Welcome to today's
webinar titled "What Happens to Your TRICARE
Coverage After Retiring?" We're thrilled to have with
us today Ms. Zelly Zim, program analyst, TRICARE
Health Plan Division, Policy & Programs Section, Defense Health Agency. The appearance of hyperlinks
does not constitute endorsement by the Department of
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Welfare and Recreation sites, Defense Department does not
exercise any editorial control over the information you may
find at these locations. Such links provided consistent
with the stated purpose of the Defense Department-sponsored
webinar. If you're like most newly
retired service members or about to retire, you're
wondering what's next. You may also be thinking
about how you can tap into available TRICARE services. This webinar will provide you
with a brief overview of how your status change
affects you and your family's
medical coverage. Join us as our TRICARE experts
review your coverage options and help you plan for your
first year out of uniform. Without further delay, I'm going
to turn things over to Zelly.
Yeah. Good afternoon or good
morning, ladies and gentlemen. I see there are so
many joining us today and taking the initiative to
understand this process. As I have mentioned my name
Zelly Zim and I am a program and policy analyst with the
TRICARE Health Plan. My primary role is the
management of TRICARE Select policy as well [Inaudible]
enrollment policies as a whole. Join me for this
afternoon's webinar, there are a few of my
wonderful colleagues. Ms. Anne Breslin is a
subject matter expert for TRICARE For Life which is
Medicare-wraparound coverage.
Mr. Jeremy Schneider is
knowledgeable on the same along with the reserve
component matters and the Affordable Care Act. Ms. Michelle Wilkerson is here a
contract support to our section and she's a wealth of
knowledge especially in regards to the
Overseas program. Again, thank you for
taking the time to join us. We will be walking through each
topic you see on the agenda in front of you with the
goal of equipping you to make informed decisions about your TRICARE
options after retirement. So to start let's
define retirement. Just the word "retirement"
requires some definition. There is Active Duty retirement
which includes your retirement after 20-plus years or medical
retirement from Active Duties.
To accept we can also include
surviving spouse status in this category. Generally healthcare benefit
eligibility for this Active Duty retirement group, coincides with your
retirement date. Under the Reserve
Retirement umbrella, you have 20-plus years
of qualifying service in the National
Guard and Reserves and eligibility
begins at age 60. There are options for healthcare
coverage before age 60 for this group as
well as factors that can affect the
date of eligibility, and we will discuss this
later on in this webinar.
If you have heard the term great
area retirees to refer to them who have completed their 20
years of qualifying service in the National Guard or Reserve and has not yet
reached the age of 60. And again, we will talk a
little bit more about that as we go forward. In other words,
they're discussing is eligibility specifically. A member's service determines
whether they have eligibility for TRICARE including when
that eligibility kicks in. The TRICARE Health Plan and the
private sector care contractor to support the TRICARE Health
Plan looks directly to the services for
eligibility determination.
The TRICARE Health Plan division
cannot affect, change or edit eligibility
on your behalf. The information that we have
and that is used to advise you with information of
your personal option is pulled directly from
DEERS which is managed by your individual services personnel office. Any issues with eligibility
dates, timelines or beneficiaries under your
account must be addressed through your service personnel
office and request it in DEERS. DEERS is the repository
for eligibility. The note in blue at the bottom
of the screen references Qualifying Life Events or QLEs. A QLE when updated in DEERS
trigger the window of opportunity to make changes to
your health plan [Inaudible] in a new health plan.
Specific to our note today,
retiring from Active Duty and turning 60 if you're a
retired reserve member or QLE, our QLEs include changes in your
family composition or moving. The full list of QLEs along
with examples you can see http://www.tricare.mil/lifeevents. The website includes information
on what to do following QLEs. Throughout this presentation I
will mention a few websites, both of them, start the same way
with that http://www.tricare.mil and whatever I say after the
last slash is what is really important to take note of in order to reference
those later. So when you retire
you have a QLE. So this change in status to
retiree means that you can make changes to your health plan
or enroll in a new plan. It is important to
note these changes are not made automatically. You need to actively select and
enroll in a TRICARE plan should you desire coverage for civilian
or private sector care. If you do not take that action,
you will lose TRICARE coverage and may only be eligible for
care at military hospitals or clinics if space is available.
