Using A Flexible Spending Account With TRICARE

FSAs and TRICARE

Can I Use a Flexible Spending Account (FSA) with TRICARE?

Many military families want to know if they can contribute to a Flexible Spending Account or FSA while using TRICARE. Using an FSA is a way to offset the costs of certain healthcare expenses (see below) by making pre-tax contributions to an FSA fund.

This helps pay for healthcare needs that are not covered by health insurance. As we’ll discover below, FSAs can be helpful for spouses or dependents covered by TRICARE, but not for those currently serving on active duty–the servicemember is not allowed to use an FSA.

How Flexible Spending Accounts Work

If your employer offers you the option of an FSA, you enroll the way you would for health insurance–as a new hire, during open season, or because a qualifying life event such as a marriage, birth, or death has occurred.

When you enroll in an FSA, you make pre-tax contributions to the fund up to an annual cap. This money is deducted from your pay before taxes–that means that your net income is taxed only after you have paid into the FSA. The applicant decides how much to spend each year for FSA-approved costs such as dental or vision care.

The money you pay into an FSA must be spent by the end of the year. It’s a “use or lose” situation and while the policies of FSA may vary from employer to employer, don’t expect a substantial amount of the unused FSA money to carry over into the new year.

Questions Readers Ask: Is an FSA considered health insurance?

As mentioned above, FSA is NOT health insurance, but may be an option you can use in association with an employer’s insurance coverage.

It is good to know the rules for using your health insurance AND how to use your FSA in conjunction with it, especially if you are using one or the other for the first time. TRICARE rules listed on the official site remind us why this is important. “Follow the rules of your other health insurance for getting care and filing claims” in order to use ANY additional coverage, FSA, etc.

Otherwise? TRICARE.mil states clearly, “If your other plan denies a claim for failure to follow their rules, TRICARE may also deny your claim.” That rule likely was not written with FSAs in mind, but it’s an important one to remember in any case–you’ll need to know how to properly file claims with your insurer and know how you can or cannot use your FSA. Sometimes you may need to learn to do both of them at the same time.

Questions Readers Ask: I’m on active duty. Can I use an FSA with TRICARE?

No. According to TRICARE.mil, those on active duty must use TRICARE and cannot use an FSA for themselves. Spouses and dependents do have options, but not active-duty military members.

Question Readers Ask: Can military spouses use an FSA with TRICARE?

As a military spouse working for a civilian or federal employer, you may be allowed to use an FSA in addition to certain TRICARE coverage. You are typically not restricted from doing so, but you may be required to coordinate with TRICARE when using “other medical coverage” such as an employer’s non-TRICARE options.

Read more: Comprehensive TRICARE Benefits Guide

Questions Readers Ask: Can I pay for my TRICARE or other health insurance premiums using my FSA?

No. You cannot use an FSA to pay your health insurance premiums. Typically you may not use an FSA to pay for any type of insurance premium or the expenses of “Continuation of Coverage”.

Questions Readers Ask: Are FSAs and HSAs the same?

A Flexible Spending Account and a Health Savings Account (HSA) are not the same. Typically, in order to use an HSA you must be enrolled in a high-deductible health plan, but TRICARE does not offer this.

There are several types of FSAs. One is a Medical FSA, and another is known as a Dependent Care FSA. (DCFSA).

  • Medical FSA: This allows you to pay care providers including orthodontists, psychiatrists and chiropractors if these expenses aren’t covered by another plan. A medical FSA may also help you pay for drugs, prosthetics, hearing aids, and other devices.
  • Dependent Care: This allows you to pay for expenses such as child care (including care for children “physically or mentally incapable of self-care”). Elder care is also paid for in certain circumstances.

Other types of FSA include reimbursement plans for commuting to a workplace, and those designed to help people adopt children. There are also “limited-purpose” FSA that may be associated with some healthcare plans.

>>Not sure where to start with your military benefits?

FSA Maximum Contribution Limits

FSAs have a maximum contribution limit subject to change each year. In 2022 that limit was $2,850. In 2023, the limit increased to over $3,000. The Dependent Care FSA limit for 2023 was 5,000, unchanged from the previous year.

These are the limits as published by the Internal Revenue Service. To learn more about these limits and how contributing to an FSA affects your taxes in the current year, consult a tax professional or an IRS representative.

TRICARE, FEDVIP Dental and Vision Rates 2023

TRICARE and FEDVIP Dental and Vision Rates 2023

Dental and vision care rates are subject to change from year to year. This article covers the dental and vision coverage costs for 2023 for the plans listed below. If you are new to TRICARE, some of your options for dental and vision coverage may seem confusing. For example, what is the difference between TRICARE and FEDVIP?

TRICARE is the healthcare insurance option offered to qualifying military members, their families, dependents, retirees, and survivors.

FEDVIP is described as, “a voluntary, enrollee-pay-all program providing dental and vision benefits” to federal employees as well as “certain retired uniformed service members, and active duty family members”. Some may be eligible for TRICARE, others may qualify for FEDVIP. Some may be technically eligible for both.

TRICARE Dental and Vision Plans

TRICARE Vision Care Coverage: The TRICARE official site reminds us, “TRICARE covers annual routine eye exams for active duty family members, regardless of plan.”

For retirees, the nature of your plan will determine the coverage. Routine eye exams are typically covered but you will need to check the terms of your plan to know what specifically applies to you.

Eye exams are typically not covered for TRICARE Select, TRICARE Young Adult Select, or TRICARE For Life.

TRICARE Dental Coverage: Dental coverage is handled differently and is considered a separate plan.

  • Typically, active duty service members receive dental care on base or on-post.
  • In certain remote assignments, this may not be possible and these troops may be authorized to seek care in the private sector, paid for under TRICARE.
  • Active-duty family members are offered options under TRICARE Dental.
  • Guard, Reserve, and Family members may be covered under TRICARE Dental depending on circumstances,
  • Retired military members and their families may qualify for coverage under FEDVIP (see below)
  • Survivors may also be covered under FEDVIP or TRICARE survivor benefit plan options.

FEDVIP Dental and Vision Insurance

FEDVIP, also known as the Federal Employee Dental and Vision Insurance Program, was established by the Federal Employee Dental and Vision Benefits Enhancement Act of 2004 and offers dental and vision benefits typically offered to federal employees, retirees, and their dependents.

