TRICARE Standard with
Supplemental Insurance
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.
|
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?
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.
| Useful TRICARE Online Guides
|
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 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.
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.
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
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.
Go to the ASI official
website
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
I. Prime
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.
II. Extra
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.
III. Standard
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.
Go to the MBA
official website
Military Loans Online Application
Uniformed Services
Benefit Association (USBA)
Tricare Supplement Insurance
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.
Military4Life.com
TravelDiscounts4Cheap