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Should You Take Your Employer’s Health Insurance If You Have Tricare?

18 May 2022

This post may contain affiliate links, from which I may earn revenue to support this free site. All opinions are my own, and I only promote products that I use and love!

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Do you want other health insurance if you have Tricare?A common question from working military spouses and military retirees is, “Should I take my employer’s health insurance, since I have Tricare?” It’s a smart question to ask, but you’ll need some details to find an answer.

Understanding How Tricare and Other Health Insurance Work Together

In Tricare language, any other health insurance is called OHI.

The most important thing to know is that Tricare always pays second to OHI except for Medicaid, Medicare, specifically designated Tricare supplements, and a couple of other very unique government programs like state-run victim compensation programs and Indian Health Care. Your employer’s health coverage will pay first and then the balance will be submitted to Tricare.

Side note: Be sure you understand your Tricare options, either active duty or retired.  I’ve talked to people who are willing to pay pretty significant premiums for OHI based on misunderstandings of the Tricare system. Often, people will tell me that they don’t want to go get their care on base, or deal with referrals. Once I explain Tricare Select, they realize that maybe they don’t need OHI to get the flexibility they want.

How Much Are You Paying For Tricare?

First, you need to know how much you’re paying for Tricare. This article can help you figure it out, but the most important part is the catastrophic cap.

A catastrophic cap is the most you’ll pay for covered services in a year. For active-duty families, the 2022 catastrophic cap is $1,000 for sponsors who joined the military prior to 1 January 2018 (Group A) and $1,120 for sponsors who joined the military on or after 1 January 2018 (Group B.) For retiree families, the catastrophic cap depends on which plan you use and also your group.

2022 Tricare Retired Catastrophic Caps

Group A
(sponsor entered military before 1 Jan 2018)
Group B
(sponsor entered military on or after 1 Jan 2018
Tricare Prime$3,000$3,921
Tricare Select$3,706$3,921

In many, many cases, just the premium on the other policy is more than the catastrophic cap on Tricare. If that is the case, you’ll have to figure out whether your other policy covers something that Tricare doesn’t cover, like chiropractic care.

How Much Healthcare Do You Use?

The catastrophic cap is important because it represents the most you’ll pay for covered care, but many families never get anywhere near their catastrophic cap. In that case, you may want to consider the ongoing costs.

Each combination of plans (active duty vs. retiree, Group A vs. Group B, and Prime vs. Select) has its own costs. As I mentioned before, this article is a good place to figure out the costs you will have for each plan. Some, like Tricare Prime for active duty family members who use a Military Treatment Facility, have nearly no out-of-pocket costs. Others plans may have an enrollment fee, a deductible, AND ongoing co-pays for care.

If you think that you never use enough health insurance to meet your catastrophic cap, map out the health care that you do use in a year and figure out what it will cost you with and without OHI. Keep in mind that these are just estimates and you could have a very light healthcare year, or you could have an injury or illness that blows these estimates out of the water.

How Much Will Tricare Pay After Your Other Health Insurance?

The first step is to submit your claim to your OHI. It’s super-important to follow the rules of your OHI. If your OHI denies a claim for any reason, including a lack of referrals, Tricare will generally also deny the claim.

Once your claim is paid by your OHI, it is then forwarded to Tricare.

If the provider was a Tricare network provider, or a participating non-network provider (who accepts Tricare assignment), Tricare will pay the smaller dollar amount of these three calculations:

  • billed amount minus the OHI payment, so no balance remaining
  • amount TRICARE would have paid without OHI, little to no balance remaining
  • amount beneficiary owes after the OHI paid (usually the OHI copayment or cost share), so no balance remaining

If the provider was a non-participating provider (does not accept Tricare assignment), Tricare will pay the smaller dollar amount of these three calculations.

  • 115 percent of the allowed amount minus the OHI payment
  • Amount TRICARE would have paid without OHI
  • Amount beneficiary owes after the OHI paid (usually the OHI copayment or cost-share)

Non-participating providers may only bill a Tricare beneficiary up to 115% of the Tricare allowed amount. If the OHI paid more than 115% of the Tricare allowed amount, Tricare will not pay any remaining portion. Tricare considers the charge paid in full and the provider may not bill the beneficiary.