On the middle of this
screen is the website http://www.tricare.mil/comparecosts. On that page, if
you select a plan, you specify the sponsor's
status is needed, the site will then
give you the fees and the cost applicable for that plan for the
current calendar year. I have heard you to use
that tool to plan ahead and to note costs for care especially since those numbers will be admitted to
you as a retiree. Another note before we
move on to next slide is when you retire you and
your family members should go in to get new ID card.
Having a new ID card is
most straight forward way or TRICARE verification of
your retired status in DEERS and we'll talk more about
this one on the next slide. I already mentioned
DEERS several times. As you are probably aware, DEERS is Defense Enrollment Eligibility Reporting System. This is where all your personal
information is managed. You know, your address
gets updated here, beneficiaries, et cetera and very important update
right now is retired status. If your uniformed service
doesn't update your retired status, you cannot
re-enroll in TRICARE. If you don't have a retired
status you don't have that QLE that's needed. If you don't have a QLE,
then again you don't have the option to make
health plan changes.
Should this happen you
will continue to show your previous data status and eventually once
that's rectified your claims would need to be adjusted
and you would need to pay retroactive enrollment
fees or on that later. In this slide there are
directions for updating DEERS on your own, as there
are certain aspects that are your individual responsibilities such as your address. Updating your retired
status, however, that's the responsibility of
your individual service.
This slide also states on
the bottom right there, it says for enrollment concerns, call your TRICARE
contractor. I would like to highlight this
message for enrollment concerns not eligibility. The TRICARE contractors will be
able to assist with enrolling you in the plan of your choice
only after your eligibility is reflected in DEERS by
your individual service. Essentially if information is
not in DEERS, it doesn't exist. So at this point, we know
that when you retire, you will have a QLE upon which you must take action to make
health plan changes and those kind of costs. And we know this whole
process hinges on updated information in DEERS. Now at this point we've done a
lot of talking about eligibility for health plans, but
let's actually introduce what these health plans are.
I will spend a little bit of
time on the Active Duty options and then pull into the National Guard and Reserve options afterwards. [Inaudible] is on everything,
so hang in there. Today there is a quiz, but all of the options
discussed here are also available with the
National Guard and Reserve retirees with the
exception of TRICARE Plus. This portion of the presentation
is still applicable to everyone that we have here. If we keep this slide as a
reference, be sure to refer to the options that
match your retirement. So this table is broken
down into before age 65 on the left side and then age
65 after on the right side. What follows along
down the left column and we'll start with
TRICARE Prime. With TRICARE Prime you have
a primary care manager, or a PCM to
coordinate your care. You must live within a Prime
service area which we will also call up PSA (Prime
Service Area), and this is because TRICARE Prime generally features the use of military
hospitals and clinics.
For retirees TRICARE Prime has
enrollment fee co-payment. Those are also
called Cost Shares and those are covered services and from network providers. When you're following the
rules of this plan, out-of-pocket costs are limited
to your catastrophic hat. Costs you pay under the
point of service options don't apply towards
your catastrophic hat. Point of service refers to
you non-emergency healthcare services from any TRICARE
authorized civilian provider in or out of the
network specifically without requesting referral
from your PCM. Any cost you pay point of
service or without a referral do not have towards
your cat cap. You only contribute towards your
cat cap with your co-payment. It's also important to note
that for TRICARE Prime, there's no deductible. Next, we have USFHP or
the US Family Health Plan. USFHP is a specific
TRICARE Prime option that's available in
select areas stateside. If you're enrolled in USFHP, you cannot get care at
military hospitals or clinics or use
military pharmacies.
