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TRICARE: Retiree Benefits

TRICARE: Retiree Benefits

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TRICARE: Retiree Benefits

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  1. TRICARE: Retiree Benefits August 6, 2003 Atlanta

  2. Introduction • TRICARE is the DOD worldwide health care program for AD and retired uniform service members and eligible beneficiaries • In this session you will learn how the program will serve you and your dependents as a retiree • Friend or foe?

  3. Map • TRICARE Basics • Options for Participation • Costs • Pharmacy • Dental • Supplemental Policies • Care at MTFs

  4. TRICARE Basics • TRICARE is a large insurance program that serves millions everyday through a network of regional contractors • www.tricare.osd.mil/ • Eligibility to participate in TRICARE is identified through DEERS (Defense Eligibility & Enrollment Reporting System) • Must stay current in DEERS in order to receive benefits • TRICARE always pays last

  5. T R I C A R E DEERS

  6. TRICARE Options – Two Distinct Periods • Before age 65: • PRIME (HMO) • Standard • Extra • After age 65 • TRICARE becomes TRICARE for Life • TFL is second payer to Medicare

  7. Before You Reach Age 65

  8. TRICARE Prime • The HMO option– requires enrollment and selection of a Prime participating provider who is the gatekeeper to specialty care • Annual Enrollment fee: • $230/$460 • No deductible • Small co-pay for outpatient and inpatient care

  9. TRICARE Standard • Is the default option and gives you the most choice/flexibility for specialty care • No enrollment fee but out of pocket expenses can be significant • Annual deductible ($150/$300) • Outpatient cost-shares are 25% of the allowable • Non-network providers can charge up to 115% of the allowable • Larger inpatient cost-shares

  10. TRICARE Extra • Like a PPO – no enrollment; is provider driven • No enrollment fee but out of pocket expenses can be significant • Annual deductible ($150/$300) • Outpatient cost-shares are 20% of the negotiated fee • Larger inpatient cost-shares

  11. Cost Summary – Retiree < 65

  12. Catastrophic Cap • The most you will ever pay out of pocket in any fiscal year (Oct 1 – Sept 30) for TRICARE approved health care as a retiree/family is: $3,000

  13. Age 65 And/or Medicare Eligible

  14. TRICARE For Life • Must be 65 or older and enrolled in Medicare parts A & B or eligible through disability • All providers who participate in Medicare are authorized participants in TFL • Loophole allows providers only to opt out of TFL; hospitals who accept Medicare must accept TFL as second payer • TFL becomes the second* payer to Medicare for inpatient and outpatient services

  15. TRICARE For Life • Reduces out of pocket expenses to near zero for covered services *If you have OHI, TFL pays third or last

  16. TFL Costs www.troa.org/TFLProfilesite/benefits/index.asp

  17. Becoming Medicare Eligible • Eligibility begins on 1st day of birth month (or 1st day of previous month if birth date is mm/01/yyyy) • Enroll through SSA – pack a lunch • Must elect Medicare B coverage in order to use TFL

  18. Pharmacy Benefits • Simplified system utilizing network pharmacies, mail order, or military treatment facilities • Must have a valid ID card (current enrollment in DEERS) • Cost is either $0, $3, or $9 unless you use non-network pharmacy

  19. Dental Benefits • No subsidized dental insurance • Delta Dental offers a policy for retirees • Advantages if you enroll within 3 months of retirement • Requires 24 months of participation and then renewable annually • 1-888-838-8737 • May receive dental care at MTFs where the benefit is offered (PHS subsidizes)

  20. TRICARE Supplemental Policies • Commercial products • Costs vary depending on benefits • More coverage = more cost • Remember that you are insuring against a maximum of $3,000/year out of pocket expense for TRICARE approved health care • www.champussupplements.com/

  21. Use of MTFs - Priorities • Active Duty • Active Duty family member enrolled in TRICARE Prime • Retirees/family members and survivors enrolled in Prime • Family members of active duty not enrolled in Prime • All other eligible including retirees and family not enrolled in Prime

  22. Questions? My Contact Information: CAPT Kitty MacFarlane 770-488-1883 Kjm8@cdc.Gov