Prescription Coverage

Prescription coverage works pretty much the same way as health care coverage. Your OHI will pay first, and Tricare will pay second. Use a Tricare network pharmacy to keep your costs as low as possible, and inform the pharmacy staff of both insurance plans.

Beneficiaries with OHI are permitted to use military treatment facility pharmacies. They will need to provide their OHI information so that the Department of Defense can bill the OHI.

Tricare beneficiaries with OHI may not use Tricare Home Delivery (Express Scripts) unless:

  • their OHI does not include pharmacy benefits
  • the drug is not covered by the OHI
  • or you have met your OHI’s benefit cap

What About Active Duty Members?

Active duty service members, including activated reservists and National Guard, can not use other health care as their primary coverage. As a general rule, they are only covered by Tricare. If an active duty service member wishes to use OHI, they need to work with their Tricare contractor first.

The Tricare Young Adult Twist

One situation in which carrying other health insurance may make sense is if you have one or more kids who are no longer eligible for regular Tricare coverage, but are not yet 26. If you are considering covering them under Tricare Young Adult, they would almost always be covered under your other health insurance, possibly at no additional charge. This could change the math entirely, particularly if you have multiple kids in that gap.

One Other Thing To Consider

There is one other thing to consider when deciding whether to use OHI with Tricare: What is your mental and emotional capacity for dealing with paperwork and other issues? In theory, OHI and Tricare are supposed to work together smoothly, and sometimes that works out. But sometimes it doesn’t. If you can’t stand dealing with insurance, or you don’t have time, you might want to stick with Tricare alone.

Every situation is different, and there’s no right answer for everyone. You have to consider the coverage and costs of your other health insurance, and the coverage and costs of Tricare, how they’ll work together, and your family’s medical needs. In many cases, Tricare beneficiaries find that there is no reason to pay for additional health insurance. Don’t make a decision without thoroughly understanding how it all works!

For more information about using Tricare with other health insurance, see the Tricare webpage on the topic.

Kate
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58 Comments
Filed Under: Medical

Comments

  1. Dale Wrobel says

    6 September 2020 at 9:27 am

    Thanks for the article, but I am having a hard time finding information on Tricare Select. I am in Group A. I am employed and have health insurance under my employer that also covers my wife. Now I understand that we will be required to pay a monthly premium starting in January for select. The only resource we use “on base” is the pharmacy. So I don’t believe we need select. But I just want to be sure. Can you shed any light on what select provides and if you already have health care coverage if you need it.

    Reply
    • Kate Horrell says

      6 September 2020 at 11:28 am

      Hi Dale – the equation remains the same, just the numbers change a little bit. Tricare Select is outstanding stand-alone coverage and I’m surprised that your employer’s health insurance is a better offer. (It does happen, but it’s definitely an exception.) If you are using your employer health insurance, Tricare Select can help with deductibles, co-pays, and cost-shares of your employer coverage.

      Reply
  2. Kim says

    14 September 2020 at 8:33 pm

    My husband is retired Army. He works for a company that has a $12K deductible insurance plan. Tricare is our secondary. We were told we had to use his company insurance if it was offered. So we do have a choice and we can cancel his employer benefits and only use Tricare?

    Reply
    • Timmy says

      21 September 2020 at 10:41 pm

      Hi, I have the same question. Do we have to opt in for employer insurance if offered? Or is Tricare ok with us declining OHI…? Also retired military. Thank you!

      Reply
      • Steph says

        24 November 2020 at 2:16 pm

        I am wondering the same thing. Did you get an answer?

        Reply
      • Kate Horrell says

        24 November 2020 at 7:34 pm

        At this time, you are not required to accept other health insurance. That’s an idea that has been tossed around, and may happen at somepoint in the future. But not now.

        Reply
        • George Walker says

          8 January 2021 at 10:51 pm

          Hi Kate, I’m retired military with 4 kids 12 and under. My wife works for Banner Healthcare and can get medical insurance through them. The cost will be around $500/month to cover my wife and 4 kids. My wife and I are confused as to whether or not to enroll in her medical insurance or should we stick to only Tricare? Please advise.

