TRICARE Standard vs. Prime
Many military families are faced with the tough decision – choose TRICARE Prime insurance, where there are little to no costs to the service member, but face all the strict limitations imposed by the HMO service; or choose TRICARE Standard insurance which is much more flexible and responsive, but only covers 80% of the medical expenses. It’s a tough choice – better care or cheaper prices?
There are definitely sound benefits to the care received with TRICARE Standard. You never have to call the HMO for approvals for specialists; you never have to ask permission to take your kids to the doctor; you don’t need referrals from a primary health care manager; you don’t have to ever go to a military treatment facility. In fact all you have to do is call a doctor’s office near your home and make sure they accept TRICARE insurance – then make your appointment and go!
However, there is an option that can help with this decision – TRICARE Supplemental Insurance. Several different private medical insurance companies offer supplemental insurance coverage that will pick up the remaining 20% of your health care costs that TRICARE Standard does not cover. What does that mean to you? For a trip to the doctor TRICARE Standard would cover 80% of that doctor’s fees and your supplemental insurance would pick up the remaining 20% – that covers all of your expenses. The only out of pocket expenses are your deductibles each fiscal year (starting October 1st each year). The deductible is $150 per person or $300 per family. Once you reach those deductibles, you will incur no further costs and your supplemental insurance covers the rest.
TRICARE Standard with Supplemental Insurance
—what this means to you and your family:
- Your family has the freedom of choice to choose any doctor (as long as that doctor accepts TRICARE)
- No need to first see a “Primary Care Provider” – your family makes appointments with the doctor or specialist directly
- No need to try to make an appointment at the closest “Military Treatment Facility” – in fact, families on TRICARE Standard are encouraged to seek local doctors instead
- Spouses and children can seek after-hours care immediately, without a lengthy referral process
- With Supplemental Insurance, you only pay either the individual deductable ($150 per fiscal year) or the family deductable ($300 per fiscal year), whichever occurs first.
TRICARE Standard Means More Flexibility
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. 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?
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.
Useful TRICARE Online Guides
- TRICARE Standard Explanation of Benefits (EOB) Example view online guide
- TRICARE Prime Handbook view online guide
- TRICARE Retail Pharmacy Benefit Guide view online guide
The Veteran’s Survival Guide
When I got my hands on “The Veteran’s Survival Guide – How to File and Collect on VA Claims” I realized at once, that this was “the gold standard” of this genre. This is truly the best and most helpful book on the subject that I have come across.
Not only does he tell you what to do, but he also gives you insights on how the VA operates and makes decisions on claims. If you have a claim to file or have one being processed right now – then you should run down and buy this book. I sincerely mean that. You cannot afford not to have a copy of this book that you can reference back to for information.in my 3 decades of helping veterans. There are none better! Author John D. Roche has taken all his personal experience of having worked for the VA and for veterans in Florida and put it into readable simple and easy to follow language.
MOAA’s MEDIPLUS® TRICARE Supplement Program
If you’re like many people, you’re paying too much out ofyour 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
ASI TRICARE Supplement for Retirees
Most military retirees who launch second careers get their health insurance through company or association health plans, despite the fact that they are still eligible for TRICARE, the health insurance program provided to the armed forces by the Department of Defense. As a result, employers end up paying expensive and unnecessary premiums.
Now there’s a better option for corporations, associations, school districts and municipalities that employ a significant number of military retirees. It’s an innovative supplemental insurance plan available through the Association & Society Insurance Corporation (ASI).
When you offer ASI’s supplemental insurance as a complement to the government TRICARE basic insurance, you give your military retirees the opportunity to receive benefits that are comparable, if not broader, than those available through your company health plan. The supplemental picks up where TRICARE benefits drop off, providing employees with the comprehensive coverage they need while lowering their out-of-pocket costs.
All Participants in the TRICARE Supplement are automatically enrolled into AMRA, American Military Retirees Association (a military benefit association). As an AMRA member, the insured will become a valued member with access to numerous discounts and membership benefits. This includes, but is not limited to discounts with Red Roof Inn, Choice Hotels, North American Van Lines, Full-Service Moving, AVIS Car Rental, National Vision with participating Wal-Mart Stores.
ASI is the exclusive Marketer and Administrator of the AMRA Voluntary Plan. AMRA is the plan’s sponsor. The plan is underwritten by The Hartford Life & Accident Insurance Company Under the new guidelines, the association is offering the product, not the employer. Other than inclusion in a defined cafeteria plan, the employer can not incentivize the premiums by paying for them.
This is a voluntary plan for TRICARE eligible members and their dependents. It requires membership in the American Military retirees Association for which dues of $1.00 per month are charged and will be added to the quoted monthly premium.
Military Benefit Association TRICARE Supplemental
The MBA TRICARE Supplement Insurance Plan provides reimbursement of eligible out-of-pocket medical expenses for insured MBA members and their families who are covered by TRICARE (Standard, Extra or Prime).
Three TRICARE Options
TRICARE Prime is a voluntary “HMO-type” plan that emphasizes preventive care. All active duty service members are automatically enrolled in Prime. If you choose this option, you and your family will enroll for a year at a time, and will receive your care from a network of civilian and military providers.
TRICARE Extra is essentially a Preferred Provider Organization (PPO). With this option, you can choose to use a network of civilian doctors and military providers and get a discount on cost sharing. There is no enrollment fee, and you may use Extra when you elect to do so.
This is the same as the standard TRICARE program. TRICARE Standard pays a share of the cost of covered health care services that you obtain from a non-network civilian health care provider. There is no enrollment fee in TRICARE Standard. After the TRICARE deductible has been met, the TRICARE Standard will Cost-share 20% of the TRICARE allowable charge for outpatient services and supplies for active duty families and 25% of the allowable charge for all others.
Uniformed Services Benefit Association (USBA)
Tricare Supplement Insurance
USBA understands how confusing the health care choices are today for military families and retirees. We also understand how important choosing the right health care supplement is … because your family will still have medical expenses even after TRICARE pays. And even though your costs may be small, in many cases they can be huge.
So why choose USBA’s TRICARE Standard/Extra Supplement plan?
Guaranteed Acceptance (subject to pre-existing condition limitation)
30-Day satisfaction guarantee
No Medical Exam Required
Your choice of 2 specially designed plans to custom fit your needs
Priced to Fit Your Budget as well as your needs
Retirees and Spouses get the Same Rates
Smokers pay the Same Price as Non-smokers
Visit the USBA Official Website for more information.