When you retire from the military, knowing about your health coverage is key. TRICARE for retirees offers full medical benefits, cutting down healthcare costs. It’s important for retirees and their families to understand the plans, costs, and who qualifies. This guide will help you learn all about TRICARE for retirees.
What is TRICARE for Retirees?
TRICARE for retirees is a health insurance program for retired military personnel and their families. It has several plans to meet the healthcare needs of those who have served. This ensures they can keep getting healthcare after leaving the military.
TRICARE Coverage Upon Retirement
When you retire, you won’t automatically keep the same TRICARE benefits. Retirement is a Qualifying Life Event (QLE). You must reenroll in a TRICARE health plan within 90 days of retiring.
Important Steps Before Retirement:
- Plan Ahead: Get ready to act within 90 days to avoid losing coverage.
- Enroll in a New Plan: You’ll lose your active-duty TRICARE plan. You need to sign up for a new retiree plan to keep coverage.
- Update DEERS: Make sure your family’s info is current in DEERS. Outdated info can slow down your reenrollment.
TRICARE Plan Options for Retirees Under Age 65
Retirees under 65 have several TRICARE plans to choose from. Each plan has its benefits and costs. These plans cover medical, dental, and pharmacy needs. Here’s a look at the main options:
1. TRICARE Prime
TRICARE Prime is the most affordable option for those in certain areas. It’s like an HMO, needing a Primary Care Manager (PCM) for referrals to specialists.
- Key Features:
- Lower out-of-pocket costs.
- Use Military Treatment Facilities (MTFs) where available.
- Need referrals for specialist care.
- Best For: Those in areas with lots of military personnel or near an MTF.
2. TRICARE Select
TRICARE Select is more flexible than TRICARE Prime, like a PPO plan. You can choose your healthcare providers without referrals. But, your costs will depend on in-network or out-of-network providers.
- Key Features:
- No need for referrals to see specialists.
- Freedom to choose healthcare providers.
- Higher out-of-pocket costs than TRICARE Prime.
- Best For: Those who want to choose their providers or live far from an MTF.
3. US Family Health Plan (USFHP)
USFHP is available in certain parts of the United States. It’s an HMO-style plan that uses a network of private doctors. It offers all services that TRICARE Prime does, but through civilian healthcare systems, not MTFs.
- Key Features:
- Care is given by private civilian health systems.
- It includes pharmacy benefits.
- You must enroll in specific areas.
- Best For: Retirees in areas where USFHP is available.
4. TRICARE Select Overseas
TRICARE Select Overseas is for retirees outside the U.S. It offers flexibility like TRICARE Select but has different rules for claims and payments.
- Key Features:
- You can choose your healthcare providers.
- You pay for services first and then get reimbursed.
- Best For: Retirees abroad needing global health coverage.
5. TRICARE Retired Reserve (TRR)
TRR is for Retired Reserve members under 60. It’s like TRICARE Select but costs more and has higher cost-sharing.
- Key Features:
- It’s a PPO-style plan.
- Premiums are higher than for active-duty members.
- Best For: Retired Reserve members under 60 and their families.
| Plan Comparison for Retirees Under Age 65 | TRICARE Prime | TRICARE Select | US Family Health Plan | TRICARE Select Overseas |
|---|---|---|---|---|
| Cost | Lowest | Moderate | Moderate | Higher due to upfront costs |
| Provider Choice | Limited | Broad | Limited to USFHP network | Broad |
| Referral Requirement | Yes | No | Yes | No |
TRICARE For Retirees Over Age 65: TRICARE For Life (TFL)
At age 65, you become eligible for Medicare and TRICARE For Life (TFL) becomes your main coverage. TFL is a Medicare wraparound plan. It adds to your Medicare benefits by covering costs Medicare doesn’t, like copays and deductibles.
Key Features of TRICARE For Life:
- No Enrollment Required: You’re covered by TFL if you’re in Medicare Part A and Part B.
- Comprehensive Coverage: TFL covers inpatient and outpatient care and prescription drugs through TRICARE’s pharmacy benefits.
- Global Coverage: Unlike Medicare, TFL covers medical services worldwide. It’s great for retirees who travel or live abroad.
TRICARE For Life Benefits
| TRICARE For Life Benefits | Medicare Pays | TRICARE Pays | You Pay |
|---|---|---|---|
| Covered by Medicare and TRICARE | Medicare-authorized amount | Remaining amount | Nothing |
| Covered by Medicare only | Medicare-authorized amount | Nothing | Medicare deductible & cost-share |
| Covered by TRICARE only | Nothing | TRICARE-authorized amount | TRICARE deductible & cost-share |
Costs and Deductibles for Retirees
Retirees will notice a big change in healthcare costs. Unlike active-duty service members, retirees pay more out-of-pocket. But, TRICARE costs are much lower than civilian plans.
Common Costs Include:
- Annual Deductibles: The amount you must pay out-of-pocket before your plan starts paying for services.
- Cost-Shares: A percentage of the cost for covered services.
- Copayments: A fixed dollar amount paid for specific services like doctor visits.
- Enrollment Fees: An annual or monthly fee required to maintain your plan.
Healthcare costs will go up for retirees. But, they are much lower than what you’d pay for private insurance.
TRICARE Costs Breakdown for Retirees:
| Service Type | TRICARE Prime | TRICARE Select |
|---|---|---|
| Annual Deductible | $300 (Family) | $300 (Family) |
| Outpatient Visits | $20 copay | 20% cost-share |
| Specialist Visits | $30 copay | 25% cost-share |
| Enrollment Fees | $300 (Family) | $450 (Family) |
Supplemental Coverage Options for Retirees
TRICARE covers a lot, but retirees might want more. The Military Benefit Association (MBA) offers extra insurance. It can help with copays, deductibles, and other costs TRICARE doesn’t cover.
- TRICARE Supplement Insurance: Helps cover out-of-pocket costs for retirees and their families under 65.
- Hospital Indemnity Insurance: Provides daily cash payments for hospital stays, helping to cover expenses not included in TRICARE plans.
Frequently Asked Questions
1. How much does TRICARE for retirees cost?
TRICARE costs for retirees depend on the plan. TRICARE Prime is cheaper than TRICARE Select. TRICARE For Life has no enrollment fee but requires Medicare Part B.
2. What happens if I miss the 90-day enrollment window after retirement?
If you miss the 90-day window, you can enroll retroactively within 12 months of retirement. After that, you can only enroll during the annual open season or after a QLE.
3. Does TRICARE cover my family after retirement?
Yes, TRICARE covers your eligible family members. But, you must enroll them in the right plan. They also need to update their DEERS information.
TRICARE for retirees is a great option for those leaving the military. It offers affordable healthcare. Knowing about plan options, costs, and extra coverage helps retirees get the best care for their families.