All of your coverage is through the not-for-profit
USFHP network. In contrast to these Prime
options, the TRICARE Prime and then USFHP, which
is a type of Prime, you have TRICARE Select. TRICARE Select allows
you to choose your own TRICARE-authorized provider
rather than having a PCM or a Primary Care Manager. If you don't need to
live within a PSA, if you don't need to live
within a Prime Service Area, you can live wherever. In general, TRICARE Select has
higher out-of-pocket costs than TRICARE Prime. With TRICARE Select there is
also an annual deductible for TRICARE-covered service. Remember, Prime did
not have a deductible. Deductibles are determined on
a count of a year basis, and deductibles are just the
allowable costs or charges for covered outpatient
services or supplies.
With TRICARE Select, after
your deductible is met, you pay per visit full payment and your out-of-pocket
costs again are limited to your
catastrophic cap. So out there, we have two big
cost differences between TRICARE Prime and
TRICARE Select. So first, Select ends up with
higher out-of-pocket costs, and this is primarily
because of two, the fact that TRICARE
Select has a deductible. Another big differentiation
between Prime and Select are the location requirements. For Prime, you must live
in a PSA, for USFHP, you have to live in specifically one of their coverage areas, and for TRICARE Select,
you live wherever. Moving along, we have
TRICARE For Life or TFL, and this is best described as
Medicare-wraparound coverage. This means that TRICARE is a
secondary payer to Medicare.
TRICARE For Life is an
option before age 65 if you have both Medicare
Part A and Part B. As a reminder, Medicare Part A
usually does not have a premium if you've paid into
Medicare taxes. Medicare Part A is
hospital insurance. Medicare Part B is
medical insurance that covers services
like outpatient care, doctor's appointments and
preventative services. Your entitlement or eligibility
for Medicare is outside of TRICARE's scope, but based
on that eligibility and the services you pay
for through Medicare, TFL, TRICARE For Life is
the military entitlement that can assist with
covering medical costs.
You need to be enrolled in
Medicare Part B in order to be eligible for
TRICARE For Life. If you do not enroll
in Medicare Part B, you will lose coverage unless you are still working and are covered
under an entirely other employer health plan. Unlike TRICARE Prime and Select, TRICARE For Life does not have enrollment free fees. Remember, that's because
you're paying for Medicare. If the care is covered by
TRICARE but not Medicare, you'll pay the TRICARE For Life
deductible and cost shares. If the care isn't covered
by Medicare or TRICARE, then you'll pay the
entire amount. http://www.tricare.mil/tflcost
has more information and a matrix that breaks
down those costs for you.
If you have questions about your
Medicare eligibility itself, you can visit http://www.medicare.gov. If you choose to live overseas,
Medicare does not pay, but you need to be
paying for Medicare to be eligible for
TRICARE For Life. Again, TFL is wrap-around
coverage that must be paired with Medicare Part A and Part B,
regardless of whether you live stateside
or overseas, right? So on the topic of overseas, we
have TRICARE Select Overseas.
This is the same
as TRICARE Select. There is a network of
TRICARE-authorized providers and you maintain the ability to
choose your own providers. You have a deductible,
you have cost shares, you have a catastrophic cap,
you have enrollment fees. The main difference is
that reflects overseas, you should expect to
pay upfront for care and follow your own claims
to get the money back as opposed to the other
way around elsewhere. Notice on the
bottom of the slide that blue box at the bottom, it mentioned that
TRICARE Prime Overseas is not available to retirees
and their family members. So if you're overseas, your
option is really going to be TRICARE Select Overseas
and TFL advocates. Lastly, on the left side
we have TRICARE Plus. Plus is a very narrow option
that gives you access to primary care at a military
hospital or clinic. Enrollment is only for
the hospital or clinic where you are enrolled. Availability of this
plan is determined by each hospital or clinic. There is no specialty
coverage under TRICARE Plus even if you're referred by your primary care at
that military facility. And as I mentioned a
couple of minutes ago, this is the one thing
on this slide that does not apply for
the National Guard and Reserve Plus Retirees.