TRICARE Dental Rates 2023

Active Duty

    • Service member only: $0
    • One family member: $11.94
    • More than one family member: $31.04

Reserve

    • Servicemember: $11.94
    • One family member: $29.84
    • More than one family member: $77.59
    • Service member and family: $89.53

Individual Ready Reserve

    • Servicemember $29.84
    • One family member $29.84
    • More than one family member $77.59
    • Servicemember and family: $107.40

TRICARE Vision Plan Rates 2023

TRICARE does not offer separate vision care coverage. Instead, you may qualify through a TRICARE plan such as TRICARE Prime, etc. Your coverage plan will determine any applicable deductibles or other fees.

FEDVIP 2023 Rates by Dental Plan

The following rates are effective for FEDVIP dental plans on 1 January 2023.

Aetna Dental

High Bi-Weekly Plan High Monthly Plan
Rating Area Self Only Self + 1
Self & Family
Self Only Self + 1 Self & Family
1 $16.48 $32.96 $49.44 $35.71 $71.41 $107.12
2 $18.15 $36.31 $54.46 $39.33 $78.67 $118.07
3 $19.32 $38.64 $57.95 $41.86 $83.72 $125.56
4 $21.32 $42.65 $63.97 $46.19 $92.41 $138.60
5 $23.16 $46.31 $69.47 $50.18 $100.34 $150.52

 

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $8.98 $18.38 $27.58 $19.91 $39.82 $59.76
2 $10.11 $20.23 $30.33 $21.91 $43.83 $65.72
3 $10.76 $21.51 $32.26 $23.31 $46.61 $69.90
4 $11.85 $23.70 $35.55 $25.68 $51.35 $77.03
5 $12.86 $25.72 $38.58 $27.86 $55.73 $83.59

Blue Cross Blue Shield FEP Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self +1 Self & Family Self Only Self + 1 Self & Family
1 $18.02 $36.05 $54.07 $39.04 $78.1 $117.15
2 $20.19 $40.38 $60.57 $43.75 $87.49 $131.24
3 $21.98 $43.97 $65.95 $47.62 $95.27 $142.89
4 $23.81 $47.62 $71.43 $51.59 $103.18 154.77
5 $26.65 $53.29 $79.94 $57.74 $115.46 $173.20

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $9.19 $18.38 $27.58 $19.91 $39.82 $59.76
2 $10.07 $20.15 $30.22 $21.82 $43.66 $65.48
3 $11.45 $22.89 $34.31 $24.81 $49.60 $74.34
4 $12.36 $24.70 $37.03 $26.78 $53.52 $80.23
5 $13.65 $27.31 $40.96 $29.58 $59.17 $88.75

Delta Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $17.64 $35.29 $53.93 $38.22 $76.46 $114.68
2 $19.35 $38.70 $58.04 $41.93 $83.85 $125.75
3 $21.23 $42.46 $63.70 $46.00 $92.00 $138.02
4 $22.60 $45.19 $67.79 $48.97 $97.91 $146.88
5 $26.34 $52.67 $79.01 $57.07 $114.12 $171.19

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $9.17 $18.34 $27.52 $19.87 $39.74 $59.63
2 $9.99 $19.99 $29.98 $21.65 $43.31 $64.96
3 $10.778 $21.55 $32.33 $23.36 $46.69 $70.05
4 $11.37 $22.74 $34.10 $24.64 $49.27 $73.88
5 $13.02 $26.04 $39.07 $28.21 $56.42 $84.65

GEHA Connection Dental Federal

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $17.25 $34.50 $51.76 $37.38 $74.75 $112.15
2 $19.40 $38.79 $58.19 $42.03 $84.05 $126.08
3 $21.21 $42.42 $63.63 $45.96 $91.91 $137.87
4 $23.70 $47.40 $71.10 $51.35 $102.70 $154.05
5 $25.69 $51.39 $77.08 $55.66 $111.35 $167.01

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $9.53 $19.07 $28.59 $20.65 $41.32 $61.95
2 $10.69 $21.37 $32.06 $23.16 $46.30 $69.46
3 $11.71 $23.37 $35.06 $25.37 $50.64 $75.96
4 $13.07 $26.10 $39.16 $28.32 $56.68 $84.85
5 $14.15 $28.30 $42.44 $30.66 $61.32 $92.95

MetLife Federal Dental Plan

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $18.42 $36.83 $55.25 $39.21 $79.80 $119.71
2 $19.43 $38.86 $58.28 $42.10 $84.20 $126.27
3 $21.58 $43.17 $64.75 $46.76 $93.54` $140.29
4 $23.48 $46.96 $70.43 $50.87 $101.75 $152.60
5 $26.13 $52.27 $78.40 $56.62 $113.25 $169.87

Standard
Bi-Weekly
Plan
Standard 
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $10.22 $20.45 $30.67 $22.14 $44.31 $66.45
2 $10.87 $21.73 $32.60 $23.55 $47.08 $70.63
3 $12.12 $24.34 $36.36 $26.26 $52.52 $78.78
4 $13.37 $26.75 $40.12 $28.97 $57.96 $86.93
5 $14.15 $28.31 $42.46 $30.66 $61.34 $92.00

United Concordia Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $16.53 $33.06 $49.56 $35.82 $71.63 $107.38
2 $18.55 $37.09 $55.64 $40.19 $80.36 $120.55
3 $20.60 $41.17 $61.78 $44.63 $89.20 $133.86
4 $22.63 $45.25 $67.88 $49.03 $98.04 $147.07
5 $24.66 $49.31 $73.95 $53.43 $106.84 $160.23

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $9.64 $19.28 $28.92 $20.89 $41.77 $62.66
2 $10.83 $21.63 $32.45 $23.47 $46.87 $70.31
3 $12.00 $23.99 $35.98 $26.00 $51.98 $77.96
4 $13.16 $26.32 $39.49 $28.51 $57.03 $85.56
5 $14.33 $28.65 $42.98 $31.05 $62.08 $93.12

UnitedHealthcare Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $21.74 $43.49 $65.23 $47.10 $94.23 $141.33
2 $22.83 $45.65 $68.48 $49.47 $98.91 $148.37
3 $23.96 $47.92 $71.88 $51.91 $103.83 $155.74
4 $27.59 $55.18 $82.76 $59.78 $119.56 $179.31
5 $32.48 $64.96 $97.44 $70.37 $140.75 $211.12

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $10.61 $21.21 $31.82 $22.99 $45.96 $68.94
2 $12.01 $24.02 $36.03 $26.02 $52.04 $78.07
3 $12.91 $25.82 $38.73 $27.97 $55.94 $83.92
4 $13.58 $27.17 $40.75 $29.42 $58.87 $88.29
5 $$15.78 $31.56 $47.34 $34.19 $68.38 $102.57