          Reply
          • Kate Horrell says

            10 January 2021 at 2:51 pm

            Hi George,

            There’s no single right answer to that question. Your wife’s plan will cost you more, as the catastrophic cap on covered services is only $3000 (Prime) or $3500 (Select.) But that extra cost may be worth it, if it is hard to find providers in your area, or if her plan covers things that Tricare doesn’t cover (like chiropractic.)

            Most people find that just Tricare works for their situation, but dig around a little to see if that would be true for you.

            Good luck!

        • Sean Stalnaker says

          10 January 2022 at 7:06 pm

          Hi Kate. Has this changed since November 2020? Are retires required to accept OHI from our employers if we have Tricare Prime for self and spouse? Where can I get more information?

          Reply
          • Kate Horrell says

            10 January 2022 at 7:59 pm

            Hi Sean,

            Nothing substantial has changed, though I may need to see if there are any 2020 figures in this post. Retirees are not required to accept employer health insurance if they have access to Tricare.

            What kind of information are you looking for? The Tricare website is pretty good. http://www.Tricare.mil

  3. Bill says

    14 November 2020 at 11:09 am

    Thanks Kate for the great information …! I’m retired ANG and became “Tricare eligible” last February. I asked about making changes (Tricare and Anthem reps) but never got a solid answer and subsequently made no changes. (Wish I would have found you sooner!!) Turns out I should have been a little more assertive, because I could have saved a bunch on premiums alone over the past 9 – 10 months. During Open Enrollment this year I discovered that my employer offers a “Tricare Supplement” which, I’m learning will pick up what Tricare Select does not. Very reasonable rate it seems. Stay tuned … I’ll let you know mid-year or so, how things are going.

    Thanks again for what you do!! Keep up the good work!

    Reply
    • Kate Horrell says

      15 November 2020 at 10:00 am

      Bill! I am so glad that you found a good solution for you! Please keep me updated!

      Reply
    • Deb says

      2 November 2021 at 12:22 am

      Bill,
      How is your Tricare Supplement working for you? We are in a similar situation, looking for real-world feedback.
      Thanks,
      Debra

      Reply
      • Bill says

        29 November 2021 at 12:29 pm

        Debra – the Tricare Supplemental that I have is Selman and Company (SelmanCo) which is offered through my employer. I pay $122.30 / month and have a $200 family deductible … really good support and coverage has been as advertised.

        Having had an “average health year” (knock on wood!!) By year’s end I will have saved roughly 15-20% over what I would have paid had I stayed with Anthem/Blue Cross.

        One downside … the paperwork with TC-Select / SelmanCo is MUCH MORE tedious … I definitely need to stay on top of it!

        Hope this helps!

        Reply
  4. David A Keck says

    5 December 2020 at 3:46 pm

    My wife retires January 1, 2021, she is 62. We use her employer’s insurance plan, it is better than the ones my employer provides. I plan to retire June 30, 2021 as well, I am 61. We also have Tricare Select and I am in Group A. The health plans my employer provides for me are expensive and are not very good plans. My question is, “Does Tricare require me to enroll in one of my employer’s health plans to keep Tricare?” Can I just use Tricare and not enroll in one of the plans provided by my employer?

    Reply
    • Kate Horrell says

      6 December 2020 at 12:07 pm

      Tricare does not require you to enroll in an available employer health plan. You can just use Tricare.

      Changes to this have been floated around for years, but there hasn’t been any significant attempt to make this a requirement for Tricare. Could it happen in the future? It could. But it isn’t the rule now, and I wouldn’t forsee that passing anytime in the near future. But definitely a good idea to belong to a military benefits organization like MOAA or TREA to keep up on these types of issues.

      Reply
  5. Sara A. says

    10 December 2020 at 6:22 pm

    What rule prevents me for buying high quality private health insurance as an active duty member (United States Public Health Service under HHS not Armed Forces)? I cannot find anything written in law but am told by tricare not to. I assume that I have consumer rights. I cannot find any law that states I cannot buy private health insurance.

    Reply
  6. Bruce C Brown says

    29 December 2020 at 10:27 am

    I am retired military and have OHI through my new employer starting 1 Jan. It is 100% paid for by my employer. I have notified Tricare that I have OHI. My employer plan has a $250 deductible and of course Tricare has $150. Do i need to meet BOTH before Tricare pays out? It seems like Tricare costs are already very reduced by the fact that the OHI would pay the bulk of any medical costs, but by having OHI, it looks like I am now having two deductibles to meet. I called Humana, they were not clear at all.

