When I mentioned the possibility of substituting TRICARE for commercial or Federal Employee Health Benefits (FEHB) I thought it was amore cut and dry proposition. But comments and questions I’ve received indicates to me that a lot of military and retired military who out to know and TRICARE, one of their major benefits, don’t. And of course if they are involved in something requiring an attorney, they can’t possibly give their attorney enough information to form a good legal strategy.
So here’s the skinny (and some of my opinions) on the commonly available TRICARE plans:
TRICARE Standard Coverage
No enrollment: TRICARE Standard is the basic TRICARE health care program, offering comprehensive health care coverage, for people not enrolled in TRICARE Prime. (Active duty service members (ADSM) must take action to enroll in Prime, and many other beneficiaries choose to enroll in Prime also.) Standard does not require enrollment.
This is perhaps one of the most overlooked areas I’ve seen, so far. When I speak to retirees about their TRICARE benefits they often respond with, “I didn’t sign up for that plan and now I have nothing. Well, if they retired from the US military, either active duty or reserve component (reservist drawing retired pay) then they almost assuredly are covered and the plan needs to be factored into all retirement planning and in particular, divorce settlements where health insurance is an issue.
Fee-for-service flexibility: Standard is a fee-for-service plan that gives beneficiaries the option to see any TRICARE-certified/authorized provider (doctor, nurse-practitioner, lab, clinic, etc.). Standard offers the greatest flexibility in choosing a provider, but it will also involve greater out-of-pocket expenses for you, the patient. You also may be required to file your own claims.
Apparently the “file your own claims” issue is a very big negative factor. None of us likes to fill out forms. However many health care professionals will file TRICARE reimbursement forms, and if the member has to do it on his/her own the process is not complicated at all. Just because TRICARE Standard may require some minor effort on a member or former spouses part one shouldn’t throw the baby out with the bathwater.
Costs: Standard requires that you satisfy a yearly deductible before TRICARE cost sharing begins, and you will be required to pay co-payments or cost shares for outpatient care, medications, and inpatient care.
The most important feature of TRICARE Standard is that there is no subscription cost. It’s hard to find a plan that costs less than zero. To user any provider a plan participant simply goes to the provider of choice, pay for the services received and TRICARE reimburses 80% of the allowable costs after an annual $150 per person/$300 per family deductible. Of course the issues comes up that even 20% of the costs can add up to a lot over the course of a year. TRICARE Standard has a catastrophic cap provision that limits a member’s costs to not more than $3000 per year. So the most a person could owe, regardless of the medical condition/treatment needs is $3,000 or let’s look at it as $250 a month. I know of a lot of commercial health plans that cover much less that cost a lot more than $250 per month … and if you don’t need the medical care, you won’t have to pay even that much. Worth a look.
Program details: For more information about the Standard benefit, see the TRICARE Handbook.
Disclaimer
As always remember that this site, although written by a retiree with substantial experience in the school of hard knocks, it is for personal, lay opinions and informational purposes only. If you have a legal question you should seek help from a legal professional. If you have questions involving current or future values of pensions you need an actuary or competent pension valuation expert. If your questions are tax-related, seek a competent tax advisor. In other cases, I recommend the base chaplain.
If you really need an accurate reading on a case involving these issues, I’d suggest you call Bill — 719-475-7529
Related posts:
- TRICARE Flavors and How To Taste Them
- Medical Care Options For Divorced Military Retirees
- Military Retirement — Special Six-Part Series
- Military Retirement — Special Six-Part Series — Part 5 — Spouse Benefits
- Proper valuation of pension plans
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