Jeffrey Wade
Military retirees have access to several health care benefits, including VA-provided medical benefits, Tricare, and other supplemental health care insurance options. Tricare is a comprehensive health care program that provides worldwide coverage for service members, retirees, and their families. It offers health plans, special programs, prescriptions, and dental plans. Tricare eligibility remains in force until the age of 65, after which retirees become eligible for Tricare for Life and Medicare. While Tricare offers many benefits, it does not cover all costs and has a yearly deductible and a cap on non-covered expenses. As a result, retirees may consider supplemental insurance policies to offset the costs not covered by Tricare. Overall, military retirees have access to a range of healthcare options to meet their needs, with the ability to choose the most suitable coverage for themselves and their families.
| Characteristics | Values |
|---|---|
| Eligibility | Military retirees and their families are eligible for Tricare. Eligibility ends at 65 years old. |
| Coverage | Includes comprehensive health plans, special programs, prescriptions, and dental plans. |
| Costs | Tricare has a yearly deductible and a yearly cap on non-covered expenses. |
| Supplemental Insurance | Tricare beneficiaries are encouraged to purchase supplemental insurance as Tricare does not cover all costs. |
| Medicare | Upon turning 65, Tricare beneficiaries become eligible for Tricare for Life and Medicare. |
| Medicare Part B | Required for Tricare beneficiaries who are eligible for Medicare under 65. |
| Medicare Part D | Most people over 65 sign up for Medicare Part D, but Tricare beneficiaries may not need to due to their pharmacy eligibility. |
| Dental Coverage | Tricare beneficiaries may be eligible for dental coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP). |
| Mental Health | Tricare covers a range of mental health and substance use disorders, including opioid treatment programs. |
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What You'll Learn
TRICARE eligibility and alternatives
TRICARE is the healthcare program for service members, retirees, and their families worldwide. It offers comprehensive coverage, health plans, special programs, prescriptions, and dental plans. When you retire, your TRICARE options change. If you don't enroll in TRICARE Prime or TRICARE Select within 90 days of retirement, you may request a retroactive enrollment up to 12 months from the date of your retirement.
TRICARE Prime, TRICARE Select, and, in certain areas, the US Family Health Plan are available to retirees. Retirees and their families can purchase TRICARE Prime coverage, but they have to pay an annual enrollment fee and copays for treatment. TRICARE Select is similar, but with higher copayments, cost-shares, and prescription costs. The US Family Health Plan is also available to retirees and their families, but they must pay an annual enrollment fee and copays for treatment.
TRICARE Retired Reserve is available to retired National Guard or reserve members and their families until they reach 60. At that point, they get the same options as retired active-duty members.
Once you turn 65, you are no longer eligible for the above programs. You can then purchase Medicare and TRICARE for Life. TRICARE for Life is free for retirees aged 65 and older if they purchase Medicare Part B coverage. For those living in the US, TRICARE for Life is a Medicare supplement. Medicare does not provide coverage outside the United States or US territories, so TRICARE for Life is the primary payer for healthcare received in other overseas locations.
TRICARE also fills prescriptions for beneficiaries while traveling. Those traveling domestically can have their prescriptions filled at a military pharmacy or TRICARE network pharmacy, get home delivery, or go to a non-network pharmacy and file a claim for partial reimbursement. If traveling overseas, beneficiaries can have their prescriptions filled at a military pharmacy or go to an overseas retail pharmacy and file a claim for reimbursement. It is recommended to fill prescriptions ahead of traveling, but if you run out of a prescription drug while traveling, TRICARE can help.
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Dependants' coverage
Dependants of retired military personnel are covered by the TRICARE Health Care Program, which provides comprehensive health plans, prescriptions, and dental plans. This coverage extends to the family members of retirees, ensuring they have access to healthcare services and prescriptions.
TRICARE offers a range of services for beneficiaries with special needs, including applied behaviour analysis, cancer clinical trials, durable medical equipment, home health care, hospice care, mental health care, and skilled nursing facility care. It also covers the cost of renting or purchasing medical equipment to improve the quality of life for retirees and their dependants. Additionally, TRICARE provides prescription drugs through the TRICARE Pharmacy Program, which offers four options: military pharmacies, home delivery, network pharmacies, and non-network pharmacies. These options are available worldwide, although there may be some limitations overseas.
