How Does Tricare Work for Retirees
Military retirees remain eligible for TRICARE, the Department of Defenseās healthcare program, and must actively enroll in a plan upon retirement to maintain coverage. Tricare for retirees extends comprehensive healthcare coverage beyond active duty, ensuring they do not lose their healthcare benefits upon retirement.
TRICARE offers multiple plan options for retirees, including Prime, Select, and TRICARE for Life, based on age, location, and military service history. Tricare for Retirees offers several healthcare plans to help you live your retired life worry-free.
Many people are unaware of these plans, as they are quite complicated. However, we have explained everything briefly so anyone can get the right information and apply for a suitable plan. We have also listed the eligibility criteria and other details here.
Tricare Programs Available for Whom?
TRICARE plans are available to military retirees and their eligible dependents after active duty ends, but retirees must actively enroll to maintain coverage. To continue receiving healthcare benefits, Tricare offers several plans to choose from and continue with.
As noted, Tricare offers different healthcare plans for retirees and their families. Hereās the list of all the available plans.
Tricare Programs for Retirees
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Tricare Prime
TRICARE Prime is an HMO-style plan for retirees that requires enrollment, an annual fee, and use of a Primary Care Manager (PCM) with referral requirements. Retirees enrolled in Tricare Prime pay an annual enrollment fee and are assigned a primary care manager. Unlike the standard plans for active employees, retirees and their families have to enroll in this plan with an annual plan. They must also pay for Copays for their treatments with this healthcare plan.
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Tricare Select
TRICARE Select is a PPO-style plan allowing retirees to manage their own care and visit any TRICARE-authorized provider without referrals. It allows enrollees to see any authorized provider without a referral. Enrollees pay an annual deductible and cost-shares for care. The deductible and cost-share amounts vary depending on the retireeās group designation and service status.
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US Family Health Plan
The US Family Health Plan is a TRICARE Prime option in select regions, offering care through civilian provider networks in place of military treatment facilities. Like the Tricare Prime plan, it requires an annual enrollment fee from the individual enrolling in this program. For additional treatments, copays must be paid by the enrolled person.
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Tricare Retired Reserve
TRICARE Retired Reserve is a premium-based plan for retired Reserve and Guard members under age 60, offering similar coverage to TRICARE Select. This plan is exclusively designed for retired guard or reserve members and their families. Retired guard and reserve members can enroll in this program until they reach 60. The plan requires annual enrollment fees and additional treatment charges under copays.
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Tricare for Life
TRICARE for Life is secondary insurance for Medicare-eligible retirees enrolled in Medicare Part A and B, covering costs not paid by Medicare. It provides comprehensive healthcare coverage worldwide. While Tricare for Life does not require an enrollment fee, beneficiaries must pay Medicare Part B premiums. It is a Medicare Supplement plan that provides healthcare coverage in US territories and overseas. It is available in multiple locations across the globe for senior citizens above 65.
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Medicare
Medicare is a federal health insurance program primarily for people aged 65 and older, but it is also available to some younger individuals with disabilities and specific diseases. While not part of Tricare, Medicare plays a crucial role for Tricare for Life beneficiaries. People with certain conditions can avail of this program and its benefits under 65.
In addition, Tricare offers special plans for dental treatments and plans for pharmacy needs to retirees. Letās check out the additional plans Tricare offers retirees.
Tricare Dental Plan for Retirees
Retirees and their dependent family members can purchase this plan. TRICARE no longer directly provides retiree dental. Retirees can purchase dental coverage through FEDVIP, which offers 12 carriers via OPM.
The OPMāOffice of Personnel Management by the US Governmentāsponsors the FEDVIP program. This program offers eligible individuals 12 dental insurance companies to choose from and treat their oral health issues.
The Retiree Dental program is accepted worldwide. If we talk about the plans that this program offers,
- FEP Blue Dental
- Humana
- Aetna Dental
- Delta Dental
- Dominion National- Regional
- Blue Cross Blue Shield FEP Dental
- GEHA Connection Dental Federal
- UnitedHealthcare Dental
- United Concordia Dental
- Triple-S Salud- Regional
- MetLife Federal Dental Plan
- EmblemHealth Dental- Regional
All of these carriers are available worldwide. The plans with regional taglines are not globally accepted. All of these plans provide varying coverage from low to high. Depending on basic requirements, individuals can choose their preferred plan and get high coverage by paying high premiums.