Regional Plans:

Dominion National

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $9.36 $18.71 $28.07 $20.28 $40.54 $60.82
2 $10.39 $20.78 $31.16 $22.51 $45.02 $67.51
3 $13.82 $27.64 $41.46 $29.94 $59.89 $89.83

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $5.55 $11.08 $16.63 $12.03 $24.01 $36.03
2 $7.08 $14.17 $21.25 $15.34 $30.70 $46.04
3 $8.15 $16.29 $24.44 $17.66 $35.30 $52.95

EmblemHealth Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$23.42 $46.79 $70.21 $50.74 $101.38 $152.12

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$19.23 $38.44 $57.67 $41.67 $83.29 $124.95

HealthPartners Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $22.14 $44.28 $66.42 $47.97 $95.94 $143.91
2 $23.24 $46.49 $69.73 $50.35 $100.73 $151.08

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $15.94 $31.88 $47.81 $34.54 $69.07 $103.59
2 $18.19 $36.38 $54.57 $39.41 $78.82 $118.24

Humana Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $18.30 $36.59 $54.89 $39.65 $79.28 $118.93
2 $20.11 $40.22 $60.32 $43.57 $87.14 $130.69
3 $21.10 $42.22 $63.32 $45.72 $91.48 $137.19
4 $22.57 $45.13 $67.70 $48.90 $97.78 $146.68
5 $24.80 $49.60 $74.42 $53.73 $107.47 $161.24

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $10.89 $22.38 $33.57 $24.25 $48.49 $72.74
2 $11.74 $23.48 $35.22 $25.44 $50.87 $76.31
3 $12.66 $25.32 $37.99 $27.43 $54.86 $82.31
4 $$13.91 $27.83 $41.73 $30.14 $60.30 $90.42
5 $15.96 $31.92 $47.87 $34.58 $69.16 $103.72

Triple-S Salud

High
Bi-Weekly
Plan
High
Monthly
Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$5.30 $10.59 $13.82 $11.48 $22.95 $29.94

FEDVIP Vision Plan Prices in 2023

In addition to dental benefits, FEDVIP offers vision coverage. The following rate information is posted here for your information. Please contact the carrier for questions or concerns.

Aetna Vision Preferred 2023

High Bi-Weekly Plan High Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$5.64 $11.26 $16.90 $12.22 $24.40 $36.62

 

Standard Bi-Weekly Plan Standard Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$3.12 $6.24 $9.36 $6.76 $13.52 $20.28

 

Blue Cross Blue Shield FEP Vision 2023

High Bi-Weekly Plan High Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$5.52 $11.03 $16.55 $11.96 $23.90 $35.86

 

Standard Bi-Weekly Plan Standard Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$3.53 $7.05 $10.58 $7.65 $15.28 $22.92

MetLife Federal Vision Plan 2023

High Bi-Weekly Plan High Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$5.10 $10.21 $15.31 $11.05 $22.12 $33.17

 

Standard Bi-Weekly Plan Standard Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$3.34 $6.67 $10.02 $7.24 $14.45 $21.69

UnitedHealthcare Vision 2023

High Bi-Weekly Plan High Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$5.10 $10.21 $15.31 $11.05 $22.12 $33.17

 

Standard Bi-Weekly Plan Standard Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$3.33 $6.65 $9.98 $7.22 $14.41 $21.62

 

VSP Vision Care 2023

High Bi-Weekly Plan High Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$6.68 $13.38 $20.08 $14.47 $28.99 $43.51

 

Standard Bi-Weekly Plan Standard Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$3.54 $7.07 $10.62 $7.67 $15.32 $23.01

Enroll in 2023

If you’re eligible for a FEDVIP dental or vision program, you can enroll, cancel, or change your coverage during open enrollment season, which typically runs from a starting date in November to mid-December each year. You can also change coverage options during a qualifying life event.

 

RELATED:

 

 

TRICARE Cost Increases In 2023

TRICARE has released its fee structure for 2023, which includes increases for certain services and options beginning on 1 January in the new year.

Fee increases affect some TRICARE enrollees differently than others. You will need to know the increases for your specific demographic and/or selected TRICARE plan as they may be different from other plans you enrolled in previously.

What kind of differences?

  • Active duty service members and their families enrolled in TRICARE Prime or the U.S. Family Health Plan are not required to pay an annual enrollment fee, annual deductible, or pay out-of-pocket costs for covered services. TRICARE Prime does feature a catastrophic cap (see below), which is the amount you must pay out of pocket before TRICARE begins paying.
  • Compare the no-fee structure for Prime to the options offered to those enrolled in TRICARE Select; these families also have no annual fees, but there are co-payment increases coming in 2023. Some enrollees may find an increase in their annual deductible on 1 January.

There are two types of TRICARE groups–TRICARE Group A and TRICARE Group B. Which group you belong to determines your fee structure. Both groups may have fee increases scheduled for 2023.

Why Fee Increases Matter

TRICARE Open Season runs from November 14 to December 13. This is the one time you can make changes to your health insurance coverage without needing a Qualifying Life Event like birth, marriage, or death in the family to do so.

TRICARE Cost Increases: Enrollment

There are no enrollment fees for active-duty families. Those who are military retirees who are considered “working age” will experience fee increases based on whether they are in TRICARE Prime or TRICARE Select:

  • TRICARE Prime Group A: Enrollment fees increase in 2023 to $351.96 per individual, and $703.92 per family. Compare those increases to the 2022 numbers; $323 per individual and $647 per family.
  • TRICARE Prime Group B: In 2023 the individual enrollment fee is $426 up from $392 in 2022 and the enrollment fee for families is $852 for 2023 up from $884 in 2022.
  • TRICARE Select Group A: $171.96 per individual in 2023, up from $158; and $345 per family, up from $317.
  • TRICARE Select Group B: $547.92 for individuals in 2023 (up from the previous year’s $504 per individual), and $1,095.96 for families (up from $1,008 per family).

Annual Deductibles

Some TRICARE cost concerns don’t affect active-duty military members and their families. One example–there are no deductibles for Prime Group A or Prime Group B.

TRICARE Select for active duty family members in Group A, grades E-4 and below, features no change in 2023 from the previous year. These beneficiaries pay $50 per individual and $100 per family. Active duty Group A, grades E-5 and above, pay $150 per individual and $300 per family, the same as in 2022.

Group B members pay $60 per individual, up from $56 in 2022, and $121 per family, up from the 2022 fee of $112. Group B members E-5 and above pay $182 per individual, up from $168, and $365 per family, up from $336.

