TRICARE and Other Health Insurance
May 29 2009
Like me, most military retirees have gone on to second careers. Most employers offer some type of health care coverage. Military retirees must choose between paying premiums or just using our earned TRICARE benefit and paying the fees or copays out of pocket, or buying a TRICARE supplement.
DoD claims that many retirees are choosing not to buy into an employer health plan because of the cost, and that many who previously bought in are dropping coverage and returning to TRICARE as their primary health insurance. The increased claims and associated cost is one of the chief reasons that DoD uses to justify TRICARE fee increases.
When TRICARE began it would in most cases pay for your copays if you used other health insurance (OHI) as the primary payer. This was seen as an incentive to use OHI as it resulted in very little out of pocket cost to the beneficiary. Years ago, in an effort to save money, DoD changed the rules and now in most cases TRICARE does not even cover OHI copays. That emphasis on short term savings helped create a bigger long term TRICARE bill as retirees saw less benefit to buying into their employer plan.
I often wonder what positive incentives DoD might offer retirees to help persuade them to buy into an employer plan.
8 Responses to “TRICARE and Other Health Insurance”
Isn’t it typical of the bureaucrats in Washington (most of whom have never served in the military) to make changes in Tri-Care to save a buck only to find out the long term costs went up. It is very unfortunate, indeed, that this group of inept officials never have to pay for their misguided decisions. The military members who have been negatively impacted time and time again as promises are broken, will be the ones who pay more for their health care. Just wait until the Obama administration comes up with comprehensive health care for all Americans. I will bet my whole military retirement that they will do so by snatching some of the benefits of the military in order to help pay the bill for others who did nothing to work for the benefit.
Today I find it harder and harder to find a provider who accepts TRICARE; or MOAA’s supplement insurance. Go to the VA hospital they say. Then, when we do, the service we receive is so poor we end up paying for needed care out of pocket just to get treated in a timely manner–or, in many cases, just to get well.
I will defend VA medicine. It has done well by me, and has saved me a lot of money. As for Tricare, there is no problem in my area for doctors to accept it, then again, I live in a military town. I have used it, too, to my advantage.
Many of us are retired and NOT employed with OHI options. Also NOT old enough for TFL.
It is foolish to assume that everyone retired and went on to second careers. It is foolish to use this as the rationale for increasing Tricare premiums. There is no empircal data to support such an assumption. We had a deal, the government and I, I served 29 years active duty and they would provide free health care for my lifetime. Congress has not held up it’s end of the bargain, and continues to chip away at benefits we were promised. They certainly aren’t chipping away at the benfits/pay raises for themselves.
Isn’t it interesting how members of congress, who have one of the best medical plans, paid for by us the tax payer, are so ready to take away the medical benefits of all military members, their families and retirees. I wonder if their medical plans were accosted and stripped away as ours have been they would be more understanding and supportive our needs?
Actually, members of Congress have the same health benefit that federal civilians do, and pay the same premiums. To be fair, it’s been Congress that has protected the military from the big fee hikes proposed by the previous Administration.
I am puzzled by the statement that “in most cases TRICARE does not even cover OHI copays”. I am inserting the pertinent section starting on page 23 of the TRICARE Standard Handbook that covers coordination of benefits between Other Health Insurance (OHI) and TRICARE Standard, clearly showing that TRICARE Standard DOES for the most part cover OHI copays.
(1) TRICARE Network Individual/Group Providers and Most Inpatient Facilities:
(a) If your OHI pays more than the TRICARE allowed amount, then no payment is authorized, the charge is considered paid in full, and the provider may not bill you.
(b) Otherwise, TRICARE pays the lesser of:
• The allowed amount minus the OHI payment
• The amount TRICARE would have paid without OHI
• The beneficiary’s liability (OHI copayment/deductible)
(2) Non-Network Individual/Group Providers that Accept TRICARE Assignment (Participating)
TRICARE pays the lesser of:
• The billed amount minus the OHI payment
• The amount TRICARE would have paid without OHI
• The beneficiary’s liability (OHI copayment/deductible)
(3) Individual/Group Providers that Don’t Accept TRICARE Assignment (Nonparticipating)
Nonparticipating providers may only bill you up to 15 percent above the TRICARE allowable charge. If your OHI paid more than 115 percent of the TRICARE allowable charge, then no
TRICARE payment is authorized, the charge is considered paid in full, and the provider may not bill you. Otherwise, TRICARE pays the lesser of:
• 115 percent of the allowed amount minus the OHI payment
• The amount TRICARE would have paid without OHI
• The beneficiary’s liability (OHI copay/deductible)
simple food for thought re finding providers who accept tricare : it was my understanding that any provider who accepts medicare is required to accept tricare and champva. I think there may be differences in coverages (limits and allowables and the like) but I didn’t think providers had a choice when it came to accepting one (medicare) and not the other. True there is a health care crisis in this country and I think we are all sitting holding our breath (at least I am) wondering what other benefits will be taken away (or how many second, third or fourth jobs we may need to find in order to pay our premiums), and I don’t have any idea where the solution is. All I know is I’m approaching 65 and I worry about how I’m going to pay my inflated Medicare part B premiums in order to have CHAMPVA for Life once I am forced to go on Medicare.