Can you change your FEDVIP Coverage?
FEDVIP coverage can be changed during Open Season or after a Qualifying Life Event such as marriage, birth, or relocation.
What are the qualifying life events that can change the FEDVIP coverage?
An individual can update, change, or begin their coverage plan under these situations:
- Marriage
- Moving to a different place
- Loss of other dental coverage
- Gaining a new member to the family
- Other applicable reasons
Children under 22 receive the benefits of this coverage until they reach 22. Family members enrolled in this program will continue receiving these benefits upon your death.
Pharmacy Benefits
Tricare also offers retirees a couple of Pharmacy Benefits programs. Letās learn more about one of them.
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Tricare Pharmacy Program
TRICARE Pharmacy Program offers prescription drug coverage through military, home delivery, retail, and non-network pharmacies for enrolled retirees. Enrolled individuals can get prescribed drugs from military treatment facilities. For that, they have to choose the Tricare Pharmacy Home Delivery option.
Besides military treatment facilities, enrolled individuals can get their prescribed drugs from Tricare Retail Pharmacies and other non-network pharmacies.
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Tricare Maintenance Medications Program
TRICAREās Maintenance Medication Program requires certain long-term prescriptions to be filled via home delivery or military pharmacy after the first fill.
Tricare Vision Benefits
TRICARE Vision Benefits for retirees are limited under TRICARE Prime. For broader vision coverage, retirees can enroll in a FEDVIP vision plan.
Some programs offer free examinations and treatments for retirees. To receive additional benefits, you must choose the right plan. Retirees can enroll in this program under FEDVIP.
Tricare for Retirees Programs includes almost all treatments and services to eligible individuals. However, several services are not included in the Tricare programs. Letās see which services are not included in the Tricare Program.
- Excluded services under TRICARE include chiropractic care, routine vision exams (under Select), hearing aids, and Extended Care Health Option (ECHO)
- Chiropractic Care and Treatment
- Eye Examinations (not included in the existing Tricare Plan)
- Hearing Aids
Tricare extended healthcare program (needs additional fees for the enrollment)
All these services are excluded from the standard Tricare Plans for retirees. Retirees can avail of all these services by paying extra premiums as these services are not included in the existing plans.
Tricare for Retirees Cost and Fees
TRICARE plan costs for retirees vary by plan type, beneficiary group (A or B), and service usage; annual fees, deductibles, and copays apply. Tricare Prime and other plans require annual enrollment fees, which an individual must pay every year. The Tricare Select Program may ask for higher copayments for specific services.
Tricare Prime
- Group A: ~$370 individual / ~$740 family
- Group B: ~$450 individual / ~$900 family
Tricare Select
- Group A: ~$180 individual / ~$365 family
- Group B: ~$580 individual / ~$1,159 family
Other charges, annual deductibles, copays, and other details are on Tricareās official portal:
https://tricare.mil/-/media/Files/TRICARE/Publications/FactSheets/TRICARE_Costs_and_Fees_Fact_Sheet_JAN_2024_FINAL_010224.pdf
Frequently Asked Questions:
What is Catastrophic Cap with Tricare Program?
The catastrophic cap is the maximum out-of-pocket amount that beneficiaries must pay for Tricare-covered services within a fiscal year. Once the catastrophic cap is reached, Tricare covers the eligible healthcare costs for the remainder of the fiscal year. This cap helps to limit the financial burden on families for covered medical services. It does not apply to non-covered services.
Is the Tricare Retired Reserve Program globally accepted?
The Tricare Retired Reserve Program provides coverage for retired reserve members and their families, but its acceptance varies based on the specific healthcare services and locations. While Tricare offers international coverage through programs like Tricare Overseas Program, beneficiaries should verify the specifics of their plan and available services in their area or intended location for care.
What costs are included with Tricare Programs?
Costs associated with Tricare Programs vary by plan and beneficiary status. Generally, these costs can include enrollment fees (for certain plans), annual deductibles, cost-shares or coinsurance, and copayments for specific services. Some plans, like Tricare For Life, act as a secondary payer to Medicare and may not require enrollment fees. It's important to review the specific Tricare plan details to understand all associated costs.
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