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.