    Reply
    • Paul says

      31 July 2021 at 11:10 am

      I’m in the same situation with 100% employee-paid coverage. My obvious goal is to avoid paying more out of pocket by using the “free” coverage…the secondary insurance treatment of copays and deductibles is confusing, should I be declining the free plan?

      Reply
      • Kate Horrell says

        2 August 2021 at 12:08 pm

        Tricky question. In theory, it would depend on the deductible and other out-of-pocket costs on your “free” coverage. But from everything I’ve seen and heard, there is a disconnect between how it is “supposed” to happen and how it actually happens. In good news, it seems like Tricare pays more than advertised, keeping actual costs lower than expected. Perhaps it is simply because if you ask 100 different times, you’ll get 100 different answers to how they work together. I was once on a conference call from someone who was representing Tricare on the call, and she clearly didn’t understand how it worked with 2nd insurance even though that was the purpose of her being on the call.

        In good news, you’re going to have outstanding coverage either way. The bigger issue that I hear people complaining about is getting the bills coordinated, especially at pharmacies. This may not matter to you if you don’t seek a lot of care, or if you have the time and patience to slog through the occasional paperwork drill. But if you have higher medical needs or life is otherwise crazy, that might be a lot.

        I wish I had a more clear answer for you. But there seems to be some aspect of “see what happens” to this process. It’s maddening but also what’s consistently reported to me.

        Reply
      • Jamie says

        3 August 2021 at 11:31 am

        Ditto. I’ve called Tricare multiple times and ask the same question and get a different answer every time. They always have to put me on hold to research it and it clearly don’t know what they are talking about. The last person I talked to recommended that I call the claims department rather than customer service Since they are the ones who actually process claims they should know how it works. She also mentioned that the way the medical service provider does the billing might make a difference as well. I haven’t had a chance to call the claims department yet. Tricare is already a big hassle! Averaging together all the answers I got and all the written Tricare guidance I can find, I believe Tricare will pay the deductible and copays of the primary health insurance as long as they are in the form of medical bills that were not paid by the primary and the claim was not denied because you didn’t follow the primary’s rules. I’m going to give it a shot and just cancel the employer coverage if it ends up costing me more than Tricare alone. I will post back with my experience.

        Reply
        • Lindsey says

          22 July 2022 at 1:10 pm

          How did this work out? I’m dealing with this issue now.

          Reply
  7. Michelle W. says

    8 February 2021 at 9:51 am

    Hello,

    My son will ‘age out’ from my employer covered insurance, leaving myself and my daughter on this plan. The only reason I signed up for employer covered insurance was for my son to have health insurance. Since he is aging out, should I go back to TRICARE, where the cost is significantly less? Also, I am looking at future health cost when I get older. Is TRICARE a better option? The hospital I go to now under my employer plan seems to have better ‘bedside manner’ but it costs a lot more for copay and prescriptions.

    Reply
    • Kate Horrell says

      10 February 2021 at 2:07 pm

      That’s a very individual question, and depends on a lot of factors. How much is “significantly less,” and how does that amount fit in your budget? Does your employer policy cover any treatments that you use and are not covered by Tricare (such as chiropractic.) Is Tricare doing a good job as a second-payer after your employer plan, or has that been complicated or difficult? Are you seeing any doctors that you want to keep and who don’t take Tricare? Which Tricare are you using right now – Prime or Select? How is that going for you? Are you an active duty family member, or a retiree family member?

      Every person will have a different answer to this question.

      Reply
  8. Jamie says

    14 April 2021 at 11:40 am

    This is so informative–thank you very much. My employer heavily subsidizes their coverage offerings to the point that I can get one of the higher deductable plans at no premium cost to me so I’m trying to understand of I should decline it. The paperwork/hassle was a great point. The piece I’m not understanding is whether Tricare (select) would cover the costs over their deductable amount but under my employer insurance deductable amount. Thanks for any insight you can offer!