Working-age retirees in Group A pay $150 per individual and $300 per family (no change).

Out-of-Pocket Costs

Out-of-pocket copays with TRICARE Select may be higher in 2023 depending on the type of care needed. There are no costs for covered preventive care visits.

Primary care outpatient visit costs within the TRICARE Select network will increase for active duty families by one dollar only for those in Group A with a $2 cost increase for Group B. Working-age retirees may see a $2 cost increase.

TRICARE Prime urgent care center visits for working-age retirees will see a copay increase by $3.

TRICARE Catastrophic Cap

What’s a catastrophic cap? This is the largest dollar amount TRICARE beneficiaries must pay out of pocket (over a single year) before TRICARE begins to pay.

The catastrophic cap for active-duty family members and working-age retirees may, depending on the nature of their coverage, go up by approximately 8.7%.

Active duty family members in Group B of both TRICARE Prime and TRICARE Select will see a $97 increase in the cap. Increases in the cap for working-age retirees, their families, and others in Tricare Select go up by $322 in 2023.

TRICARE Premium-based plans

2023 sees higher costs for TRICARE premium-based plans:

  • TRICARE Young Adult Prime sees an increase of 11% in the new year, going up to $570 each month in 2023.
  • TRICARE Young Adult Select will see a 10% increase in 2023, going up to $291 a month.
  • Tricare Reserve Select sees a 2023 increase of 4% to $48 a month for individuals and up to $240 for families.
  • Tricare Retired Reserve gets a 9% increase for a total of $549 a month for individuals and up to $1,321 for families.

Some TRICARE Costs Are Not Going Up

There are a few exceptions to the 2023 cost increases. Outpatient care is one of them. The co-pay for outpatient care is actually going down in some cases. The co-pay goes down by one dollar in 2023 for Group A TRICARE Select members. Group B does not fare so well–the co-pay costs for Group B increase in 2023 by $2.

Get more information on your TRICARE costs and options in 2023 at the TRICARE official site.

TRICARE Open Season Checklist 2022

Fall season is also TRICARE Open Season; this is the time when military families can make changes to their TRICARE coverage without needing the justification of a major life event like a birth or death in the family.

Who Can Qualify for TRICARE?

  • Military members
  • Military spouses
  • Dependent children
  • Dependent parents or Parent-in-Law
  • Qualifying ex-spouses
  • Surviving spouse
  • Surviving children/dependents

Who can Change Coverage During TRICARE Open Season?

TRICARE Open Season is for family members, not active duty service members. That’s because Active Duty coverage for TRICARE is dictated by the duty location; TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, etc.

Active duty troops must use TRICARE Prime or one of its alternates. Family members have more options, and during Open Season you can change those options to better suit you. You don’t have to change plans, but the opportunity is there once each year.

When is TRICARE Open Season?

TRICARE Open Season starts on November 14, 2022, and ends December 13, 2022. The open season dates may change from year to year.

TRICARE Checklist: Consider Your Basic Options

During Open Season you have the choice to do nothing and remain in your current healthcare plan. But you also have the option to enroll in a new plan or change plans. You can also switch between family coverage and individual coverage.

TRICARE Checklist: Update DEERS With The Most Current Information

If you have dependents or anticipate having dependents who have not been added to the Defense Enrollment Eligibility Reporting System or DEERS, those dependents must be added before TRICARE coverage can start on those beneficiaries.

Keep all your information current in DEERS for best results; it is a terrible idea to try to update DEERS and TRICARE at the same time. Update DEERS first.

TRICARE Checklist: Changing Your TRICARE PLAN

The first thing to do if you’re considering a new TRICARE plan? Review the details of your current plan and compare it to others you might be considering. A side-by-side comparison is crucial to make sure you get as much out of your health insurance as possible. The basic options include:

  • TRICARE Prime: Managed care, and offering the most affordable coverage according to the TRICARE official site.
  • TRICARE Select: Self-managed care. TRICARE says this option offers “the most freedom” thanks in part to not having a required primary care manager.

You can compare TRICARE plans to learn more about how these options work. Once you have compared the features and options, it’s time to review the costs, which you can do using a TRICARE cost comparison tool offered on the official site.

It’s crucial to know all your options. Did you know there’s a wide range of TRICARE coverage you can select from once you decide whether you want managed care or self-managed care. Your options may include

  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Select
  • TRICARE Select Overseas
  • TRICARE For Life
  • TRICARE Reserve Select
  • TRICARE Retired Reserve
  • TRICARE Young Adult
  • US Family Health Plan

TRICARE Checklist: Planning Future Care and Coverage

If you need to review your Open Season TRICARE coverage options, there are some big questions to ask. They include:

  • Is your family size changing this year?
  • Are you getting married or divorced this year?
  • Are you moving this year?
  • Are you PCSing this year?
  • Are you turning 60 or 65 this year?
  • Are you retiring or separating from military service this year?

If the answer to any of these questions is YES, that may affect your choices and options for coverage.

Remember, active duty troops who leave active duty will have to elect for different TRICARE coverage options depending on whether they are going into the Guard or Reserve, retiring as a military pension-qualified veteran, or if you are simply separating from the service and going into civilian life.

You don’t need to wait for TRICARE Open Season to make coverage changes on some of the life milestones listed above; if you experience any of those circumstances you may be eligible to make Open Season-type changes within a 90-day window.

These are known as Qualifying Life Events and you can either make the changes during open season or wait until these events actually occur to modify your healthcare options.

 

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Thousands of Rural Pharmacies to Depart TRICARE Network

In October of 2022, some 400 thousand TRICARE beneficiaries could be forced to search for a new retail pharmacy as thousands of rural pharmacies depart the network. In 2021, Walmart left the TRICARE pharmacy network. It was a move widely reported at the time as being associated with a dispute with the TRICARE pharmacy management company, Express Scripts, over how much of a military discount to offer.

According to some sources, Walmart was unwilling to offer “more competitive” prices to veterans. At the same time this move was announced, a separate announcement welcomed retail giant CVS to the TRICARE pharmacy network.

These moves leave the impression among some that pharmacy options coming and going from the network is fairly common. At least up to now.

The Exodus Begins October 24, 2022

Between 14 thousand and 15 thousand rural pharmacies are departing the TRICARE retail pharmacy network by the last week in October. This change affects some four percent of the TRICARE population, which may not sound like much until you read the actual number of people that may be burdened by the move.

