Tricare health coverage is one of the most important benefits of military service. It provides excellent coverage at an amazing price. Tricare beneficiaries usually get to choose which Tricare plan they want to use. The different plans have different out-of-pocket costs. Depending on your Tricare plan, your status (active duty or retiree), your family size, and your average health care costs, a Tricare Supplemental Insurance policy (usually called a Tricare supplement) may help you save even more money and/or make your health care costs more predictable over the course of the year.
Tricare supplements are offered by several companies and organizations. A Tricare supplement will cover some or all of the costs not covered by your Tricare policy. Every family has different needs, and every plan is different, but you should look at what is available and see if a Tricare supplement would benefit your family.
A Short Tricare Primer
In order to understand whether a Tricare supplement is worthwhile for you, you have to have a basic understanding of your Tricare benefits. Tricare coverage may have four different types of costs: a premium, a deductible, co-payments, and out-of-network costs.
Tricare also has an annual catastrophic cap per family. The current (2019) catastrophic caps are:
- $1,000 for active duty families whose sponsor who entered the military prior to 1 January 2018
- $1,028 for active duty families whose sponsor entered the military on or after 1 January 2018, plus Tricare Reserve Select (TRS) families and any families with a member on Tricare Young Adult (TYA)
- $3,000 for retired families whose sponsor entered the military prior to 1 January 2018
- $3,598 for retired families whose sponsor entered the military on or after 1 January 2018, plus those using Tricare Retired Reserve
Knowing about the catastrophic cap is important to deciding whether a supplement is cost effective for you. For example, folks with a larger family might find that the supplement is nearly as expensive as their catastrophic cap. Keep in mind, however, that there are some things that don’t apply to your catastrophic cap that a supplement might cover. It’s a very individual decision!
What Does A Tricare Supplement Pay For?
Every policy is different, but a Tricare supplement typically covers the co-pays for care, prescription co-pays, and allowable excess charges (that would not apply to your catastrophic cap.) Some plans even pay for your deductible!
Here’s an example: Jo Retiree has Tricare Prime goes to the physical therapist three times a week to recover from an injury. Her co-pays are $90 per week. Her Tricare supplement would cover those co-pays.
Who Might Buy A Tricare Supplement?
Each situation is different, but generally a supplement can be financially beneficial to retirees whose only health insurance is Tricare. Some active duty families who do not use Tricare Prime may also find a supplement worthwhile. If you have other health insurance, such as employer-provided insurance, in addition to your Tricare coverage, you probably don’t need a Tricare supplement. Again, every case is different – you need to explore your exact situation.
The Math and Guesswork of Deciding Whether To Buy A Supplement
- In most cases, you start that decision by figuring out how much the supplement will cost you. Most premiums are determined by age and family size, so a larger family or an older couple or individual will pay more than a smaller family or a younger couple or individual. This is important to figuring out if a supplement makes sense for you.
- Then add the cost of any deductible you’ll have to pay. Most Tricare supplements have a deductible, and Tricare has a deductible which may or may not be covered by the supplement itself. Add the total cost of the premiums and any applicable deductibles to get the yearly cost of the supplement.
- Compare the total cost you’ve calculated to your catastrophic cap (listed above.) Obviously, if the cost of the supplement plus deductibles is higher than the catastrophic cap, that’s not a very good deal for you. If the supplement plus deductibles is less than the catastrophic cap, then you’ve got to do some guessing and balance your tolerance for risk.
How much care do you typically get in a year? Is it more or less than the cost of the supplement? How do you feel about possibly having a higher-than-usual medical year that costs you more than expected, keeping in mind that you’ll not go over your catastrophic cap as long as you don’t have uncovered service?
In most casts, the difference between the supplement and the catastrophic cap is only a few hundred dollars, so we’re not talking about a tremendous amount of risk either way.
Where Do I Buy A Tricare Supplement?
If you do an internet search on “Tricare supplement,” many choices will come up. Most are offered through military organizations who contract an insurance company to provide coverage. Also, some employers may offer a Tricare supplement, purchased through them, and paid for via payroll deduction.
Here are some of the organizations that offer Tricare supplemental insurance:
Air Force Sergeants Association: health insurance
American Military Retirees Association: http://tricaresupplement.com/
How Do I Know Which Company To Use?
Be sure to get a copy of the potential policy from several groups to see which coverage will best fit your family’s needs. Check things pre-existing condition coverage, deductibles, and maximum benefit limits. The Tricare website has an excellent list of questions to ask about any supplemental insurance policy. Be sure that the policy specifically states that this is a Tricare supplemental policy to ensure that Tricare can pay before the supplement.
Also, consider the cost to join the organization that is sponsoring the policy.
If you’re getting a Tricare supplement through your employer, you may not have a choice of policies. You can still make sure their cost is competitive.
Tricare supplements can be a great way to bring predictability to your health care costs, and they may save you money on your co-pays and other costs. Be sure to investigate the choices and see if a Tricare supplement is the right choice for your family.
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