Alyssa Lane
Tricare is the U.S. military's health care program that functions as government-managed health insurance. It is often considered the gold standard for medical coverage. Tricare offers a range of insurance programs for military personnel and their families, including active-duty families, National Guardsmen, reservists, and military retirees. However, some people may wonder if Tricare is worth keeping compared to civilian insurance. This decision depends on various factors, such as eligibility, cost, coverage, and provider availability. While some individuals may prefer Tricare due to its comprehensive coverage and low costs, others may opt for civilian insurance for a wider range of provider options, especially in specialized areas like mental health.
| Characteristics | Values |
|---|---|
| Cost | Tricare is cheaper than civilian insurance. |
| Coverage | Tricare covers more than civilian insurance. |
| Copay | Tricare has less copay than civilian insurance. |
| Network | Tricare has a smaller network of providers than civilian insurance. |
| Mental Health Counselors | Tricare has fewer mental health counselors than civilian insurance. |
| Dental/Eye Premiums | Tricare has higher dental/eye premiums than civilian insurance. |
| Deductibles | Tricare has lower deductibles than civilian insurance. |
| Eligibility | Tricare is only available to current and former military service members and their families. |
| Management | Tricare is government-managed health insurance, while civilian insurance is privately managed. |
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What You'll Learn
Tricare's eligibility criteria
Tricare is a healthcare program for service members and their families, retirees and retiree families, survivors, and certain former spouses worldwide. This includes active-duty service members, active-duty family members, National Guard and Reserve members, and their families. To be eligible for Tricare, you must be listed in the Defense Enrollment Eligibility Reporting System (DEERS). If you live overseas with an APO/FPO address, you must list this as your mailing address.
Tricare eligibility also depends on the specific Tricare plan. There are several plans available, including Tricare Prime, Tricare Select, TYA, TRS, and TRR. Each plan has different costs for care and coverage. To see what Tricare plans you may be eligible for, you can use the Tricare Plan Finder tool. Once you know your plan, you can visit Tricare Enrollment to learn how to enroll or purchase a plan. You can also use the Tricare Covered Services tool to see if a specific service is covered.
It's important to note that dental coverage is separate from Tricare's medical coverage, and your eligibility for dental coverage may differ. To confirm your eligibility for Tricare, you can do so online or by calling 800-538-9552. Your service personnel office can also help you determine your Tricare eligibility.
For providers, it is essential to verify Tricare eligibility for beneficiaries at the time of service. A valid Common Access Card (CAC), uniformed services ID card, or eligibility authorization letter is required. Additionally, beneficiaries must provide valid ID information and eligibility dates.
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Civilian insurance: availability and limitations
Civilian insurance is widely available, and can be obtained through an employer or a private insurance programme. It is possible to have civilian insurance in addition to Tricare, though Tricare will only pay out after other insurance providers. This means there is no coordination of benefits, and you are responsible for all costs.
Civilian insurance providers may have exclusions for military duty status, and may not pay for care or may recoup claims for services received while on active duty. It is important to disclose your military status to your insurance provider to avoid claim denials or recoupments. Civilian providers must also comply with Service regulations, which include providing all medical records to your current primary care manager.
Civilian insurance can be more flexible than Tricare, allowing you to keep your regular doctors and dentists, and often has a better acceptance rate for specialists such as mental health counsellors. However, it may be more expensive, with higher premiums and deductibles.
Civilian insurance can be a good option for those who want to keep their existing doctors and specialists, or for those who need more flexible coverage. It is important to carefully consider the costs and benefits of both Tricare and civilian insurance before making a decision.
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Cost comparison
Tricare is the US military's health care program and functions as government-managed health insurance. It is often considered the gold standard for medical coverage. Tricare offers several coverage plans for current and former service members and their families. The cost of Tricare depends on military service status. For example, an active-duty family enrolled in Tricare Prime pays no fees, while retiree families pay out of pocket. In 2023, the average employer-provided family healthcare plan cost $23,968, with employees typically paying 29% of the overall cost or $6,575 a year. In comparison, Tricare Prime costs $726 annually with a $3,000 catastrophic cap, while Tricare Select costs $356 annually with a $4,157 catastrophic cap.
