When it comes to TRICARE, many military families are faced with decision: choose a TRICARE option with little to no outside costs but with limitations on your healthcare choices imposed by the HMO; or choose another TRICARE program with more flexible choices in healthcare providers, but only covering 80% of your military family's medical expenses.
Some military members can feel like they have to choose between the lowest cost for their healthcare, or more freedom of choice in healthcare providers.
There is a way to get both from your TRICARE benefits: you can choose a TRICARE supplement program.
LET'S REVIEW THE TRICARE BASICS
TRICARE Prime is a voluntary "HMO-type" plan where Military Treatment Facilities (MTFs) are the principal source of health care. All active duty service members are automatically enrolled in Prime. You and your family enroll one year at a time, and receive your medical care from a specified network of civilian and military healthcare providers.
TRICARE Extra is a Preferred Provider Organization (PPO). With TRICARE Extra, you choose from a network of civilian doctors and military providers, and get a discount through cost sharing. There is no enrollment fee, and you may use TRICARE Extra whenever you want.
TRICARE Standard is a fee-for-service program. TRICARE Standard pays a share of the cost of covered health care services from a non-network civilian health care provider. There is no enrollment fee in TRICARE Standard. After the TRICARE deductible has been met, TRICARE Standard will cost share the allowable charges for outpatient services and supplies for active duty families.
With TRICARE Standard you never have to get HMO approvals for seeing specialists; you never need permission before taking your children to see the doctor; no referrals from a primary health care manager are required; and you don't have to go to a military treatment facility. It's easy: just call the office of the doctor you prefer and just make sure they accept TRICARE insurance.
Now, if you want to retain maximum flexibility and choice and still get maximum cost coverage, there is one more option that can take TRICARE Standard to the next level: add a TRICARE supplemental insurance policy to your TRICARE Standard.
Several different private medical insurance companies offer supplemental insurance coverage to pick up where TRICARE Standard leaves off; that is, these insurance providers will cover the remaining 20% of your health care costs that TRICARE Standard does not cover.
With a TRICARE supplement program, a trip to the doctor means TRICARE Standard covers 80% of that doctor's fee, while your TRICARE supplemental insurance picks up the remaining 20% - and you're 100% covered. Your deductible is $150 per person or $300 per family. Once you reach those deductibles, there are simply no further costs while your supplemental insurance kicks in to covers your balances.
Many military associations and private companies offer supplemental insurance policies. Supplemental insurance always pays after TRICARE pays. So, after your TRICARE insurance plan pays its portion of the bill, supplemental insurance reimburses you, the TRICARE beneficiary, for out-of-pocket medical expenses you have will have paid to civilian providers to cover their fees. The reimbursement is based on your supplemental plan's coverage policies. Each supplemental insurance plan may have its own rules regarding eligibility, benefits covered, pre-existing medical conditions, cost shares and deductibles and procedures for claims processing.
When you want maximum healthcare choices and maximum healthcare coverage of costs, using a supplemental insurance policy to augment your TRICARE Standard can be the healthiest way to go.