Approximately 400 thousand people in the TRICARE system could be required to find a new TRICARE network retail pharmacy to use. TRICARE has a “pharmacy standard” that requires one TRICARE pharmacy within a 15-minute drive for 90% of all TRICARE users. But if you fall into the 10% that does have a longer commute to a network option, it may be wise to consider switching to the home delivery option.

TRICARE retail pharmacy partners can be found in more than 40 thousand retail outlets.

What To Expect From TRICARE

If you are affected by this change, you will receive an official communication from Express Scripts notifying you of the change and your options under TRICARE in your area. Both CVS and Walgreens are still in-network TRICARE pharmacy options, and when the time comes you may transfer prescriptions to a participating pharmacy.

How do you do this?

It may be as easy in some cases as taking your prescription bottles to the new participating pharmacy and having your new pharmacist do the transfer. You can also request that your doctor send prescription information to the new provider, or contact Express Scripts to switch your prescriptions to home delivery.

Switching To TRICARE Home Prescription Delivery

There are multiple options for changing to TRICARE home prescription delivery service. You will need to create an account with Express Scripts if you do not have one already. Once your account is active you can opt into home delivery as well as choose to order refills online and track prescription shipments.

You may also have an option to have your physician submit electronic prescriptions using the Express Scripts “e-Prescribe” feature. In such cases the doctor submits the order, Express Scripts processes it, and mails you the medications.

If you are required to make a co-pay the invoice is included in the shipment. Your doctor can send prescriptions directly to Express Scripts, no third party is needed.

Those who need to transfer their prescriptions using a mobile device can do so using the Express Scripts Mobile App. Search for it by name in Google Play or the Apple App Store. Another option is to call Express Scripts at (877)363-1303. Have your prescription bottle ready as the representative will need that information to make a transfer.

You can also apply by mail via the Home Delivery Order Form. Complete and mail this form to the address listed on it, along with your prescription.

Why Set Up Home Delivery Through Express Scripts?

Convenience and the lack of a commute to get to a participating pharmacy aside, the biggest benefit for some is that you can receive up to 90 days of your prescription by mail via Express Scripts. You can also set up an auto-refill option to eliminate the need for reminders as the refill date gets close.

Those two things are a major advantage for some and it’s likely one of the biggest reasons some choose the home delivery option. Add to that free standard shipping, and this could be one of the more cost-effective and time-saving pharmacy options open to you.

 

TRICARE: A Comprehensive Guide

When you join the United States military, you become eligible for healthcare coverage under the military’s health insurance program, TRICARE. For those who serve this is not optional, but for dependents and spouses, there are ways to use TRICARE as their main coverage or as a supplement to health insurance they get elsewhere through an employer or by other means.

The TRICARE official site describes itself as the health care program for members of the uniformed services and qualifying family members for all of the above. TRICARE works by offering health care options through a network of on and off-base providers.

All active duty service members are automatically covered by TRICARE when they begin their military career by going to basic training. Enrollment is required, and each branch of military service determines your eligibility for TRICARE.

Who Qualifies for TRICARE?

There is an extensive list of people who qualify for healthcare coverage through TRICARE, and they are not necessarily all active duty, Guard or Reserve members. Some foreign troops may qualify, some former spouses and even some in-laws may qualify.

TRICARE basically subdivides its members into two basic groups. Military members are referred to as “Sponsors” with DEERS-registered spouses and children being “Family Members”. But among these groups, there are those who qualify for TRICARE based on their status as any of the below:

  • Active duty service members
  • Active duty immediate family members
  • National Guard/Reserve members and families
  • Retired service members and families
  • Beneficiaries eligible for both TRICARE and Medicare
  • Survivors
  • Children
  • Certain qualifying former spouses
  • Medal of Honor recipients and families
  • Dependent parents
  • Parents-in-law
  • Foreign Force members and families

To qualify for TRICARE coverage you and your spouse/dependents must be registered in the DEERS system. Those who ship out to basic training aren’t technically enrolled in TRICARE yet, but they are covered by it. A formal enrollment process is required in spite of the initial coverage, which is effective for up to 180 days until you are placed on active duty. Family members may also be covered.

Read More: TRICARE Basics

TRICARE Coverage Plans

The plans listed below are offered based on where you will perform your military duty. For example, for those who are active duty and stationed stateside, TRICARE Prime or TRICARE Prime Remote is typical, depending on location. The TRICARE plan active duty service members use when assigned to an overseas base is typically either TRICARE Prime Overseas or TRICARE Remote Overseas.

  • TRICARE Plus
  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Select
  • TRICARE Select Overseas
  • TRICARE For Life
  • TRICARE Reserve Select
  • TRICARE Retired Reserve
  • TRICARE Young Adult
  • US Family Health Plan

Of the options listed above, active duty troops are automatically enrolled in TRICARE Prime when shipping out to basic training. Spouses and dependents may have other options to consider when the time is right–knowing what those options are is crucial to making the most informed decisions about your health insurance.

Read More: TRICARE Prime vs. Select: How to Decide

TRICARE Costs

Costs vary depending on your plan. For example, an active duty service member who is enrolled today in TRICARE Prime will pay zero dollars in premiums and there is no deductible. Compare that to TRICARE Reserve Select, which features the following costs from 2022:

  • Service Member only: $46.70/month
  • Service Member and Family: $229.99/month

Much depends on whether you are getting a premium-based plan or not. Some TRICARE plans such as Prime Overseas costs may depend on whether you have selected a “point of service” plan or not. In many cases when serving overseas you will get your primary care on-base or on-post, with referrals to off-base providers in the network possible depending on the need and other factors. Active duty service members don’t have the point-of-service option but their family members may.

Getting Medical Care Under TRICARE

You will typically use a care provider within your network, which may be an on-base clinic or hospital but may also include off-base non-military options. You may also qualify for TRICARE coverage with authorized non-network providers, depending on the circumstances.

Options vary between plans, you will need to review the specific policies of the TRICARE plan you qualify for to learn what is possible under that plan.

An authorized TRICARE provider is described on the official site as, “any individual, institution/organization, or supplier that is licensed by a state, accredited by a national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE.”

Read More: What TRICARE Covers

Carrying Other Health Insurance Besides TRICARE

The TRICARE official site notes that active duty service members cannot carry other health insurance besides TRICARE. That rule does not apply to dependents and spouses. Under federal law, TRICARE pays after all other health insurance, except for:

  • Medicaid
  • TRICARE supplements
  • State Victims of Crime Compensation Programs
  • Other Federal Government Programs

Spouses and dependents who carry other health insurance such as that through an employer will have that insurance pay first. Once that payment is made your care provider can submit a claim for any qualifying remainder via TRICARE.

