.
USFHP enrollees are not eligible for benefits through the Tricare Pharmacy Program and must use their USFHP provider for prescription drug coverage.
Tricare For Life
Tricare for Life serves as Medicare-wraparound coverage for Tricare beneficiaries who are entitled to Medicare Part A and have purchased Medicare Part B coverage. If you or a family member has only Medicare Part A, enroll in Medicare Part B before you retire to avoid a lapse in coverage. You must enroll within eight months of your retirement date to avoid a Medicare Part B surcharge. The surcharge is a 10 percent premium increase for each 12-month period that you could have enrolled but did not.
In the United States and its territories, Tricare pays last for services covered by both Tricare and Medicare. Medicare does not pay for services received overseas. For overseas care, Tricare pays first, and you pay the applicable Tricare Standard cost-shares and annual deductible. For Medicare details, visit www.medicare.gov; for Medicare enrollment information, visit www.ssa.gov; and for TFL details, visit www.tricare.mil/tfl.
Tricare Overseas Program Standard
If living overseas, you may be eligible to use TOP Standard and receive military treatment facility care on a space-available basis. TOP Standard is available to retired service members, their families and others living or traveling overseas, and is similar to Tricare Standard, including cost-shares and annual deductibles.
As you can see, there is a lot to sort through when it comes to health care after retirement. To make the best decision for you and your family, you will need to consider your individual situation and take a close look at each available option. Like retirement planning, you need to integrate health care and health care expenses into an overall plan. Don't discount the robustness of Tricare health services and how they figure into your retirement financial plans.