Q. I have health and dental insurance through my employer, but as a new military spouse, I was automatically enrolled in Tricare when I was registered in the Defense Enrollment Eligibility Reporting System. I have several questions about this.
If I don't want to use Tricare, can I just choose not to? Or am I required to make my insurance provider aware that I am eligible for Tricare and, if so, can my insurance provider require me to use Tricare as primary or secondary insurance?
Tricare seems confusing to me. Is my intuition correct or is it pretty comparable in structure and administration to standard civilian insurance plans?
Is there a benefit to using Tricare, either in addition to or in lieu of my insurance, that maybe isn't obvious to me?
A. By law, Tricare must be last payer to all other health insurance except in very narrow and specific circumstances that almost surely do not apply to you.
For family member beneficiaries like you, who have separate insurance coverage through an employer and prefer to use that as their primary coverage, there really isn't a downside to using Tricare; it would simply serve as a backup secondary payer. In that capacity, if your primary coverage charges you co-pays, cost shares and/or deductibles, Tricare might very well cover some of those costs that you would otherwise have to pay out of your pocket.
Tricare is not health insurance in the traditional sense; it's a health benefit. That said, its structure is similar to private-sector health insurance. The two basic options are Tricare Prime, modeled on private-sector HMOs, and Tricare Standard, modeled on private-sector fee-for-service plans.
Prime requires enrollment, but as an active-duty family member, you would pay no enrollment fee, no network co-payments and would have minimal out-of-pocket costs. Prime requires beneficiaries to coordinate their care through a primary care manager, who provides most of the beneficiary's health care and makes referrals for any necessary specialty care.
Tricare Standard requires no enrollment and offers greater choice — beneficiaries can basically see any Tricare-authorized health care provider — but Standard tends to have higher out-of-pocket costs than Prime, depending on how much health care a beneficiary uses.
Your active-duty husband is required to use Prime. But you can use either Prime or Standard. Since you would be using Tricare as a secondary payer, there is less hassle and more flexibility if you stick with Tricare Standard. In this scenario, you would simply tell any health care provider you visit that you are a military family member beneficiary using Tricare Standard as your secondary insurance. Again, there's no real downside, and there may be an upside in Standard covering some of your primary plan's costs.
You can get more information about how Tricare works with other health insurance here: www.tricare.mil/ohi.
Email questions to tricarehelp@militarytimes.com. Include "Tricare" in the subject line and do not attach files.