For dental care, retirees and their dependants can utilise the Federal Employees Dental and Vision Insurance Program (FEDVIP), which offers a choice of multiple dental insurance companies. This program is also available for eligible beneficiaries who require vision insurance.
It is important to note that TRICARE eligibility for retirees and their dependants typically lasts until the retiree reaches the age of 65. At that point, TRICARE coverage ends, and the retiree becomes eligible for TRICARE For Life (TFL) and Medicare. To maintain TRICARE eligibility before turning 65, individuals must enrol in Medicare Part B.
In the case of the sponsor's death after retiring from active duty, surviving family members remain eligible for TRICARE with the same health plan options and costs. Surviving spouses remain eligible unless they remarry, and children remain covered until they age out or lose eligibility for TRICARE for other reasons.
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Dental and vision coverage
When it comes to dental and vision coverage for retired military personnel and their families, there are a few options available. One of the primary options is the Federal Employees Dental and Vision Insurance Program (FEDVIP), which is a voluntary program offered by the Office of Personnel Management (OPM). FEDVIP provides comprehensive dental and vision insurance to federal employees, including military retirees and their eligible family members. It is important to note that FEDVIP is separate from Tricare, and enrollees are responsible for paying the premiums.
FEDVIP offers a range of plan options, including both dental and vision coverage, from a choice of insurance carriers. The program allows enrollees to purchase insurance on a group basis, resulting in competitive premiums and no pre-existing condition limitations. There are standard and high option plans available. The high option plans offer more coverage for a higher premium and may be suitable for those anticipating major dental work. On the other hand, the standard option plans are more affordable and suitable for those who only need preventive dental care.
The VA Dental Insurance Program (VADIP) is another option for dental coverage. VADIP offers discounted private dental insurance for veterans and their family members who meet certain requirements. Eligibility for VADIP includes being a current or surviving spouse or dependent child of a veteran or service member and being enrolled in the Civilian Health and Medical Program of the VA (CHAMPVA). VADIP plans cover many common dental procedures, and enrollees can choose from a range of insurance providers, including Delta Dental and MetLife.
It is important to understand your specific dental and vision needs and to compare the different plans available to make an informed decision. Factors to consider when choosing a plan include premiums, deductibles, co-pays, annual maximums, and the availability of providers in your area. Additionally, it is worth noting that FEDVIP enrolment typically occurs during the annual Federal Benefits Open Season in November and December, with changes also permitted within 60 days of a qualifying life event.
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Mental health coverage
For those who are enrolled in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), mental health counseling is included in the benefits. Spouses, dependents, and survivors of veterans who meet certain service-connected disability requirements can benefit from CHAMPVA.
Additionally, VA health care benefits provide coverage for veterans and their families. Depending on household size and income, veterans may be able to get lower costs on monthly premiums and out-of-pocket costs on private insurance or qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP).
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Prescription coverage
TRICARE Prime is a health maintenance organization-type managed care program for which retirees are required to pay an annual enrollment fee. Enrollees are assigned a primary care manager who determines the most appropriate, available source of care, either a military treatment facility or a civilian network provider. TRICARE Prime is also an option for those on terminal leave.
TRICARE eligibility remains in force until the beneficiary turns 65 years old. Upon reaching 65, TRICARE ends, and the beneficiary becomes eligible for TRICARE For Life and Medicare. When using TRICARE For Life, TRICARE is the second payer after Medicare in most cases. With TRICARE pharmacy eligibility, it may not be in your financial interest to purchase Medicare Part D, the Medicare pharmacy benefit. If you have TRICARE, you don’t need to join a Medicare Prescription Drug Plan.
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Frequently asked questions
Tricare is a health care program for service members, retirees, and their families worldwide. It provides comprehensive coverage, health plans, special programs, prescriptions, and dental plans. Tricare eligibility remains in force until you are 65 years old. Upon reaching age 65, Tricare ends, and you become eligible for Tricare for Life and Medicare.
Tricare covers a range of mental health and substance use disorders. It offers opioid treatment programs, emergency inpatient hospital services, and office-based opioid treatment. Tricare also fills prescriptions for beneficiaries while traveling.
Tricare has a yearly deductible to be paid and a yearly cap on non-covered expenses. You are responsible for the cost of non-covered items up to the cap amount. There are lower copays and cost shares for non-active beneficiaries.
Yes, retirees have several other health care benefits to choose from, including VA-provided medical benefits and other supplemental health care insurance options.