    Reply
  9. Cindy says

    18 May 2021 at 9:33 am

    The private hospital/clinic in Merida Yucatan, Mexico will no longer accept Tricare. You can pay yourself and seek reimbursement, but Tricare was offering such low payments for reimbursement for medical care. They have stopped accepting and billing Tricare directly. (my understanding that for one person’s surgery, Tricare wanted to pay only $200 USD for surgeon fees. What is going on? The hospital was happy as they could be up to the last three or four months.

    Reply
  10. Elizabeth M says

    6 June 2021 at 4:26 pm

    Hi

    So I was diagnosed with breast cancer stage 4 in November 2019. Since than I have accumulated a deductible 3 times… 4500 x 3 =13500… not to mention lots in prescription co-pays and things that were just not covered under my husband’s ohi. The deductibles are currently killing me as it is. So now I am eligible to get tricare select and I think that maybe both insurances would be best thing for me. What are you thoughts.

    Reply
    • Kate Horrell says

      7 June 2021 at 11:33 am

      Elizabeth, I’m sorry to hear of your situation. Are you paying for the other health insurance? Tricare Select has a catastrophic cap of $3500 per year (if your sponsor entered the military before 1 January 2018, slightly higher if they entered after that date.) You may find it cheaper and easier to have just Tricare. A quick spreadsheet should show you which way to go.

      Best wishes for successful treatment!

      Reply
      • Elizabeth M says

        7 June 2021 at 12:18 pm

        Hi Kate
        Thank you so much for the well wishes. I do appreciate that.

        Yes my husband pays over 100 per week for his insurance. I am the veteran and I entered the military before 2018 and have now reached 60 years of age and qualify for tricare.

        To boot my husband’s insurance is changing yet again on July 1st so I am thinking I will have yet another 4500 deductible under the new insurance. It seems to never stop.

        Thank you for the reply

        Reply
        • Kate Horrell says

          8 June 2021 at 9:06 am

          Elizabeth, I am reluctant to make any recommendations based upon the limited information you have shared, but I suspect Tricare would be much cheaper for both of you. There is an enrollment fee, but that amount is applied to your catastrophic cap.

          Have you read through these articles? I hope that they make it easier to understand what Tricare pays for and how. https://www.katehorrell.com/tricare-costs-and-fees/

          https://www.katehorrell.com/military-retiree-medical-tricare-prime-select-or-usfhp/

          Let me know if you need any help comparing your options. Also keep in mind that you’ll switch to Tricare for Life in 5 more years.

          Congratulations on reaching the age for retirement pay, and thank you for your service.

          Kate

          Reply
  11. Kathy says

    15 June 2021 at 10:53 am

    My husband is retired from the military and we currently have Tricare Prime. If my employer offers insurance do I have to take it as my primary insurance and Tricare Prime as my secondary? Or can I just keep Tricare Prime for my insurance?

    Reply
    • Kate Horrell says

      16 June 2021 at 9:36 am

      You can keep Tricare as your primary insurance.

      Reply
  12. C C says

    12 October 2021 at 10:20 pm

    So my wife and I just got married and we are trying to navigate the insurance world. I am medically retired with VA coverage and honestly I use VA coverage the most since I went through an MEB and my issued are covered by the VA. My wife on the other hand has a High Deductible HSA plan for her and our daughter. We have heard that you cannot have an HSA plan alongside Tricare. We are not really sure what our next step is nor what is true, but we are trying to figure out the best option/s possible.

    Any guidance would be greatly appreciated!

    Reply
    • Kate Horrell says

      22 October 2021 at 7:39 am

      CC – It is correct that you can not have an HSA if you have Tricare coverage, but it is the opinion of at least one of the major military financial education organizations that if you don’t sign up for a Tricare plan, you are eligible to have an HSA.

      You’ll have to consider the price of Tricare vs. the price of your wife’s plan plus the tax benefits of an HSA, especially if she is able to sock money away there. You probably won’t be able to predict with exactness but you should get close enough to be comfortable with whatever you decide.

      Congratulations on your marriage!

      Reply
  13. Mark says

    24 November 2021 at 1:52 pm

    I retired on 1 MAR of this year from a state job and also from the National Guard. I am carrying both OHI from my previous employer ($400 per month) and my wife and I are enrolled in Tricare Select ($25 per month).

    Is there someone I can talk with to compare the plans or should I just draw it out and compare both plans. I live in a part of the state with great health care and have found a provider and hospital that accept Tricare. I had the OHI for over 35 years and can’t cut the cord! I feel like I’m wasting $4800 a year.