On the right side, we have
your option for age 65 and after which is
TRICARE For Life. Again, Tricare For
Life-wraparound coverage to support those entitled to
Medicare Part A and who are paying for who are enrolled
in Medicare Part B. Now that's a lot on one slide,
but now you have an idea of the main differences
between each plan. We'll continue to review those
differences as we go on and you can also go to
http://www.tricare.mil/planfinder to find out which plans are
available in your specific area. Now, once you decide
what plan you want, you may be asking
yourself when to enroll. There are some essential dates
associated with enrollment. A QLE or Qualifying
Life Event opens up a 90-day window
for plan changes. So if you want to enroll in a
plan with no breaking coverage, you need to enroll
within 90 days of your Active Duty retirement date. This is really important so
I'll give you an example. We've got Sergeant First Class
OneSource and he retires from Active Duty effective
January 1, 2022.
He needs to enroll in a plan
within 90 days after January 1. He's eligible to initiate
that enrollment if his retirement
date is in DEERS. So should he do so? The effective date for his
retirement coverage will be January 1, 2022. We have already discussed
the other bullets that are on this slide, except for the third one, which I'd like to call
your attention to. Those three plans, TRICARE Prime
Remote, TRICARE Prime Overseas, and TRICARE Prime
Remote Overseas are not available
after retirement. That's why they were not on the
previous slide on that chart. So after Sergeant First
Class OneSource, what happens if he didn't make an enrollment selection
within his 90-day window what if as of
today, July 21, 2022, he is not yet enrolled? Does he have to wait for
Open Season this November? Thankfully, no.
So Sergeant First
Class OneSource is not stuck waiting
on Open Season. He can request a retroactive
enrollment up to 12 months after his Active Duty
retirement date. This is really important. So again, if he retired
effective June 1, 2022, he has until January 1, 2023 to
request retroactive enrollment. So I have to pay the enrollment
fees back to January 1, 2022, but with this retroactive
enrollment, any claims he approved during that time period
or that his family approved during that time period
can be reprocessed under the plan he has now
chosen for his family. Let's not forget about Sergeant
First Class OneSource. We'll come back to
him briefly later on. So without enrollment
in a health plan, a retiree is only
eligible for space available care at a military
hospital or clinic. If the 12-month window for
retroactive enrollment is missed, there are
only two ways for an Active Duty
retiree to enroll. One, during the next
TRICARE Open Season, which is a one-month period that usually begins on
Veterans Day in November, or two if a sponsor or a family member experiences
a different QLE.
To clarify, this concept of
retroactive enrollment that extends the QLE window is only applicable to the
retirement QLE specifically, and that's both for
Active Duty retirement and National Guard and
Reserve Retirement. These next two slides that
I will go to offer more information about TRICARE
Prime and TRICARE Select. I touched on a little
bit of this already, so I'll just get the
highlights here.
So remember that for
TRICARE Prime, you have a PCM that
is managing where and how you will
receive your routine care and who writes your referral
for specialty care. Though TRICARE Prime
generally features the use of military
hospitals and clinics, having TRICARE Prime
does not mean that all of your care would be
at a hospital or a clinic. Prime is only available in the
PSAs or the Prime Service Areas, and the military hospitals and
clinics within the PSA have what is called the
right of first refusal, and this is just what if
they manage their patients, their workload, their priorities and that mean that
you're seeing elsewhere, even if you have Prime
and you live in a PSA. As we mentioned previously, Prime does have a
yearly enrollment fee.
Cost shares which you know
also notes copayments apply if you get care within
the TRICARE network. Point-of-service fees
are applied if you get authorized care from a
non-network provider. On TRICARE Select, so
TRICARE Select again is a self-managed program that gives you the
flexibility to see the TRICARE offer our provider of your
choosing for both routine and specialty care. You don't have to
live within a PSA and you're not bound by a referral requirement. For this flexibility, you
will pay deductibles and cost shares in addition
to your enrollment fee.