Spouses and dependents with other health insurance are advised to follow the rules of your main insurer for care and claims, and if your main insurance denies a claim because you did not follow their rules TRICARE may likewise deny the claim. It’s best not to treat TRICARE as a “second chance” option if you fail to meet the requirements of your primary insurer.

Read More: Using Other Health Insurance Besides TRICARE

Getting Other Medical Treatment and Care

Military spouses, dependents, veterans, and military retirees may have additional health care treatment options from the Department of Veterans Affairs. Most currently serving military members know they may qualify for VA medical care depending on their circumstances, but did you know that certain qualifying spouses and dependents may also be eligible for VA care? When exploring your TRICARE options, it’s important to also use any other medical benefits offered to you as a dependent or spouse.

Read More: VA Health Benefits For Military Spouses And Dependents

Enrolling In TRICARE

Knowing the type of TRICARE plan you need is key, but timing also counts. Your prior health coverage may have had similar features to plans offered by TRICARE in that you can enroll in or change during an open season period, or after a Qualifying Life Event (QLE). If you are selecting a premium-based plan such as the Continued Health Care Benefit Program you can enroll at any time.

A QLE can be a marriage, the birth of a child, or retirement from active duty. QLEs offer you a three-month (90 days) opportunity to change your TRICARE enrollment. If you aren’t sure about your options or your eligibility for a specific TRICARE plan, review your eligibility online or call 1-800-538-9552 to get assistance.

Depending on the QLE you may gain or lose certain health care coverage options. If you have a QLE you may be able to change your current TRICARE plan or enroll in a new one.

Read More: TRICARE Qualifying Life Events And Your Health Insurance

TRICARE Coverage Exclusions

There is a list of “covered services” on the TRICARE official site, which is too extensive to publish here, but includes services deemed medically or psychologically necessary. There is also a list of specific issues that are NOT covered by TRICARE under any circumstances. Those include, but are not limited to:

  • Alternative Treatments
  • Assisted Living Facility Care
  • Augmentation Mammoplasty
  • Aversion Therapy
  • Blood Pressure Monitoring Devices
  • Elective Psychotherapy and Mind Expansion Psychotherapy
  • Elective Services or Supplies
  • Exercise Programs
  • Experimental Procedures
  • Fluoride Preparations
  • Gym Membership
  • Hospitalization for Medical or Surgical Error
  • LASIK Surgery
  • Massage
  • Medical Care from a Family Member
  • Therapeutic Absences from Inpatient Facility
  • Uncovered Services and Supplies
  • Unnecessary Diagnostic Tests or unnecessary Inpatient Stays
  • Unproven Procedures
  • Vestibular Rehabilitation
  • Vision Therapy

There is no value judgment inferred from inclusion in the list above. As you can see, it’s a mixed bag of legitimate services that simply aren’t covered by TRICARE and services which may yet be unproven or not considered medically necessary. Such lists are subject to change, it’s best to speak with a TRICARE rep before you assume certain types of care may or may not qualify for coverage.

Use the TRICARE Covered Services tool at the TRICARE official site to see what may be currently approved under TRICARE. You can search via the link above using relevant keywords or categories.

Read More: TRICARE and Non-Covered Services

Is TRICARE Available Worldwide?

The United States has two TRICARE regions.

  • TRICARE East
  • TRICARE West

Overseas, TRICARE features a single region divided into three separate areas:

  • TRICARE Eurasia-Africa
  • TRICARE Latin America and Canada
  • TRICARE Pacific

What to Know About TRICARE Coverage

No two TRICARE options are exactly the same. Here’s what you need to know about some of the basic differences between these plans.

TRICARE for Active Duty

Active duty service members are covered in TRICARE from the moment they begin their military service, but they must enroll in the program when the opportunity is available. Initial coverage lasts six months before going on active duty after initial training and technical training.

There are a variety of active duty TRICARE options including:

  • TRICARE Prime
  • TRICARE Select
  • TRICARE Prime Overseas
  • TRICARE Select Overseas

Active duty troops, as mentioned above, cannot use any other health insurance program other than TRICARE. The same is NOT true for spouses and dependents as we will examine below.

Read More: TRICARE for Active Duty Service Members 

TRICARE for Spouses and Dependents

Spouses and dependents of active duty service members have options under TRICARE including but not necessarily limited to:

  • TRICARE Select: a preferred provider organization plan (PPO) offered to those in the United States.
  • US Family Health Plan: this is a TRICARE Prime option available through networks of community-based health care systems. This plan is not offered to all and is not nationwide. It is available only in “designated US Family Health Plan” areas.
  • TRICARE Select Overseas: This plan provides comprehensive coverage for family members living at overseas duty locations.

Read More: TRICARE for Spouses and Dependents

TRICARE For Reserve And National Guard Members

TRICARE benefits will vary based on the service member’s status. One of the most important initial benefits is something called Line of Duty Care which applies to members of the Guard and Reserve who are injured or get sick in the line of duty up to and including weekend drills, ADT, IDT, or other official training. TRICARE coverage is provided for travel to and from official duty as well.

Line Of Duty coverage is designed to address issues that may require an emergency room visit during Guard/Reserve training that is not considered being ordered to active duty, federal service, etc.

Line Of Duty care is separate from other TRICARE coverage such as TRICARE Reserve Select, pre-activation benefits you may be entitled to when called to federal service, and benefits provided under military transition assistance programs.

Read More: TRICARE Benefits For Guard and Reserve Members.

TRICARE Options for Retirees

It should be noted that when we discuss “retirees” in this context we are referring specifically to military members who are eligible to draw military retirement pay. We are not referring generically to all who are retired from work in general, just those who retired from military service.

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

These healthcare options are offered based on location (stateside or overseas) and in some cases by age (TRICARE For Life is one example). Co-pays and enrollment fees may apply depending on age, status (Guard/Reserve versus active duty), and eligibility for Medicare Part A and B.

TRICARE Prime is the stateside option for those who have retired from the military and have not reached the age for Medicare eligibility. Once you have reached the age of eligibility for Medicare, you are no longer approved for TRICARE Prime as a retiree and must choose one of the other options open to those who can also use Medicare.

TRICARE requirements for members of the National Guard and the Reserve are different from those who retired from active duty service, and you may need to contact a TRICARE rep to discuss your specific circumstances if you have both active service and Guard/Reserve service in your military career history.

Read More: TRICARE For Active Duty Retirees

 

 

TRICARE Qualifying Life Events and Your Health Insurance

When you enroll in TRICARE, your status as a single or married service member determines the type of coverage you’ll enroll in.