    Reply
    • Kate Horrell says

      25 November 2021 at 10:55 am

      You can get professional help to compare the two plans, but I suspect you’re more than capable of doing it yourself. Be sure to consider premiums, deductibles, cost-shares and co-pays, and catastrophic caps. Because you say that you are paying $25/month for Tricare Select, I am thinking that you are receiving military retirement pay and on “regular” Tricare, not Tricare Retired Reserve. With that, you’re looking at a $3,706 catastrophic cap for 2022 (assuming you are Group A, entering the military before 1 January 2018.) Simply the premiums for your OHI exceed your Tricare catastrophic cap.

      The other two things to consider are: does your OHI cover stuff that Tricare doesn’t cover, like chiropractic, and do you have any kids who are on your OHI who would require a premium payment for Tricare Young Adult.

      You’ve got this, but if you don’t, I can recommend some people to help.

      Happy Thanksgiving!

      Reply
  14. Jim says

    6 April 2022 at 4:35 pm

    I am in Group A with Tricare Select. My wife is 63 and is paying over $600 a month for employer insurance. We want to drop the employer insurance but here in Maine very few providers accept Tricare. On the other hand almost all providers accept Medicare. (Her gastroenterologist accepts Medicare but not Tricare.) If we dropped the employer insurance and had to go to non-Tricare providers, would that be a financial problem? What if we had a Tricare supplement? (I am over 65, retired military.)

    Reply
    • Kate Horrell says

      11 April 2022 at 9:24 am

      Have you looked into the out-of-network costs with Tricare Select? Often the cost different between in-network and out-of-network is minimal. Obviously every situation is different, but I don’t even ask if someone is in-network or out-of-network anymore, simply that they are “participating.” See if this helps: https://www.tricare.mil/FindDoctor/AllProviderDirectories/NonNetwork

      Reply
  15. Whitney says

    7 April 2022 at 3:12 pm

    If I have Tricare prime and I also take my employers OHI can I still been seen on base and other MTFs? I know they would bill the OHI but it would be “out of network” so would I be responsible for payment of deductible and whatever the OHI did not cover? Or do they submit a claim to the OHI and everything not covered is then covered by tricare prime? Or am I no longer eligible to be seen on base if I have OHI?

    Reply
    • Amber says

      22 October 2022 at 8:11 pm

      This is my question too! Open season is almost upon us and I’m sick of tricare not covering FDA approved medicine for obesity. FEHB is under directive to cover them starting in 2023. I love my pcm and my children’s pcm. I literally only want FEHB to cover the obesity meds which are 1250 monthly out of pocket. :/

      Reply
  16. john courtney says

    26 June 2022 at 4:20 pm

    Retired AF and I am a few months away from turning 65. My spouse is 60. I work for a fortune one hundred firm with great medical benefits that cover my wife and I for about $275 month. Tricare has been my secondary insurance.

    I made about $320K last year and will make about $350K this year. The rate for Medicare for income above $284,000 up to $340,000 is $442.30 – so essentially I will have to pay more and in return, get less flexibility about what medical provider I can see.

    It appears I need to sign up for MEDICARE part B or I lose Tricare for Life as a co-pay. It also appears I can sign up for Medicare in the future once I retire without a penalty – but I lose Tricare for Life for co-pay coverage until that time.

    So either decline employer coverage and pay more for Part B – or keep employer coverage and pay more because I lose Tricare For Life. Given I have never used TRICARE as a primary insurance since I retired in 2005, I haven’t cost the DoD very much. Despite that – I seem to have no good option before me? Am I reading this situation correctly?

    Reply
    • Kate Horrell says

      27 June 2022 at 8:38 am

      I do think that those are you only two options. (Readers – do you see another choice here?) While TFL is great coverage, if you are into the IRMAA income brackets, the underlying Medicare can get more expensive.

      Reply
  17. Lindsey says

    22 July 2022 at 1:22 pm

    My new employer says that under my contract, I must accept their healthcare which is free it’s a 90/10 hdhp plan. I have Tricare Prime for medically retired at the 2012 rate for life, so long as I pay it every year. What I cannot get an answer for is how much my copays will be. I know that the 90/10 plan would become my primary, will Tricare pay that 10% copay or will I. In some instances, 10% would be cheaper, but in most, it would be more. All I got from Tricare is that they defer to the primary insurance— which is meaningless to me.