The out-of-pocket costs
are lower, and you remain within the TRICARE authorized
network providers. The factor to consider as you
compare TRICARE Select and TRICARE Prime,
maybe to look at where the authorized
providers are in your area. As I promised, we are going to
shift to looking at options specifically available for our National Guard and
Reserve retirees. Remember the term
gray area retirees that I mentioned
at the beginning, so that's the group
we have here on the far left of this table. From a National
Guard or Reserve, if you retire before age 60 or in gray area retirees
from your retirement date until when you turn age 60, during that time you
have the option to enroll in TRICARE
Retired Reserve or TRR.
We will talk more about
TRR in the next slide, but in the meantime, while on the subject
of gray area retirees, I'd like to address something that we sometimes
get questions about, so that is the age 60
part of the definition. Some periods of Active Duty or
active service can reduce the age requirement
below 60 years of age, and this is called a
reduced age retirement. You have to consult with
your branch of service, periods of Active Duty or active service
within your own portfolio. If you have reduced
age retirement, your branch of service will select that in DEERS and then when you go to
whole in a health plan from the middle
column on the slide, it will then show it's eligible, though you haven't
reached age 60. So on to the middle column,
the options here match what we discussed for the before
age 60 Active Duty retirees. Once the National Guard or
Reserve retiree reaches age 60, if you live [Inaudible] side, you can choose between
Prime and Select.
Prime would be an option if you'd like a
Primary Care Manager and live in a PSA and
alternatively you could get Prime through USFHP if you live
in one of those specific areas. Regardless of where you
live, you have access to TRICARE Select which
widens your network. TRICARE Select is also available
overseas as we mentioned, and lastly, while you're
still under age 65, TFL may be an option if you have both
Medicare parts A and B. As you can see on the far right, TRICARE For Life remains as your TRICARE option at age 65 and beyond, as long as it's
paired with your Medicare. We will talk more about
TRR, so here it is.
At any time between
your retirement and before you turn age 60, you can qualify
to purchase TRICARE Retired Reserve. Contrary to the Active Duty
retirement process that we discussed earlier, there is not a specific
90-day enrollment window after your
retirement date and you don't need to wait
until an open season. TRR has something that we call
continuous open enrollment. Again, if you'd like to
avoid a break in coverage, timing is key.
If you're enrolled in
TRICARE Reserve less, you must request enrollment in TRICARE Retired Reserve within 90 days of your transfer to the Retired Reserve. TRICARE Retired Reserve is similar to TRICARE
Reserve Select, in that you can choose
to see any TRICARE-authorized provider receiving care
at a military hospital or clinic is on a
space available basis. Information about enrollment
fees and premiums for TRR can also be found on
http://www.tricare.mill/comparecosts and you can use that tool to
prepare and see what to expect. I'm on Slide 15 now, and if you
are retired from the Reserve or National Guard, your options
look generally the same as what we discussed
previously for your Active Duty retiree counterparts. In regards to eligibility, this
slide details what needs to happen before you try to enroll
in a TRICARE health plan. As you see here, you need
your 20-year letter, you need to be drawing your military retirement pay, and you guessed it, your eligibility must be reflected.
If all those things are true,
you can then enroll in TRICARE Prime which includes your
FSHP, TRICARE For Life, or TRICARE Select. What you choose is going to
depend on your individual situation to include
where you live. You may remember that I said
that before age 60, Guard or Reserve Retirees, gray area
retirees could request enrollment in TRR at anytime due
to continuous open enrollment. That's not the case once you
turn 60 and you're looking to enroll in one of
these other plans. That continuous open
enrollment is unique to TRR. Once you turn 60 and you meet all your criteria on
the previous slide, the 20-year letter, the drawing military
retirement pay and DEERS, you have 90 days to make a health plan
selection to enroll. The 90-day window is our
standard QLE window because this is specifically
the retirement QLE, however, you have the opportunity to request retroactive
enrollment for up to one year. Remember the example
I gave earlier with Sergeant First
Class One Source? The same applies here.
