Is Tricare Prime right for us???

[infoseeker]

Tricare eligibility for myself (age 60 this Nov) and spouse (age 55) is just around the corner. I have tried to educate myself on Tricare's rather complex choice for health care coverage. Am I missing something with what I've learned Our plan is to pick up Tricare Prime and immediately suspend spouse's FEHB. (He retired just a few months ago, so FEHB suspension has not yet been finalized). We think Prime is right for us because neither of us have chronic health care issues, we live in an area where Prime is authorized, the health care providers we have been seeing for years are (by pure luck) authorized network primary care providers with Tricare, there are plenty of Tricare authorized specialists within easy travel if needed. Lastly, why pay $450/month premium for FEHB when we can pay $520/year for Tricare Prime? I've read that some who have Prime also purchase a supplemental. Why would that be necessary? Just when I think I have it figured out, I get confused again. Any advice, questions, comments would be welcome. thanks!

 

[JPatrick]

Don't see why a supplement would be needed with Prime.
DW uses Tricare Standard with a supplement through MOAA. Cost is $160 per quarter (for supplement)

 

[packrat44]

I and DW switched from FEHB 9 years agoto Tricare Prime. (Three years ago I had to switch to Tricare for Life due to age.) DW still on Tricare Prime. Excellent coverage; bargain price. I see no need for a supplemental.

 

[Greg V]

I'll be in a similar situation in the near future. Just curious about your analysis of Tricare Prime vs Tricare Standard as you made your choice.

 

[mickeyd]

I used Tricare Prime for about 5 years (DW is still covered until age 65) and I am now on Medicare/TFL combo. It is the best medical plan that we have ever been on. The cost (about $20/mo for single) is by far the cheapest you can find. If you have a military/federal medical facility in your area the clinic is quite good and meds are at no cost.

 

[martyb]

Gotta question about Tricare Prime. I will be eligible for TP at age 60 (5 yrs from now). My wife is 3 yrs younger, so will be 57 when I am 60. I am the retiree. Will my wife also be eligible when I am? Are spouses of retired reservists even eligible for Tricare? I have looked all over the Tricare site, and can't find the answer to these specific questions. If my wife is eligible for coverage (she is not a veteran) will I have to maintain FEHB for her until she reaches age 60? I know these are pretty basic questions, but again...I haven't read anything that addresses them. Maybe I just missed that section I figure that Tricare benefits might be somewhat different for a reservist vs. retired active duty.

 

[mickeyd]

My wife is 3 yrs younger, so will be 57 when I am 60. I am the retiree. Will my wife also be eligible when I am? Are spouses of retired reservists even eligible for Tricare?

Yes. Make sure that you are correctly enrolled in DEERS.

I figure that Tricare benefits might be somewhat different for a reservist vs. retired active duty.

They are the same. Once you reach 60 you have same benefits as retired active duty folks. What a deal.

 

[martyb]

Thanks for reminding me to take a look at my DEERS enrollment to make sure it's up to date. I'm looking forward to being able to suspend FEHB and go on Tricare Prime. That will be like getting a pay raise. So...even though my wife will be only 57, she'll be covered at the same time as me...right?

 

[Nords]

So...even though my wife will be only 57, she'll be covered at the same time as me...right?

Yep-- the coverage is triggered by your age (60, although a very few Reservists can retire earlier if they were mobilized during the last few years) and her spouse status. Her age isn't part of the eligibility.

Of course you'll be paying the family premiums for that Tricare coverage, not the individual rate.

You also have the Survivor Benefit Plan premiums to consider. If she elected coverage while you were gray area then you may have to pay two years of premiums before she's eligible to reassess her decision.

 

[dtbach]

I'll be eligible for Tricare in about 4 months. We are not near any military installations so I assume Prime is the best option right? Do I need to wait until 60 to enroll in DEERS or can this be done ahead of time?

 

[mickeyd]

Do I need to wait until 60 to enroll in DEERS or can this be done ahead of time?

You need to enroll PRIOR to age 60. I seem to recall 90 days. You probably need to go to a DEERS/Tricare office near you to get a retired ID etc.

 

[mickeyd]

Give this a look. Should point you in the right direction.

TRICARE Home

 

[Nords]

I'll be eligible for Tricare in about 4 months. We are not near any military installations so I assume Prime is the best option right? Do I need to wait until 60 to enroll in DEERS or can this be done ahead of time?

If you're saying that you're a gray-area Reservist/Guard ("retired awaiting pay") then you should already be in DEERS.

Prime is probably the best option. Even though I'm surrounded by military treatment facilities, I still prefer a civilian care manager.

Checking DEERS:
I am a retired Reserve component (RC) (National Guard/Reserve) member. When I start getting retiree pay and am eligible for TRICARE benefits, does my spouse also become TRICARE eligible?