    Reply
    • Kate Horrell says

      23 July 2022 at 11:03 am

      Lindsey, there are a couple of variables that play into what you’ll end up paying, though typically it is very little to nothing. Those variables include whether the provider is participating or non-participating, whether the service is covered under your other health insurance and/or Tricare, and other variables.

      This webpage is pretty good at explaining most of it, and the details are the same for Tricare East (Humana.) https://www.tricare-west.com/content/hnfs/home/tw/bene/claims/ohi.html

      Reply
      • Lindsey L Hiltibidal says

        23 July 2022 at 11:52 pm

        Thank you! I hadn’t looked at this because I’m in Tricare East, but it seems promising if they are the same.

        Reply
  18. Paul Lenz says

    8 August 2022 at 3:11 pm

    Kate, thanks for running this website first. Second, I just retired from the Navy and got a job with Johnson & Johnson. Their healthcare plan is $450 a year which is quite inexpensive, so I was considering taking that and Tricare Select which would only be another $158. From my understanding, it sounds like for $608 a year, I would have full coverage with a very unlikely chance of having to pay any further out of pocket expenses for health care. Am I understanding this correctly? Sounds like I wouldn’t even have to worry about the catastrophic cap. It seems like I should go that route, correct? Thanks.

    Reply
    • Kate Horrell says

      9 August 2022 at 12:05 pm

      Paul – I always hesitate to speak in absolutely when it comes to how OHI will work with Tricare. But based on the information available, it does sound like you are correct. I think the worse thing that could happen here is that you try this option, discover that we are both wrong, and you’ve spent that $450 unnecessarily.

      Congratulations on your retirement and best of luck on your new career!

      Reply
      • Paul Lenz says

        12 August 2022 at 8:35 am

        Kate,

        Thanks for your help. I figure with open enrollment being just a couple months away, I can always opt out if it doesn’t work and only be out the $450. Thanks for answering. I needed some fresh eyes who know how this all works to double check me. You’re the best!

        Reply
  19. EDA NICHOLS says

    14 October 2022 at 1:34 pm

    We have been applying the principle that employees who want to waive employer provided insurance while receiving Health & Welfare fringe, cannot waive if the insurance is through, Tricare; Medicare; Medicaid; Veterans Administration (VA); Indian Health Services (HIS); Individual plans (non-Employer Sponsored plans), including individual Qualified Health Plans purchased through a state or federal Affordable Care Act Exchange or Marketplace. For more information, refer to 32 C.F.R. §199 and 42 U.S.C. §1395y(b)(3). Tricare opt-outs are prohibited by a law that is similar to a prohibition against allowing incentives for Medicare-eligible employees to not enroll in a group health plan- the penalties are up to $5000 per violation. The actual language from the CFR is located in the attached (FedReg 199.8 Tricare Waivers.pdf). VA health care is NOT considered a health insurance plan. VA is required to bill private health insurance providers for medical care, supplies, and prescriptions provided for treatment of Veterans’ nonservice-connected conditions.

    I have employees telling me that Tricare does allow them to waive our plan, but I don’t believe the employee has explained to Tricare that they are receiving H&W fringe. Wouldn’t the H&W fringe be construed as an incentive to waive and make Tricare primary payer and be viewed as a violation? My question to you is, are we misinterpreting the regulation when we assume the H&W is an incentive and if we allow the government benefits to be primary instead of secondary, can they really take the cash in lieu of benefits?

    TRICARE; Relationship Between the TRICARE Program and Employer-Sponsored Group Health Coverage
    Federal Register :: TRICARE; Relationship Between the TRICARE Program and Employer-Sponsored Group Health Coverage

    Reply
    • Kate Horrell says

      17 October 2022 at 4:58 pm

      I am not a lawyer, and I’m also not a human resources expert. But never in my 30-plus years of dealing with military medical have I heard of any prohibition on opting out of other available insurance. In fact, there’s an entire business built around offering Tricare supplements to employees who opt-out of the employer’s regular health care coverage. https://blog.selmanco.com/blog/tricare-is-the-health-insurance-employers-need-to-know-with-tricare-supplement

      Keep in mind that Tricare is structurally different than other government healthcare coverage such as Medicare and Medicaid. Beneficiaries have to opt-in to Tricare coverage and pay an enrollment fee. (There is no enrollment fee for active duty family members, but that’s a zero enrollment fee, not the absence of an enrollment fee.) Tricare is also not legally health insurance – it is a health benefit plan.