You have 12 months from
this retirement QLE date to request enrollment
in a health plan. If you do so and back pay
necessary enrollment fees as applicable, your coverage
will be retroactive to your retirement date. If you miss this window,
you'll need to wait until the next
TRICARE Open Season. Let me clarify
that a little bit. So for TRS and for TRR, you do
have continuous open enrollment, and so you don't need to wait
for the next Open Season or QLE.
So for both, TRICARE Select and for TRICARE your
Retired Reserve, they both have that continuous
open enrollment aspect. If you're looking for the
TFL option at this point, remember that timeline and availability is directly
tied to your eligibility for Medicare Part A and your
enrollment in Part B. Before we move on
from National Guard and Reserve Retirement enrollment at age 60, I'd just like to mention
the reduced age retirement one more time. So if that's something
that applies to you, it will be reflected by your branch of service and DEERS, and you would receive your 20-year letter
and your pay accordingly. Based on that date reflected
by your branch of service, that's when you enter
into this age 60 to 65 retirement category that
we've been discussing, even if you're
younger than that due to your reduced
age retirement.
At this point, we've discussed
retirement dates, updating, DEERS, eligibility, ages,
enrollment timelines, and what the different
options look like, but how do you actually enroll? How do you actually
purchase TRICARE coverage? This slide answers
that question. Depending on your preference,
you can enroll online, by phone, by mail, or if you're
overseas, even in person. So this is a good time to note
that you don't have to enroll to use TRICARE For Life. Coverage for TRICARE For
Life is automatic as long as you have Medicare
Part A and Part B and you probably
guessed it by now if you're registered in DEERS. So again, TRICARE For Life is
the only one which you don't need to actively enroll for
because that will be reflected once you enroll for
Medicare Part A and Part B.
So Health Plan Information. This slide is a great reference
point for your portfolio. Each page gives more
information about each plan that we've covered today. And additionally, there's a link
here for TRICARE Young Adult which may apply to
your adult children. If you have a college
student in other sites that might be helpful, use http://www.tricare.mil/lifeevent/
college. If you have more questions
about TRICARE For Life, there was actually a webinar in March that was titled How to
Get Started with Medicare and TRICARE, and that
was recorded and that's accessible via the
Military OneSource website. The audio and transcripts
for that is available on the Webinar section
of that website, and there was also a
series of TRICARE For Life-related
podcast episodes, and those can be accessed at http://www.newsroom.tricare.mil/podcast The web pages that are
on this slide along with the compared plan tools and the cost tools, are
things that can just help to round out your
knowledge as you choose the best option for your family.
There are several contractors
that manage the network used by the TRICARE plans
we've discussed today. Their contact information
is listed here, and these are the ones that you could call when
you're looking to enroll if you choose to do the
phone call option, and then their websites are here if you'd like to do that online. The contractors for East,
West, Overseas and USFHP can give you information specific to where you live, and this is as I said, the contact information
you can use when you're actually ready
to enroll in a plan. The online resource or the
TRICARE For Life contractor has all your benefit information
on that side as well. Though we talked about
the medical benefits, but switch gears a bit and
talk about pharmacy. The TRICARE Pharmacy Program
comes along with enrollment in a TRICARE health plan, with
the exception of USFHP, which is because USFHP has its
own separate pharmacy program. As you can see in the
middle of this slide, there are four options for
filling prescriptions. http://www.tricare.mil/pharmacy, that's
listed at the bottom of this page, that website has a helpful
chart that shows the co-payment associated with each
prescription option based on the type of medication.
For all retirees and family
members that's non-Active Duty, there are selected brand name
maintenance medications that can only be filled
twice at retail, and then they must be filled
via home delivery or military pharmacy. If this is not a third time by
a beneficiary residing within the United States or United
States territories, the beneficiary is then responsible
for 100% of the cost. For many maintenance
medications, home delivery is a 90-day supply while retail
network pickup is only and a 30-day supply. So, there are
definitely some benefits to home delivery instead.