So does your status as an active duty service member. When these things change, they may be considered Qualifying Life Events, which provides an opportunity to modify your TRICARE coverage within a 90-day window of the event. You may (depending on circumstances) be able to enroll in a new TRICARE plan or change the nature of your health care coverage in other ways.

Qualifying Life Events (QLE)

If you get married, have a child, experience a death in the family, or separate from military service, you have experienced a TRICARE QLE.

Basically, any change in your status that may require additional health care coverage may be considered a QLE from what’s already been mentioned above to other situations like dependent children becoming adults or moving away to college, accepting military retirement pay, or other factors.

These are not the only ones that may open a 90-day window for you to change your coverage, but no matter how you experience a QLE it is important to review your current policy and talk to a TRICARE rep to learn how you may be able to change your health care to suit your current needs.

In order to modify an existing plan or enroll in a new one, you must update DEERS with information related to your Qualifying Life Event, make enrollment changes within 90 days, and pay any required fees or premiums needed for the new coverage.

A List of TRICARE Qualifying Life Events

This list may not be comprehensive. QLE requirements are subject to change through legislation, TRICARE program changes, or other variables. The following list is current at press time:

  • Retiring or separating from active duty
  • Activating or deactivating for federal service
  • Getting married or divorced
  • Getting an annulment
  • Birth or adoption of a child
  • Having a child placed in the home by a court
  • Children becoming adults
  • Death in the family
  • Children moving away to college
  • Relocation to a new zip code
  • Gaining or losing a Primary Care Manager
  • Dependents gaining or losing command sponsorship at a military assignment
  • Turning 60
  • Becoming eligible for Medicare
  • Gaining or losing other health insurance

What to Know About Qualifying Life Events

Some QLEs aren’t good. Losing a Primary Care Manager (PCM), for example, requires you to find a new one and begin a new relationship with your replacement PCM. Other situations are just as unpleasant, but more punitive. A good example would be a dependent losing command sponsorship at an overseas assignment due to misconduct–not uncommon depending on the location and other variables.

What do you need to know about TRICARE in such cases? If you don’t report these changes in status for TRICARE beneficiaries, when it comes time to get care for these beneficiaries you may be denied payment under TRICARE and be liable for the full cost of the care. Failing to report QLEs in cases where coverage eligibility is in question may result in a loss of coverage.

This is also true in cases where the enrollee is about to age into Medicare or start drawing military retirement pay. If you do not choose to modify your TRICARE coverage in these cases you may lose it when you age out or officially become a military retiree.

What to Do After a Qualifying Life Event

After any QLE you will need to update your DEERS records to reflect your new status after the event. Once your DEERS records are updated you can make any TRICARE changes  you’re authorized to make online, by mail, or by phone.

You May Not Have to Change Your Coverage

If you experience a TRICARE Qualifying Life Event, you are not required to modify your coverage in certain cases. In others you are definitely required to act.

In cases where you remain eligible for the current health plan following the QLE, you do not need to do anything. If you are not in a health plan and fail to enroll, your only healthcare options may be military hospitals and/or clinics. You are not guaranteed treatment under such conditions, it may be provided on a space available basis.

In cases where you are due to retire from active duty you must make a TRICARE “enrollment decision” within 90 days of your retirement date. Failure to do so may result in your losing health care coverage.

Making Enrollment Changes When You Haven’t Experienced a QLE

You do not have to wait until you experience a Qualifying Life Event to change your TRICARE coverage, but if there is no QLE you will have to wait until TRICARE open season begins. Open Season happens annually starting on the Monday of the second full week in November to the Monday of the second full week in December.

In 2022 open season was scheduled for November 14 through December 13, 2022. If you decide to make changes in your enrollment during open season, those changes may typically happen at the beginning of the new year.

Who Does Open Season Apply to?

The TRICARE official site says open season enrollment is for anyone in or eligible to enroll in TRICARE Prime options including TRICARE Select and the U.S. Family Health Plan. Those eligible for open season have three courses of action they can use:

  • Remain in your current TRICARE plan. You will not be required to re-enroll and you can stay in the plan as long as you are eligible to do so.
  • Enroll in a TRICARE plan if you are eligible but not currently enrolled in TRICARE plans such as Prime or TRICARE select.
  • Change TRICARE plans. Are you already enrolled in a TRICARE Prime option or TRICARE Select? The TRICARE official site says you are permitted to change plans and/or switch between individual and family TRICARE enrollment.

Enrolling In TRICARE Health Plans

Coverage by TRICARE is automatic when troops are sent to basic training. That does NOT mean you are automatically ENROLLED in a healthcare program. When it is time to enroll or to change your enrollment, you can do so online using the milConnect portal, or you can submit enrollment forms by mail or fax. There are different forms for TRICARE Prime, TRICARE Select, and the U.S. Family Health Plan. You can also enroll by phone. You will need to call a regional contractor or coordinator:

Starting or changing your healthcare coverage may require you to provide proof of identity, updated DEERS records, and other information. The safety of your private data including account numbers, Social Security Numbers, and other information is key–you will need to remember some best practices where safeguarding your personal data is concerned.

When you begin or change TRICARE coverage, keep in mind that you should never give out private information including bank account numbers or routing numbers to third parties who have called you unsolicited. It’s one thing for you to call the number or numbers listed above to make arrangements for coverage.

It’s another thing entirely to get a phone call you did not solicit from a number you don’t recognize and have that person claim to be your health insurance representative. Never give private data or payment data to someone who has called you unsolicited.

TRICARE warns about such scams. Always refuse to give information to people who have called you. It’s different when YOU have called THEM. If you suspect you have been contacted by a scammer claiming to represent TRICARE, contact a representative immediately. If you gave any personal data to the caller, be sure to let the representative know and be sure to ask what steps you need to take next to protect your accounts and your identity.

 

 

Using Other Health Insurance Besides TRICARE

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
  • Survivors
  • 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:

  • Medicaid
  • 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.

TRICARE for Active Duty Military Retirees

Many who retire from active duty military service are a decade or more away from qualifying for Medicare or other age-based 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, and 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. We will cover TRICARE options for those who have retired from the National Guard or the Reserve in a separate article. 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

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

 

 

TRICARE for National Guard and Reserve Members

TRICARE Benefits for Reserve and National Guard Members

Members of the National Guard, Reservists, and their families may be eligible for coverage under TRICARE. Eligibility depends on the service member’s military status, which may change many times over a career in the Guard or Reserve. Your care options may vary depending on whether your current status is:

  • Inactive
  • Activated
  • Deactivated
  • Retired

You and your family can verify basic eligibility for TRICARE via the Defense Manpower Data Center or by logging into Beneficiary Web Enrollment (BWE) on the MilConnect official site. Family members are eligible if they are listed in DEERS and the service member qualifies for TRICARE.