      It is my understanding that you can offer cash in lieu of benefits as long as it meets certain parameters. https://blog.curative.com/how-to-compensate-employees-who-opt-out-of-health-insurance/

      I personally have received a cash monthly payment for not accepting my employer’s health insurance because I am covered by Tricare.

      Again, not an HR expert. But you might want to find someone who really knows this stuff because I believe it is entirely possible y’all are mistaken.

      Reply
  20. Jessica says

    24 October 2022 at 2:13 pm

    How does Tricare find out about your other health insurance? My husbands job is offering fertility benefits which is the only part of that insurance we are interested in and plan to use it for.

    Reply
  21. Vernon Groeber says

    16 March 2023 at 8:49 pm

    I am retired Army. My wife and I are under TRICARE for Life. I have Medicare she has a TRICARE Supplement. She is now working part time. Her employer offers Health insurance. I think the answer is no but is my wife required to take her employer’s insurance as OHI?

    Reply
    • Kate Horrell says

      17 March 2023 at 3:43 pm

      Hi Vernon,

      I’m a little confused…you have Medicare and Tricare for Life, and your wife has? Tricare and a Tricare Supplement?

      Either way, your wife is not required to take other health insurance.

      I hope that helps.

      Reply
      • Vernon Groeber says

        17 March 2023 at 8:30 pm

        Thanks for reply. My wife is not old enough for Medicare so we have the supplement for her secondary. Only recently did she have opportunity to get employer health insurance. You answered my question as she can get more pay in lieu of benefits. Thank you.

        Reply
  22. Katie says

    23 March 2023 at 6:42 pm

    Hi Kate. Husband is retiring and interviewing for jobs, which means looking over employer benefits packages. One question I haven’t found a clear answer to…..will Tricare, used as secondary insurance to an employer plan, cover the primary plan’s deductible? For instance, one company only offers a high deductible plan ($1500) but it’s free for the employee….so what deductible will he actually end up paying if he takes both insurances? Just the Tricare Select Retiree deductible of $150? Or also the employer plan deductible of $1500?

    Second question….this employer plan is ONLY available with the HSA included (that the employer partially funds). Is husband able to enroll in this plan and Tricare as secondary, or must he choose one or the other due to Tricare not being available with an HSA? So does that rule….no HSA with Tricare….include no HSA even from a different primary plan?

    Reply
    • Kristin says

      8 April 2023 at 1:55 pm

      I have this question too!

      Reply
  23. Jamie says

    9 April 2023 at 12:41 pm

    Regarding the deductible, I had the same question and couldn’t get a straight answer from anyone including Tricare. I have a free (to me) high deductible plan from my employer and Tricare select. So far I’ve only used insurance once for a checkup, and the expense was paid by tricare and considered a contribution toward my deductible on the primary. I’m don’t know about the HSA but I think it’s not allowed. My employer has an HSA option I would prefer but I didn’t select it because of the tricare rule.

    Reply
  24. Lindsey says

    10 April 2023 at 10:13 am

    I was told no HSA with Tricare Prime for combat-wounded medically retired personnel. My employer offered an HSA plan, but when I explained, they allowed me to take a different healthcare plan with an FSA. I work for a MAC as a Provider Enrollment Rep, and I must take their Blue Cross in order to work for them. I was worried about it but actually ended up paying the same or less most of the time because BC picks up some, Tricare picks up some, I have more flexibility with Doctors, and I don’t need referrals with my new plan. So, I can use the FSA plan, but not the HSA plan, HSA’s are great, and it’s too bad, but I need to keep my Tricare coverage.

    Reply

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Hi! I'm Kate! Accredited Financial Counselor®, Navy spouse, and mom of four.

Here at the blog, I talk about the financial issues that affect military families - pay, allowances, and benefits. Plus college stuff, landlording, moving, taxes. We cover a little bit of everything.

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