“Plan for what is difficult while it is easy” is an apt quote regarding healthcare in general and Tricare in particular. If you’re transitioning out of the military, it’s important to know your responsibilities and form a strategy well in advance of your separation date.
Plan ahead before you leave
It’s recommended to start scheduling you and your family’s Tricare coverage planning at least six months before retiring. Necessary medical exams, researching different coverage options and plans that may be a better fit due to a new location are part of the prep-work. Re-enrolling in an existing plan, changing plans, and paying enrollment fees are just some of the changes you should be prepared to meet.
Schedule your exit medical exam as early as possible
To ensure proper healthcare after you separate, it’s essential to be on top of your Separation Health Assessment while you’re still active duty. The exam must be performed at a military hospital, military clinic, or VA facility 90 days before retirement and terminal leave. If you plan on filing claim with the Department of Veterans Affairs, calendar the exam earlier than 90 days. While the VA refers to the exam as the “disability exam,” all active duty are required to take it on the way out.
The separation health assessment tracks your medical history and your current health. Prior to the exam is the time to prepare and review your medical history and check to see it’s complete and correctly notated in your file, specifically injuries and medical concerns identified during your military career. You’ll need to complete a “Report of Medical History” or DD Form 2807-1 form before your exam.
You must re-enroll in Tricare
Upon retirement, you and your family’s status and plan options change; use vigilance to avoid a break in coverage. Re-enrollment in your chosen Tricare plan is usually required within 90 days after your retirement date from active duty — whether you’re planning to keep the same type of plan or not.
Even if you’ve already enrolled in Tricare Prime or Tricare Select, you must re-enroll. You and your family will need to arrange for new ID cards, and some beneficiaries may have to begin paying an annual enrollment fee.
If you miss the 90-day deadline, retroactive enrollment can be requested within 12 months of your retirement date. If approved for retroactive coverage, your enrollment fee or fees are also calculated retroactively to your retirement date.
If you miss the 12-month deadline, you may only re-enroll during Tricare Open Enrollment Season or if you or a family member experience a Qualifying Life Event, such as moving, marriage, or the birth of a child. Know you plan, in some plans the move must be relocation to a new country.
Expect changes in your Tricare when you retire
While on active duty, there are no out-of-pocket expenses, and family costs are minimal. But a retiree should expect to encounter costs. Depending on your current Tricare plan, they may include:
- Annual enrollment fees and copayments for Tricare Prime.
- Higher copayments and cost-shares for Tricare Select.
- Possible higher prescription costs.
- Catastrophic cap increases.
Be advised that hearing aids and chiropractic care are not covered under Tricare. However, an additional premium-based dental plan may be available to most military retirees thru the Federal Employees Dental and Vision Insurance Program (FEDVIP). Eligibility can be determined through the FEDVIP website.
The five Tricare plans for retirees and their families
There are five Tricare health plans available to veterans and their families after retirement; each fulfills different needs and operates under different qualifying parameters. The five plans are Tricare Prime, Tricare Select, US Family Health Plan, Tricare for Life, and Tricare Select Overseas.
The Tricare Prime plan is a managed care option available in what is called a prime service area. These are areas where military hospitals and clinics are within specific geographic proximity to the sponsor or beneficiary. Drivetime and distance relative to the Primary Care Manager (PCM) determine your eligibility for this plan. Some exceptions allow a waiver of the distance requirements. Tricare Prime is further divided into three programs, Prime Remote, Prime Overseas, and Prime Remote Overseas. These plans cover rural areas and areas over a certain distance from providers, here and abroad.
The Tricare Select plan is a self-managed, preferred provider organization plan available only in the United States. An enrollment fee and annual deductible are required, and cost shares apply for covered services.
The US Family Health Plan is an additional Tricare Prime option available through community-based networks in not-for-profit health care systems. The plan is only available in six specific areas of the United States. The areas range from the Northeast to Texas and Louisiana, but only those geographical areas are covered.
The Tricare For Life plan is for eligible beneficiaries who have both Medicare Part A and B. Coverage is automatic. There is no enrollment form required. You’re covered under the Tricare for Life plan if you already qualify for Tricare in DEERS and are entitled to Medicare Part A and Medicare Part B. However, it is crucial that you routinely monitor your DEERs information to keep it updated and current
The Tricare Select Overseas plan provides comprehensive coverage in all overseas areas.
To access this plan, you must first register with the Tricare Select plan and then move on from there. Enrollment is required.
Special programs designed to fill veteran healthcare gaps
The Transitional Assistance Management Program (TAMP) covers those facing involuntary separation. Sponsors and family members who are eligible can choose from any of the five Tricare plans under TAMP and also have access to military hospitals and clinics. The program’s coverage is limited to 180 days.
The Continued Health Care Benefit Program (CHCBP) is a premium-based plan that straddles the interim period between military benefits end and civilian health plans begin. The CHCBP provides temporary health care coverage that lasts from 18 to 36 months after you lose eligibility for Tricare. It offers the same coverages as Tricare select.
