Tricare Standard Supplemental Insurance
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Many military
associations and private companies offer supplemental
insurance policies. Before purchasing a supplement, however,
TRICARE beneficiaries should carefully consider their
individual and family members’ health care needs. Unlike
Other Health Insurance (OHI), which pays first for health
care services before TRICARE pays—supplemental insurance
always pays after TRICARE pays.
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After
TRICARE pays its portion of the bill, supplemental insurance
reimburses TRICARE beneficiaries for out-of-pocket medical expenses
paid to civilian providers based on the supplemental plan coverage
policies. Each supplemental insurance plan may have its own rules
regarding eligibility, benefits covered, pre-existing medical
conditions, cost shares and deductibles and procedures for claims
processing. Cost shares for TRICARE beneficiaries may be substantial
if they use TRICARE Standard or Extra. Below is a list of questions
to help beneficiaries decide if they should purchase a supplemental
insurance.
1. What type of health care services does the supplement cover? Will
the plan cover amounts beyond what TRICARE allows?
2. Does the supplement pay for services not covered by TRICARE or
limit the conditions it does cover?
3. How much is the supplement premium? How often is it paid?
4. Are there different premium rates based on military status
(active or retired) or age?
5. Can premium payments be increased? Under what conditions?
6. Is there a deductible to pay before the supplement pays?
7. Is there a maximum limit on benefits (lifetime, annual, etc.)?
8. Is there a pre-existing condition clause? If so, how long is the
waiting period?
9. Are there treatments that must be pre-approved before care can be
received?
10. Does the supplement cover enrollment fees or copays?
11. Will the supplement pay my cost-share under the TRICARE
Diagnostic Related Group system?
12. Does the TRICARE supplement convert to a Medicare supplement? If
so, how long before it can convert?
13. Does the supplement cover inpatient, outpatient, long term or
overseas care?
14. Does the supplement have membership fees (annual or lifetime)?
15. Will the supplement continue to cover care upon retirement from
active duty?
16. Will the plan continue to provide coverage for surviving TRICARE-eligible
spouses and family members?
17. What are the procedures for filing a claim? Is there a time
limit to file a claim?
18. Does the plan have higher rates for smokers?
19. Does the plan cover college students who live in a different
part of the country?
20. What happens if beneficiaries move to another region, does the
plan move with them?
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Tricare Standard Means More Flexibility
No enrollment: TRICARE Standard is the basic TRICARE health care program,
offering comprehensive health care coverage, for people who choose not to be
enrolled in TRICARE Prime.
Fee-for-service flexibility: Tricare Standard is a fee-for-service plan that
gives beneficiaries the option to see any TRICARE-certified/authorized
provider (doctor, nurse-practitioner, lab, clinic, etc.) without having to first
call an HMO or get permission or a referral from your Primary Health Care
Provider. Tricare Standard offers the greatest flexibility in choosing a
provider, but it will also involve greater out-of-pocket expenses for you, the
patient. You also may be required to file your own claims.
Costs: Standard requires that you satisfy a yearly deductible before TRICARE
cost sharing begins, and you will be required to pay co-payments or cost shares
for outpatient care, medications, and inpatient care. Purchasing
supplemental insurance can offset most or even all costs.
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MOAA's MEDIPLUS® TRICARE Supplement Program
If
you're like many people, you're paying too much out of
your own pocket for medical bills—hundreds, maybe
thousands of dollars each year. No doubt you have some type of health
protection, but you may not have had the time to look for the best coverage at
the best price. As a result, you may have mediocre coverage—and less cash in
your wallet. There's no need to worry. Over 100,000 MOAA members and their
families did the research and found the perfect solution: MOAA's MEDIPLUS
TRICARE Supplement Program.
These members and their families have compared MEDIPLUS to employer-sponsored
plans, HMOs and other TRICARE Supplements. They've shopped for lower prices,
better deals and more comprehensive coverage. And—time and time again—they found
nothing compares to teaming TRICARE with MEDIPLUS.
Freedom of Choice
With MEDIPLUS, you're in control because you choose your family's doctors and
specialists. There are no "network" or "preferred provider" lists. Your family
can go to any TRICARE-authorized doctor at any time. This isn't the case with
HMOs or many employer plans, where your choice of doctors is restricted. If your
family doctor isn't on their list, you're forced to find a new one or pay more
of the bill yourself.
You can use MEDIPLUS to cover yourself, your spouse and your children—even if
you have different protection needs. That's because MEDIPLUS gives you more
choices than other plans:
MEDIPLUS In- and Outpatient Plan—The best plan if you want complete protection
for hospital bills, doctor bills and prescription drugs. This plan has two
deductible options for retirees and their families: a $300 per person [$600 per
family] deductible or a $150 per person [$300 per family] deductible. The In-
and Outpatient Plan for Active Duty family members has no deductible.
MEDIPLUS Inpatient Only Plan—Your ideal protection if you just want coverage for
expensive hospital stays. Plus, you'll have protection for certain outpatient
surgeries. This protection is available to retirees with a $200 deductible or
without a deductible.
MEDIPLUS TRICARE Prime Plan—This plan works with TRICARE Prime for retirees to
virtually eliminate out-of-pocket expenses.
Plus, you don't have to worry if your doctor charges more than TRICARE allows.
In addition to the TRICARE copayments, MEDIPLUS pays your covered "excess
charges" at 100% after the TRICARE and Plan deductibles are met. This means
you'll pay less out of your own pocket. MEDIPLUS will pay up to what your doctor
bills—even if it's above the reasonable and customary charges for your area.
This protection for excess charges is especially important, since excess charges
are not applied to TRICARE's annual Catastrophic Cap. Even if you meet this
limit, you'll still have to pay excess charges UNLESS YOU HAVE MEDIPLUS.
Learn more about
MOAA's MEDIPLUS Tricare Supplemental Insurance
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