TRICARE After Retirement

TRICARE Program for Retirees

Soldiers who are retired have the option to continue with TRICARE if they wish.  Other options are healthcare through their new employer or using the options from the Affordable Care Act.  For the purposes of this post, I will only discuss TRICARE here.

TRICARE after retirement can be divided into TRICARE in the United States and Overseas.  This post will only discuss the TRICARE costs i the United States.  I will put the information for the TRICARE Overseas Program (TOP) in a future post.

TRICARE in the United States after Retirement

To enroll, you must contact the correct region: either TRICARE East or TRICARE West (or TRICARE Overseas, but that will be discussed in another post).

Then, you will have two choices for TRICARE when you retire in the United States, TRICARE Prime or TRICARE Select.

The payments are divided into Group A and Group B which are defined as:
Group A: if you or your uniformed services sponsor's initial enlistment or appointment began before 01Jan2018
Group B: if you or your uniformed services sponsor's initial enlistment or appointment began on or after 01Jan2018


TRICARE Prime for Retirees and their Families

Annual Enrollment Fees
Group A: $289.08 per individual/ $578.16 per family - per year
Group B: $350 per individual/ $700 per family - per year

Annual Deductible
None

Costs for Covered Services:                    Group A           Group B
Preventive Care Visit                              $0                     $0
Primary Care Outpatient Visit                $20                   $20
Specialty Care Outpatient Visit              $30                   $30
Urgent Care Center Visit                        $30                   $30
Emergency Room visit                           $60                   $60
Inpatient Admission (Hospitalization)   $150                 $150   per admission

When you see a TRICARE-authorized provider other than your primary care manager for any non-emergency services without a referral, you pay:

• A yearly deductible before TRICARE cost-sharing begins: $300 per individual/ $600 per family
• For services beyond this deductible, you pay 50% of the TRICARE-allowable charge
• These costs do not apply to the catastrophic cap

TRICARE Select for Retirees and their Families

Annual Enrollment Fees
Group A: $0 - per year
Group B: $450 per individual/ $900 per family - per year


Annual Deductible - must meet deductible before TRICARE cost-sharing begins:
Group A: $150 per individual/ $300 per Family per year
Group B in network: $150 per individual/ $300 per Family per year
Group B Out-of- network: $300 per individual/ $600 per Family per year
Network means a provider in the TRICARE network.  Out-of-network means a TRICARE-authorized provider not in the TRICARE network.

Costs for Covered Services:                    Group A In      A Out         Group B                B Out
Preventive Care Visit                              $0                     $0               $0                          $0
Primary Care Outpatient Visit                $28                   25%            $25                        25%
Specialty Care Outpatient Visit              $41                   25%            $40                        25%
Urgent Care Center Visit                        $28                   25%            $40                        25%
Emergency Room visit                           $109                 25%            $80                        25%
Inpatient Admission (Hospitalization)   $250/day          $901/day     $175/admission    25%
Hospitalization for Group A, daily rate is paid or 20% of hospital bill, whichever is less; plus 20% of separately billed services for in network and 25% of separately billed services for out-of-network.


TRICARE Prime and TRICARE Select Calendar Year 2018 Catastrophic Cap:
Group A: $3000 per family
Group B: $3500 per family

Pharmacy Program Costs

Pharmacy Types                                        Generic        Brand-Name       Non-formulary
Military Pharmacy                                    $0                $0                         Not Available
TRICARE Pharmacy Home Delivery      $7                $24                       $53
TRICARE Retail Network Pharmacy      $11              $28                       $53
Overseas                                                  25% cost-share after the yearly deductible is met; reimbursed

Summary

You will have up to 30 days to decide if you want to enroll in one of the TRICARE programs.  During that 30 days, you will be reimbursed by TRICARE once you sign up and send them the receipts.

Each family will have a unique situation to consider.  Whether they are located near a military facility or not.  Whether they will primarily live overseas or not.  The health care you ultimately select shouldn't be a decision you make at the last minute.  Take and estimate of your retirement living situation and make a plan.

TRICARE house open seasons available to enroll.  If you miss this open enrollment time period, you may apply to enroll if you have a life changing situation such as a move to another area of coverage or if you retire during a time when no open enrollment is taking place.  In that case, you will have to contact TRICARE and explain your situation.

I will discuss the TRICARE Overseas Program and the available Dental and Vision programs in future posts.

Good luck!!

RR


Resources
TRICARE Online
TRICARE-West
TRICARE-East/ Humana Military
Express Scripts - TRICARE Pharmacy Services
MILCONNECT - Update DEERS Information