All beneficiaries billing
prescriptions in overseas pharmacy will need to pay
upfront for medications and seek reimbursement
through the claims process, which is similar to what we talked about earlier in
terms of TRICARE Select Overseas where you're paying
upfront as well. As I mentioned, you can go to
the website that's listed here for the pharmacy options and for
copayments that accompany your TRICARE coverage. You can also see if your
medications fall under the maintenance list that must be
filled through home delivery and you can find that
out by visiting http://www.health.mil/selectdruglist.
The TRICARE dental program that
you may be familiar with is no longer available
upon retirement. Instead, look into if
you qualify for FEDVIP. FEDVIP will give you the option
for dental and vision coverage, and it is offered by the US
office of personnel management which is known as OPM. To enroll in vision coverage, you must be enrolled in a TRICARE health plan so one of the plans that
we've already discussed but dental coverage is
available even if you choose not to enroll in a
TRICARE health plan. FEDVIP has its own
dedicated open season and its own set of QLEs and you can learn
more about that at http://www.fedvip.com. When it comes to
the FEDVIP open season, it often coincides with
the TRICARE open season, and so you can make all
of these decisions at the same time. So here we've got a snapshot
of a few of the resources that are available for download, and those are available at tricare.mil/publications.
Each one of these brochures
goes through the information we covered today and
incorporates it with information for many of the websites as mentioned
throughout the webinar and these publications, they're just a great
place to start as you learn more about your TRICARE
coverage after retiring. Here, we have some online tools. I would highly suggest
that you go look through each one of these. You'll gain a lot of
great information. You can use the Plan Finder, which will allow you to
enter your sponsor status, Medicare eligibility,
and your location. You can compare costs
or compare plans. You can research what services
are covered by TRICARE, which ones are not. You can also use the
formulary search tool for your pharmacy needs. When you're using these tools, you may notice reference to Group A and Group B.
For purposes of enrollment fees,
cost sharing, deductibles, and catastrophic cap, TRICARE Prime and TRICARE
Select enrollees are classified in one
of these two groups. They're generally based
on the sponsored date of initial service. Before January 1,
2018 is Group A and after January 1,
2018 is Group B. You just need to
take note of that and use that information as
you navigate these tools. If you're a surviving
family member or you're medically retired, there are cost considerations
that are specific to you and that you'll discover
as you use these tools. For example, if your
sponsor was Group A, which means an initial service date before January 1, 2018 and you're a survivor, you don't pay TRICARE
Select enrollment fee. For all its hiring
service members, the first step to
understanding TRICARE coverage is just to begin
researching your options.
Webinars like this one are
a good place to start, and these tools will help
you further understand and tailor your plan towards your family's needs. You can also sign up for email
updates or follow TRICARE on social media for
additional updates. With that, we've now reached
a portion of the presentation where we'd like
to hear from you. So I have several colleagues
that have joined me, and we look forward to answering as many of your
questions as possible. I will now turn it back over
to Tina to kick us off with the first question. Awesome. Thanks, Zelly.
First question. Does your current TRICARE
coverage end on your ETS or retirement date or are you
covered during the transition? Right. So, yes, your current coverage
ends on your ETS date if you do not make a selection from one of the ones
that we discussed in this presentation today.
If you don't make one of those
selections before your ETS date. However, as we talked about the
retroactive eligibility, if you miss that first 90-day window after your
retirement date, you can then request retroactive
eligibility up to one year out, and then TRICARE will go ahead and work with you
to reprocess fees and if you pay your
enrollment fees, they'll reprocess claims and your eligibility
will be backdated to your retirement date. So it'll eventually look like
there was no gap in coverage, but you do need to take action
within that one-year time frame to make sure that you don't
have any gap in coverage. Okay. How do you know what
TRICARE plan you're in? If you are on active duty and
you're still on active duty, you should be able to find that
information on milConnect or with your health
plan provider. If there's something
that Jeremy or Michelle would like to add on that one. That one you can get by
calling your local contractor.