Tricare users have reported that the insurance is cheaper and covers more with lower copays, especially for families. For example, one user reported that giving birth cost them only $80 with Tricare. Additionally, Tricare Reserve Select is very much worth it, according to another user, who paid a lower premium for health, dental, and eye care but had a higher deductible.
However, it is important to note that Tricare may have limited provider options outside of primary care. Some users have reported difficulty finding specialists such as pediatricians and mental health counselors that accept Tricare.
Active-duty service members can use other health insurance (OHI) under certain circumstances and when complying with DoD and Service regulations. However, Tricare won't be the second payer, and there is no coordination of benefits with OHI. Service members are responsible for all costs associated with OHI, and their military status must be disclosed to avoid claim denials or recoupments. Additionally, Tricare processes claims after other health insurance, and claims must be filed with other health insurance first.
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Coverage and benefits
Tricare is the US military's health care program and functions as government-managed health insurance. It is often considered the gold standard for medical coverage. It offers many insurance programs for service members and their families, including active-duty families, National Guardsmen and reservists and their families, and military retirees and their families.
Tricare brings together the healthcare resources of the Military Health System, such as military hospitals and clinics, with a network of civilian healthcare professionals, institutions, pharmacies, and suppliers. The Military Health System is a global, comprehensive, integrated system. Depending on your plan, you may be able to get care from a military hospital or clinic, a civilian network of providers, or Tricare-authorized non-network providers. There are two types of Tricare-authorized providers: Network and Non-Network. Users are responsible for all costs when using non-network providers and may have to file their own claims.
Tricare offers various specialized programs, including Tricare for Life, which is Medicare wraparound coverage for Tricare beneficiaries with Medicare Parts A and B, and Tricare Young Adult, which qualified adult children can purchase after eligibility for regular Tricare coverage ends. There are also three dental programs: the Active Duty Dental Program, the Tricare Dental Program, and the Retiree Dental Program. Tricare Overseas provides healthcare for those relocating overseas, and Tricare pharmacy options allow prescriptions to be filled at military or civilian pharmacies.
As an active-duty service member, you can use other health insurance under certain circumstances and when complying with DoD and Service regulations. However, Tricare will not be the second payer, and there is no coordination of benefits with other health insurance. Other health insurance may have exclusions for military duty status and may not pay for care received while on active duty. It is important to disclose your military status to your other health insurance to avoid claim denials or recoupments. If Tricare pays first and then discovers you had other health insurance, it will take back any payments made and reprocess your claim only after your other health insurance has paid.
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Claims and reimbursements
If you are using civilian providers, you must comply with Service regulations, which include providing all medical records to your primary care manager. It is also your responsibility to keep your doctor and contractor updated on your other health insurance. If Tricare pays first and then discovers you have other insurance, they will take back the payment and reprocess your claim only after your other insurance has paid.
Tricare recommends that you download and submit your region's other health insurance form. Your claim must first be filed with your other health insurance, and if denied, Tricare may also deny the claim. If your other insurance does not cover the entire cost, you can file a claim with Tricare. It is important to note that Tricare will not be the second payer and will not coordinate benefits with your other insurance.
If you are using a Tricare-authorized civilian provider, you may have higher costs, and you may need to file your own claims. In terms of reimbursements, a Reddit user mentions that even if you go out of network, providers can legally charge only up to 15% of the standard amount, which can be beneficial in terms of cost-saving.
Overall, while claims and reimbursements may vary depending on your specific situation and plan, it is important to stay informed about the regulations and keep your providers and contractors updated to ensure smooth processing.
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Frequently asked questions
Tricare is the U.S. military's health care program and functions as government-managed health insurance. It offers various coverage plans for current and former service members and their families.
Tricare is often considered the gold standard for medical coverage. It is cheaper and covers more with less copay. It also has a low deductible and allows users to keep their regular PCP.
One drawback is the limited provider options outside of primary care. Some users have also reported difficulty finding mental health counselors that accept Tricare.
Yes, you can use other health insurance alongside Tricare, but only under certain circumstances and in compliance with DoD and Service regulations. However, Tricare will not be the second payer, and you are responsible for all costs.
