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TRICARE for Active Duty Military Retirees

Joe Wallace

Many who retire from active duty military service are a decade or more away from qualifying for Medicare, or other age-based military benefits and services. Your choices for healthcare will be affected by this, and your location (stateside or overseas) is another factor to consider when planning your health care coverage.

For the purposes of this article, the phrase “retirement” refers specifically to those who have served enough time to qualify for military retirement pay. We are not discussing the generic “retirement” age for drawing civilian pensions, Social Security, Medicare, Medicaid, etc. For this article, “retired” means “retired from military service.”

Additionally, this article is specifically for those who have retired from active duty military service. In a separate article, we will cover TRICARE options for those who have retired from the National Guard or the Reserve. The rules for those retiring from the Guard/Reserve are different from those who retire from active service, especially where qualifying ages are concerned. If you aren’t sure whether your military service qualifies you for a specific type of TRICARE health insurance, contact a TRICARE representative who can review your specific circumstances.

TRICARE for Active Duty Military Retirees

Retired military members may be eligible for a variety of TRICARE options, including:

• TRICARE Prime
• TRICARE Select
• US Family Health Plan
• TRICARE For Life
• TRICARE Select Overseas

TRICARE Prime for Retired Military and Family

TRICARE Prime does not feature enrollment fees or network copays for active duty troops and families. For retired service members and their families, such payments are required. You are only eligible as a military retiree for TRICARE Prime if you have not become eligible for Medicare based on age.

Once you have reached the age of eligibility for Medicare, you are no longer approved for TRICARE Prime as a retiree.

You are required to enroll in TRICARE Prime as a retiree. Once approved, you are assigned a primary care manager or PCM who may be at a military base or a facility within your network. You will get referrals to specialists for care you can’t get with a PCM. Prime is an option for those who are living in the United States.

TRICARE Select for Retired Military Members and Family

TRICARE Select is described on the official site as a “self-managed” preferred provider organization (PPO) plan for those in the United States.

This option is offered to military retirees and is typically used when you have other health insurance. Certain military retirees will have to pay enrollment fees when signing up for TRICARE Select, and you may be responsible for cost shares and an annual outpatient deductible.

When using TRICARE Select, you can schedule an appointment with any TRICARE-authorized provider, either network or non-network. Unlike Prime, you will not need referrals for “most primary and specialty appointments,” but you may need pre-authorization from your regional contractor, depending on the nature of your care.

Military retirees and family members typically don’t receive a TRICARE card under TRICARE Select. Your military retiree ID may serve as your insurance card. When using TRICARE Select, expect to pay your costs up front and be later reimbursed by TRICARE.

TRICARE Select Overseas

Similar to TRICARE Select, but made available to retirees and family members in “all overseas areas”. Enrollment is required, and certain military retirees will have to pay enrollment fees when signing up for TRICARE Select.

You will pay upfront for care and be reimbursed by TRICARE after submitting a claim. You can use TRICARE Select to schedule an appointment with any approved overseas care provider, referrals are not necessary, but you may need pre-authorization for some care options.

TRICARE US Family Health Plan for Retirees

The TRICARE US Family Health Plan is described on the official site as, “an additional TRICARE Prime option available through networks of community-based, not-for-profit health care systems” located across six regions in the USA. Military retirees and their families can apply for this health coverage, but there are restrictions.

Prior to October 1, 2012, the US Family Health Plan was open to Medicare-eligible beneficiaries age 65 and older. On October 1, 2012, this rule was modified; now Medicare-eligible beneficiaries who are 65 and older “can no longer enroll in the US Family Health Plan” but should apply for TRICARE For Life (see below).

This plan is not available outside the United States and is offered within certain areas including:

• Maine
• New Hampshire
• Vermont
• Upstate and Western New York
• Northern Tier of Pennsylvania
• Maryland
• Washington D.C.
• Parts of Pennsylvania, Virginia, Delaware, New York City
• Long Island
• Southern Connecticut
• New Jersey
• Philadelphia and area suburbs
• Southeast Texas
• Southwest Louisiana
• West Virginia
• Massachusetts
• Rhode Island
• Northern Connecticut
• Western Washington state
• Parts of eastern Washington state
• Northern Idaho
• Western Oregon

TRICARE for Life

This option is specifically for military retirees who are TRICARE-eligible and have Medicare Part A and B. Enrollment for this program is NOT required–it is automatic if you meet the requirements. This plan is available worldwide and requires payment of Medicare Part B premiums.

Under TRICARE For Life, you are allowed to use any care provider who takes Medicare, which is the first payer. TRICARE For Life pays after Medicare handles its portion. Your Medicare card and retiree ID are what you need to use these services. This coverage requires no enrollment fees, but as mentioned above you will pay Part B fees.

Typically, for care covered by both TRICARE and Medicare, you pay nothing. If care is paid for by only one of the two, you may be responsible for the deductible and cost share for that insurer (TRICARE or Medicare), and in cases where neither insurance applies you may be liable for “billed charges”.

TRICARE for Medically-Retired Service Members

Some service members are placed on either a Temporary Disabled Retirement List or a Permanently Disabled Retirement List. The TRICARE official site says you and your family may qualify for TRICARE benefits offered for retired service members (see above). Furthermore, if you have a disability rating of less than 30% (the TRICARE official site specifies this is a rating separate from the VA disability rating system) and are separated from active service, you may qualify for certain “transitional health care benefits” under TRICARE:

• Transitional Assistance Management Program, which offers 180 days of health care benefits after regular TRICARE benefits expire. There are no premiums.
• Continued Health Care Benefit Program, a premium-based plan offering health coverage for 18-36 months when you lose eligibility for TRICARE. This plan offers the same coverage as TRICARE Select (see above).

What qualifies someone to go on the Temporary Disabled Retirement List? You typically must have a medical issue that makes you “unfit for military service” and you must have a 30% disability rating “separate from the one given by the Department of Veterans Affairs”. On the temporary list, you are re-evaluated approximately every 18 months for up to five years. If your condition has improved you may be removed from the list, if it has gotten worse you may be placed on the permanent list.

Things to Think About When Considering Your TRICARE Options

If you are getting ready to retire from military service, there are three basic questions you should ask about your plans that could affect your healthcare choices. How close to being Medicare-eligible are you? Are you planning to retire stateside or do you plan to live overseas? And finally, how close to a military base will you be? This is important because you may need a TRICARE plan that does not require you to travel long distances to get care. The distance issue isn’t a factor in all cases, but those requiring more specialized care should take travel into consideration.

And finally, the TRICARE official site issues a reminder; If you become eligible for Medicare under age 65 (for any reason) you are required to use Medicare Part B to keep TRICARE.

 

To learn more about TRICARE and other benefits, healthcare, loans, and more. We recommend reviewing our comprehensive Retiree Military Benefits Guide. You can find information about coverage, eligibility, and more in the guide.