Tricare: Supplemental Insurance

TRICARE is the United States Military health care program for military members and their families, providing worldwide, comprehensive healthcare coverage including health plans that meet the minimum requirements of the Affordable Care Act, plus prescriptions, dental plans, and special plans tailored for certain types of medical conditions or coverage requirements. The TRICARE system is managed by the Defense Health Agency.

TRICARE requires certain co-pays and there may be health expenses not covered by a particular plan; that is where TRICARE supplemental insurance can help. But supplemental insurance should not be confused with TRICARE itself. The supplemental plan a servicemember and family might choose will not be affiliated with TRICARE but with another agency.

What Kinds Of Out-Of-Pocket Costs Might Require TRICARE Supplemental Insurance?

A service member’s individual out-of-pocket expenses under TRICARE will vary depending on the medical condition and the type of TRICARE plan the service member chooses. There are a variety of coverage options that have varying degrees of out-of-pocket costs.

TRICARE Coverage Options

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

Active duty military members who choose one of the TRICARE PRIME options have no out-of-pocket expenses, no enrollment fees, no network co-pays, and no point-of-service fees. Once the active duty military member starts adding family members, the potential for co-pays and out-of-pocket expenses begins.

Retirees, family members of military retirees, and other beneficiaries are subject to enrollment fees, co-pays, and point-of-service fees.

The non-Prime TRICARE options include more deductibles, co-pays, and other potential cost-sharing expenses. Active duty members typically pay less than other groups eligible for coverage for co-pays, deductibles, etc.

For those enrolled in certain programs such as TRICARE For Life, no enrollment fees apply but the veteran must be covered by Medicare Part A and Medicare Part B.

Not all plans feature the same requirements, co-pays, or deductibles, but it’s clear that once you move down from TRICARE Prime, additional expenses will apply that may make it worthwhile to explore TRICARE supplemental insurance options.

How Does TRICARE Supplemental Insurance Work?

The first thing to know about TRICARE supplemental insurance is that it is not associated with TRICARE at all, but rather provided by a third party. The U.S. government weighs in on supplemental insurance on the TRICARE official site, stating:

“Many military associations and private companies offer supplemental insurance policies. Unlike other health insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance, which pays first, supplemental insurance pays after TRICARE pays its’ portion of the bill.”

The TRICARE official site warns its’ insured clients to consider supplemental insurance carefully since the cost of the additional plan may exceed the actual out-of-pocket expenses the plan is designed to offset (depending on circumstances).

Does Everyone Need Tricare Supplemental Insurance Coverage?

The short answer is no. Active duty members are fully covered under TRICARE Prime options, and those with special circumstances may not necessarily need to resort to additional coverage thanks to a set of special TRICARE programs such as the Extended Care Health Option (ECHO).

The Extended Healthcare Option is open to TRICARE beneficiaries diagnosed “with moderate or severe intellectual disability, a serious physical disability, or an extraordinary physical or psychological condition” according to the TRICARE official site. Those beneficiaries include:

  • Transitional Compensation Program
  • Active duty family members;
  • Family members who are covered under the Transitional Assistance Management Program
    Children or spouses of former service members who are victims of abuse and qualify for the
  • Family members of deceased active duty sponsors (while still considered “transitional survivors.”)
  • Family members of activated or ordered to active duty service for more than 30 days in a row including the Army National Guard, Army Reserve, Navy Reserve, Marine Corps Reserve, Air National Guard, Air Force Reserve, U.S. Coast Guard Reserve;

TRICARE Policy Changes May Affect Your Coverages

Some who started out not interested in TRICARE supplemental insurance may, due to policy changes and other factors, wind up needed supplemental coverage. A good example of this was the 2013 TRICARE policy changes that resulted in certain military retirees losing access to TRICARE Prime and needing to switch to TRICARE Standard.

That policy change affected military retirees, their dependents, surviving dependents, and TRICARE Young Adult members who live outside a reasonable commuting distance to the nearest military medical facility or base closure site.

The switch to TRICARE Standard in those cases resulted in changes to co-pays and other expenses, and likely sent some former TRICARE Prime enrollees affected by that change in search of supplemental insurance.