To log in to these portals to check TRICARE eligibility, you need one of the following:

  • Common Access Card (CAC),
  • DFAS (MyPay) Account, or
  • DoD Self-Service Logon (DS Logon) Premium (Level 2) account

What TRICARE Benefits Are Provided for Reserve and National Guard Members?

The TRICARE benefits and health plan options below depending on the service member’s status.

  • Line of Duty Care
  • TRICARE for Inactive Guard/Reserve (on duty 30 days or less)
  • TRICARE When Activated (on duty for more than 30 days)
  • TRICARE When Deactivated
  • TRICARE When Retired

TRICARE Line Of Duty Care

Line Of Duty care applies to members of the Guard and Reserve who, “…incur or aggravate an injury, illness, or disease while in the line of duty” which can include drill weekend, ADT, IDT, or other training as specified on orders. Coverage is provided for travel to and from official duty as well.

You will not show up in DEERS as being eligible for TRICARE under these circumstances, However, Line Of Duty coverage is meant to anticipate circumstances that may result in an emergency room visit during military training in a Guard/Reserve capacity. Line Of Duty care is completely separate from other TRICARE coverage such as TRICARE Reserve Select, pre-activation benefits you may be entitled to when called to federal service, and benefits provided under military transition assistance programs.

Due to the nature of this coverage, TRICARE Line of Duty coverage is NOT considered minimum essential coverage for the purposes of meeting the requirements of laws like the Affordable Care Act.

TRICARE for Inactive Guard/Reserve on Duty for 30 Days or Less

TRICARE Reserve Select is offered to those who are not on active duty orders, not covered under other Transition Assistance programs such as TAMP, and to those who are not eligible for the Federal Employee Health Benefits program. TRICARE Reserve Select is a premium-based health insurance plan offered to qualifying members of the Guard/Reserve and their families worldwide.

The TRICARE official site notes that those in the Individual Ready Reserve do not qualify for this healthcare option.

If you have TRICARE Reserve Select, you may get care from an authorized provider in your network or out-of-network.

TRICARE for Activated Guard and Reserve Members

Those who are activated and placed on active duty status are enrolled in one of the following plans depending on the location of duty; stateside, overseas, stateside remote duty, or overseas remote duty. Plans include:

  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas

You will be covered by one of these plans as applicable but you are required to formally enroll, typically when you arrive at the duty station. Family members may be added to your plan at enrollment time. TRICARE is the only health benefit option you have when activated for federal active duty service. TRICARE coverage allows you to claim zero out-of-pocket expenses when claiming “covered services” and when you do have to pay, TRICARE reimburses you 100%.

TRICARE Coverage When You Are Deactivated

There are two options for coverage when you are deactivated. One is TRICARE Reserve Select (see above) which is offered first. This is for those who are not on active duty orders, not covered under other options such as TAMP, and to those who are not eligible for the Federal Employee Health Benefits program.

When you are deactivated, you have another option to claim benefits under a program called  TAMP; the Transitional Assistance Management Program. This adds 180 days of health care benefits which begin after regular TRICARE benefits end. There are no premiums to be paid for under TAMP.

Who is eligible for TAMP?

Sponsors and eligible family members who meet one of the following conditions:

    • You are involuntarily separating from active duty under honorable conditions
    • You received a voluntary separation incentive (VSI)
    • You received voluntary separation pay (VSP) and can’t receive retired or retainer pay upon separation.
    • You are a Guard or Reserve member separating from a period of more than 30 consecutive days of active duty for a pre planned mission, or working to support a contingency mission or COVID-19 response
    • Separating following involuntary retention (AKA “stop loss”) in support of a contingency operation
    • Separating after agreeing to remain on active duty for less than one year in support of a contingency operation
    • Receiving a sole survivorship discharge
    • Separating from regular active duty service and agreeing to become a member of the Selected Reserve of a Reserve Component.

You can view your eligibility for TAMP in DEERS or via MilConnect.

TAMP Coverage Periods

During TAMP coverage periods, you and your family members may qualify to enroll for or use one of the following:

    • Military care facilities
    • TRICARE Prime
    • TRICARE Select
    • US Family Health Plan
    • TRICARE Prime Overseas
    • TRICARE Select Overseas

As mentioned earlier in this article, TRICARE coverage options like Prime and Select are based on duty location.

TRICARE When Retired

If you retire from military service, having served the full duration of a military career 20 creditable years or more in the Guard or Reserve, you may qualify for TRICARE benefits as a military retiree. It’s important to note that you must draw a military pension or be eligible to draw one to qualify. Being retired in a non-military sense has no bearing on this coverage or its availability.

Retired Reserve members and their families have TRICARE options which are based on the age of the military member. For those under 60 years old, you may qualify to buy into TRICARE Retired Reserve; turning down this option means you will not qualify for other TRICARE retiree coverage until you turn 60.

For those who opt-in to TRICARE Retired Reserve who have children who are about to age out of TRICARE, an option called TRICARE Young Adult may help.

For those ages 60 or older,  the TRICARE official site says, “you and your family become eligible for the same TRICARE health benefits as all other retired service members” and such options depend on where you live. Stateside the following options apply:

  • TRICARE Prime
  • TRICARE Select
  • TRICARE For Life (with Medicare Part A & Part B)
  • US Family Health Plan

Outside the United States, the following options may be offered to you:

  • TRICARE Select Overseas
  • TRICARE For Life (with Medicare Part A & Part B)

Things to Know About TRICARE Options for Family Members of National Guard or Reserve Members

Your TRICARE coverage is provided when the service member is eligible for the coverage. These scenarios can include circumstances where one of the following applies:

  • On military duty for less than 30 days
  • Activated
  • Called to active duty service for more than 30 consecutive days
  • Deactivated-after leaving active duty for more than 30 consecutive days

Did you know you can purchase TRICARE Dental Program coverage? This is an option completely separate from the other TRICARE coverages, and you must enroll for dental coverage. As mentioned above, all dependents to be covered under TRICARE must be registered in DEERS.

Those who are eligible for TRICARE and Medicare Part A should know that you are typically required to carry Medicare Part B in order to continue using TRICARE.

 

 

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