TRICARE is a healthcare program for military members and their families. This health coverage is offered to qualifying military members on active duty, in the Guard and Reserve, veterans, and military retirees. TRICARE is also offered to surviving spouses and dependents, and even “certain former spouses” according to TRICARE.mil. TRICARE is offered stateside, overseas, and at remote assignments. Your basic healthcare plan may depend greatly on your geographic location.
When a new recruit ships out to basic training, they are automatically covered by TRICARE. Enrollment is required and happens later, but from the moment new troops begin serving they have health insurance coverage.
Some may already have health insurance coverage through their parents or a spouse. For active duty troops, one of the major questions about TRICARE is how it works with other plans, and when. As we will discover below, there are major differences between the options that service members have compared to their family members.
Who Qualifies For TRICARE?
Those offered TRICARE coverage include, but may not be limited to:
- Active duty service members and families
- National Guard/Reserve members and families
- Retired service members and families
- Retired Reserve members and families
- Beneficiaries eligible for TRICARE and Medicare
- Medal of Honor recipients and families
- Dependent parents and parents-in-law
TRICARE Coverage Rules For Active Duty Service Members
Those serving on active duty or ordered to active duty are given TRICARE as their health insurance, and no alternative is permitted. This is NOT true of family members, veterans, retirees, and others. Those on active duty will use TRICARE as their only health coverage.
TRICARE Rules For Those Who Are Not Active Duty
The rules we mention here apply to all non-active duty TRICARE enrollees. Guard and Reserve troops not on active duty, retirees, family members, and all others under the “non-active duty” umbrella should know about the information in this section.
TRICARE rules state that when you carry any other health insurance besides TRICARE, it’s known as “other health insurance” for the purposes of making claims. When you carry other health insurance, TRICARE is the final payer, not the first payer.
There are exceptions. They include:
- TRICARE supplements
- State Victims of Crime compensation programs
- Other federal government programs
You will file your non-TRICARE health insurance claims first, then you or your care provider will file a claim with TRICARE.
TRICARE and Medicare
When using Medicare and TRICARE together, you should expect Medicare to pay first along with any other health insurance. TRICARE pays after these two have paid–you will need to check the Medicare official site to see whether your insurance or Medicare pays first for the treatment or services you receive.
What Happens If Your Other Health Insurance Ends
Some may start out with other health insurance through an employer or school, but what happens when those coverages end? When you graduate from school or quit a full-time job, health insurance is terminated at some stage, and in such cases TRICARE makes provisions to become the primary insurer.
This is not necessarily automatic. You will need to submit a form to TRICARE to inform them your other health insurance is being terminated. You should also inform your Primary Care Manager or another care provider to avoid delays in payment between the old insurance and TRICARE.
The TRICARE official site warns that changing your other health insurance coverage options without informing TRICARE and your Primary Care Manager could result in being denied a TRICARE claim.
Avoiding Coverage Lapses And Other Problems
One of the most important things you can do to avoid gaps in coverage, delayed payments, or other issues? Keep the system updated.
This involves letting your TRICARE contractors and care providers know when you gain or lose access to other health insurance. You will also need to keep your family information updated in DEERS, especially when there are changes in family status.
If you have a newborn, an adoption, marriage, divorce, death in the family, or other event that could alter the nature of your health insurance coverage, update your military DEERS records as soon as possible. In cases where you have had a baby overseas, the TRICARE official site advises that your baby is covered by Prime “for the first 120 days after birth, but you must take steps to enroll your child to continue Prime after the first 120 days”.
Permanent Change Of Station or PCS season is also an important concern. Are you and your family about to receive permanent change of station orders to an overseas base? If you are currently assigned stateside, your TRICARE coverage options will change.
You should contact a TRICARE representative as soon as you have orders to discuss how to switch your coverage from the stateside version of TRICARE Prime to the overseas version. Failure to update could result in serious lapses in coverage or care. Start working on your transition as early as possible.
The same is true when transitioning back to a stateside base from an overseas assignment. And those who are being reassigned without command sponsorship of dependents–going on a remote assignment while leaving the family behind at a stateside location until the remote duty is finished–require extra consideration in TRICARE.
You won’t want to be in a hurry to sort out those details, start working with your TRICARE rep as soon as you can to get your TRICARE needs sorted out in these circumstances.
What to Know About TRICARE and Using Other Health Insurance
There are some crucial things to know about using TRICARE and other health insurance together. One of those things is fully understanding the rules for the other insurance option. If you do not file according to the rules of the other insurer, your claim may be denied. This is an important factor–you will read this advice again, as this is a common error.
If you try to submit a claim to TRICARE after having been denied by your primary insurer, it may be rejected by TRICARE as well.
Submitting to TRICARE before your primary insurer will typically result in the claim being denied. Do not submit claims to TRICARE first. In the event that TRICARE accidentally pays when you have other insurance, the error will force TRICARE to reclaim the funds. Your claim will only be processed after the primary insurer does in such cases.
When Your Primary Insurance Doesn’t Cover All Costs
The TRICARE official site advises you to follow all rules for submitting claims to the letter. If you do so and you are still not fully covered for a procedure or other care, file a claim with TRICARE, but know that TRICARE, as mentioned above, typically denies claims that were also denied by your main insurer if your claim was rejected because it did not follow the rules. This is a very common mistake that can be easily avoided with a little extra effort.
Is TRICARE Always The Best Option?
In some cases the answer may be yes–if you are at an overseas location and do not know the local language or customs, TRICARE is likely the best option unless an employer’s plan has similar considerations for you as an outsider to the country or culture. You may find language support services
If you are stateside and you feel that other health insurance offers you an advantage as a spouse, dependent, or another non-active duty beneficiary, taking that other insurance may be the best move. It is important to compare plans and determine the best option–sometimes it’s TRICARE, sometimes it’s not.