TRICARE reserves the right to change its’ policies in the future, so knowing your options for additional covered if and when needed is definitely a good idea if future medical expenses are anticipated for chronic conditions, recurring issues, etc.

Reserve Activation, National Guard & Tricare

If you’re a National Guard or Reserve member moving into an activated status for more than 30 days, you qualify for Tricare under the same programs as all active-duty troops. That coverage lasts the length of your activated service.

How do activated Guard and Reserve members enroll in Tricare or shift their Tricare coverage from the Tricare Reserve Select plan to the active-duty plans? Here are the details.

How Activated Guard and Reserve Members Enroll in Tricare

When your Active Guard Reserve (AGR) Title 32 or Title 10 orders of 30 or more days are updated in the Pentagon’s personnel system, known as the Defense Enrollment Eligibility Reporting System (DEERS), you are automatically enrolled in the Tricare Prime plan.

That plan allows you to receive primary and specialty care with no out-of-pocket costs, but does require referrals if you need to see anyone other than your primary care provider. If you live within about 45 minutes of a military treatment facility, it could also mean that you’re required to be treated on base. That could be a big change if you already have medical care in your community that you know and like.

A second plan option, known as Tricare Select, allows you to be seen off base at a civilian doctor of your choice, and does not require referrals for specialty care. However, you will be required to pay cost shares, with a $1,000 cap each year. How much you pay for visits depends on when your service member first joined the military and whether your doctor is in-network.

Since your enrollment defaults to Tricare Prime, if you want to instead use the Tricare Select plan, you’ll need to call your regional contractor.

How Activated Guard and Reserve Members Move from Tricare Reserve Select

When your orders of 30 or more days are updated in DEERS, your Tricare enrollment will automatically switch from Tricare Reserve Select, a plan for which you pay a monthly premium, to Tricare Prime, which carries no out-of-pocket costs for those who get referrals and see in-network doctors. Like those using Tricare for the first time, if you want to switch to Tricare Select, you’ll need to contact your regional contractor.

How Tricare Costs Differ Between Tricare Reserve Select and Active-Duty Tricare

Tricare Reserve Select is a premium-based plan, and costs about $220 a month for a family. Once activated, the service member’s care is provided on base at no cost, while the family is instead covered by one of the active-duty family Tricare plans. Unlike Tricare Reserve Select, those plans do not have a monthly premium fee.

Tricare Reserve Select carries deductibles and cost shares set by federal law, tied to a schedule known as “Group B,” regardless of when the service member joined.

Activated families can choose to use Tricare Prime, which carries no fees so long as users follow referral rules, or Tricare Select, which comes with out-of-pocket fees at many visits, just like Tricare Reserve Select.

How much activated families on Tricare Select pay, however, depends on when the service member originally joined. If that date was before Jan. 1, 2018, the fees are tied to a schedule known as “Group A.” If they joined after that date, the fees are tied to the same schedule as Tricare Reserve Select, “Group B.” That means that, depending on original join-up date, your out-of-pocket fees on Tricare Select may be the same as they were on Tricare Reserve Select.

Out-of-Pocket Costs Don’t Reset When You Switch

When you switch plans due to activation or any change in status, such as retirement, your out-of-pocket fees don’t reset. That means if you already paid $600 toward your annual out-of-pocket max, known as the catastrophic cap, while on Tricare Reserve Select, you won’t reset to $0 paid when you’re switched to an active-duty family plan.

Your Premium Will Be Refunded

If you already paid your Tricare Reserve Select monthly premium, the money will be repaid by check at a prorated amount from the date of your active-duty orders. You can call your regional contractor to confirm that the reimbursement check has been processed.

Changing Back to Tricare Reserve Select

If you were active for 30 or more days for a contingency operation, typically an overseas deployment in support of the wars, you will receive 180 days of active-duty family Tricare through Tricare Select or Prime after your orders end.

If you are moving back to regular drilling Guard or Reserve status, you can shift back to Tricare Reserve Select as your activation time ends. You’ll owe the typical Tricare Reserve Select premium payment, and it must be turned in by mail with a Reserve Component Health Coverage Request Form (DD Form 2896-1) postmarked no later than 60 days after the loss of your active-duty coverage.