Tricare options:
Where can Reserve component (RC) family members get more information on their TRICARE options?

Tricare Retired Reserve (before age 60):
My husband recently retired from the active reserves. He is 49 years old. Are we entitled to TRICARE benefits?

Frequently Asked Questions - Home

 

[dtbach]

Thanks Nords!

 

[dtbach]

Holy crap! After trying to slog through all the web sites where nothing is definitive I'm wondering if anything I've experienced in the military is as complex as this! Are they deliberately trying to make it as hard as can be?

 

[Nords]

Thanks to a poster's PM, I've learned quite a bit more about Tricare eligibility.

The 2008 National Defense Authorization Act added an early-retirement provision for the Reserves. The legislation is a hairball but it essentially says "If you complete 90 days of qualifying active duty in a fiscal year then you can begin to receive your retirement pay three months earlier". If a Reservist completes at least 360 days of mobilization within the same FY (or at least 90 days in each of four separate FYs) then they could start receiving retired pay at age 59. In one USMC Reservist's letter (Notice of Eligibility AKA "20-year letter") it ways "Members of the Ready Reserve called to active service after 28 January 2008 may have their entitlement to retired pay eligibility age reduced from age 60 by three months for each aggregate of 90 days served on active duty."

There are two perennial complaints with this legislation:
(1) For some reason it specifies "within the FY". Not sure why, but the wording means that 30 days in one FY and 60 days in the next does not count. It has to be all within the same FY. This wreaks havoc with Reserve accounting, some of which is already tied to the calendar year and other parts which are tied to the "anniversary date" when the Reservist started their service.
(2) It's only after 28 Jan 2008 and not retroactive to 9/11. If it was retroactive to one of the biggest Reserve mobilizations since WWII then as many as 500,000 more could start receiving their pensions before age 60.

Many veteran's advocacy groups have focused on these two problems (unsuccessfully, so far) but there's a third problem: the Tricare eligibility date doesn't change. No matter how much sooner than age 60 you could start receiving your pension, your retiree Tricare coverage does not start until age 60. The legislation only covered Reserve retirement, not Tricare.

This means a Reservist who might receive retired pay earlier than age 60 would still have to sign up for other health insurance (perhaps Tricare Retired Reserve) until they reached age 60 and then could go on to regular Tricare. And then at age 65 (or whenever Medicare eligible) they'd go on to Tricare For Life.

Clear enough? I'll blog about this in more detail in a couple weeks and include some links, but that's the gist of it. Terry Howell at the Military Advantage blog may also write about that soon.

By the way, the Tricare premiums are going up for many of us next week. Here's a link to the MOAA reminder with the new rates:
Health Care Happenings » Reminder: TRICARE Prime Enrollment Fees Increase on October 1st! For example in my case the monthly family premium rises from $38.34 to $44.88.

This is not a complaint or even a kvetch-- I'm quite happy to pay more for Tricare if it means that more civilian doctors will support it-- but the subject is complicated and the rates are not necessarily going up for everyone.

My Tricare provider, TriWest, assures me that the new amount will be automatically deducted from my checking account with absolutely no action on my part. We'll see how that goes.

Holy crap! After trying to slog through all the web sites where nothing is definitive I'm wondering if anything I've experienced in the military is as complex as this! Are they deliberately trying to make it as hard as can be?

That's a rhetorical question, right?

 

[packrat44]

For example in my case the monthly family premium rises from $38.34 to $44.88.

This is not a complaint or even a kvetch-- I'm quite happy to pay more for Tricare if it means that more civilian doctors will support it-- but the subject is complicated and the rates are not necessarily going up for everyone.

QUOTE]

+1.

To me, this is one of the best bargains going for a vet. It can allow someone to retire several years earlier than someone who does not have this benefit.

 

[infoseeker]

Short update: Just enrolled myself/spouse in tricare prime. Thought I was fully informed on prime vs standard. I knew that since I still have OHI (other health insurance), tricare is the secondary payer. What surprised me was that since I opted for prime (unlike standard) tricare does not act as a secondary. Once OHI insurance has paid, the bill is considered paid in full and I am responsible for the rest. OK, fair enough. Now I will need to drop my OHI (too bad, because the entire premium was paid for by my employer). Also too bad, as I saw my OHI as a very afordable option for my 25 yo son to have at least a year of coverage when he is discharged from the Navy, in college and unemployed. (Inconsistent with the 2010 health care reform laws, Tricare allows this only if your <26 yo adult child is unmarried). All solved for them, however, when she finds employment in her field as a teacher and has employer offered plan.

All in all, I am so very pleased and fortunate to be able to have tricare. Just a little bit of unknown at the moment, as fed retired spouse is still waiting to hear about suspension date of his HCI. Ideally his is suspended when tricare begins jan 1.