How Does Tricare Work for Retirees?
Military retirees are eligible for Tricare, the healthcare program provided by the Department of Defense for service members, retirees, and their families. Tricare for retirees extends comprehensive healthcare coverage beyond active duty, ensuring they do not lose their healthcare benefits upon retirement.
If you are retiring soon and worrying about your healthcare insurance, Tricare has multiple plans. 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 Programs are available for military retirees and their families. Military employees lose their healthcare insurance when they retire from their duty. 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. Here’s the list of all the available plans.
Tricare Programs for Retirees
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Tricare Prime
Tricare Prime is a managed care option available for military retirees and their families, offering a network of providers for comprehensive healthcare services. 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 self-managed, preferred provider network option for military retirees and their families. 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 retiree’s group designation and service status.
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US Family Health Plan
The US Family Health Plan is open to all retirees and their families. 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
The Tricare Retired Reserve plan is different from the ones listed above. 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 a Medicare wraparound coverage for Tricare beneficiaries who have Medicare Part A and B, regardless of age. 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. Let’s check out the additional plans Tricare offers retirees.
Tricare Dental Plan for Retirees
Retirees and their dependent family members can purchase this plan. FEDVIP offers the program- Federal Employees Dental and Vision Insurance Program.
The OPM—Office of Personnel Management by the US Government—sponsors 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?
Under the qualifying life event, you can change your FEDVIP coverage during the open enrollment season. The enrollment season for FEDVIP Coverage runs from mid-November to mid-December. An enrolled individual can change it during this period.
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. Let’s learn more about one of them.
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Tricare Pharmacy Program
The Tricare Pharmacy Program gives you additional benefits on prescribed drugs. 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
Tricare Maintenance Medications Program allows enrolled individuals to refill their prescribed drugs via a home delivery. They can also use military pharmacies to avail themselves of the benefits instead of going to the retail pharmacy shop.
Tricare Vision Benefits
The Tricare Vision Benefits program offers retirees and families discounted rates on certain eye examinations and basic eyecare treatments. However, individuals must choose the right Tricare Program.
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. Let’s see which services are not included in the Tricare Program.
- Services that are Excluded from Tricare Programs
- 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 Healthcare Programs for Retirees cost differently for each individual. 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: $363 per individual and $726 per family
- Group B: $438.96 per individual and $879 per family
Tricare Select
- Group A: $177.96 per individual and $355.92 per family
- Group B: $564.96 per individual and $1,131 per family
Other charges, annual deductibles, copays, and other details are on Tricare’s 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.
See Also
Does Walgreens Deliver Prescriptions?
What is the Catastrophic Cap for Tricare?
Financial Help for Seniors on Social Security
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