I believe the numbers
have been provided there and the websites
and links to those, and that would be the best
way to determine exactly which plan you're
currently enrolled in. Another follow up question. How long do you
have to take action? Right, so to take action, you have essentially
it's a QLE period. So you have 90 days
from your ETS date. But again, that's if you
don't want a gap in coverage. If you miss that 90-day
window, you have one year. Okay and then this
is two questions. If you need to get a new ID. Sorry, Jeremy, go ahead. I just wanted to add in just a
clarification to that one year.
There is for the reservists, the retired reservists
who are turning age 60, they will end up
having a retroactive period of up to one year. For other people who
wait beyond the 90 days, they would have a gap, and their next opportunity
to enroll would be at the next open season or if they have
another QLE, but then they would have
a gap in coverage between their ETS date
and that later date. Thank you so much. And then the other… it's
two questions in one, so I'll read one and
then the other.
If we need to get a new ID, should we wait until after signing up for TRICARE coverage? No, you don't have to wait
till after you sign up for TRICARE coverage. You can go ahead and do
that as you are retiring, and then that way you know that you have that
ID card because that's what will be basically your
medical benefits card as you move forward
after retirement. And then the second part of the
question is what counts towards catastrophic cap
on TRICARE Select? For TRICARE Select, your cap is
going to be primarily focused on your deductibles or what's
going to count towards that. So just to reiterate
that piece, so you have your
annual deductible that's for TRICARE
coverage services, and then that's determined
on a calendar year basis.
Once your deductible is met, you
can pay per visit copayments, and then your
out-of-pocket costs are limited to your
catastrophic cap. So it's just your out-of-pocket
costs that contribute to your catastrophic cap and the cat cap that's
posted for TRICARE Select every year as well, and it
resets on January 1 of the year. Thank you. Are fees for the first year
of retirement prorated based on the date of eligibility? All right, Jeremy, is
this one that you'd like to answer for the proration. Sure. So, your enrollment
fee will be prorated to the time of the
year that you enroll. It's going to be if you only
have six months of coverage within the year, you're
only going to pay half of the enrollment
fee for that year. Okay. And then how long do you have
after retirement to sign up, and how long are you covered
after retirement? This one again goes back
to the QLE time frame. So you have 90 days if you
avoid the gap in coverage, and then you have up to one year and as Jeremy
clarify for the…
If you're not a
retired reservist, then after that point, you have to wait until your next QLE or until the next
open season. And then how long you're covered
after retirement depends on what age and what
plan you're in. So if you are active duty, if you're active
retiree before age 65, you have all those options
that we talked about Prime with FHP Select TRICARE for
life left overseas plus.
And then once you reach age 65,
whether you are active duty or you are a retired reservist, you have TRICARE for
life as your option and that is ongoing. I'm a spouse and I'm six
months older than my husband, a retired member. Can I register before him? My guess is that this
is [Inaudible] would be significant if the spouse is
then eligible for Medicare and then in that case, yes,
they could register before because they still have
the active duty sponsor so they can register for
TRICARE for Life beforehand. But I'll also pass this question
over to you with Anne Breslin who is our TRICARE for Life. Thanks, Zelly. This is Anne. If the sponsor is retired then
the older spouse should sign up for Medicare at the normal time and signup for both Medicare Part A and Part B. If the sponsor who is
younger is active duty, then the older spouse would
sign up for Part A only and sign up for Part B the month before his or
her sponsor retires. That would help avoid
a gap in coverage when the retirement occurs.
Is there a listing of PS areas? Yes, so if you go on
tricare.mil/planfinder, you can put in your zip code and your location there, it will show you
what's available, and the PSAs for the most
part are around MTF and they're about a 40 miles
radius around the MTF. They're based on drive time. But yes, as I said, you can go
to tricare.mil/plan finder to find that information. For TRICARE Prime, do we
have to be seen by a PCM on the nearest
military installation? For TRICARE Prime, you
need to be seen by a PCM within your Prime Service Area and you would gain knowledge
of that when you sign up for that or when you look
at what is within that PSA.
Jeremy or Anne,
is there anything you'd like to add to that? This is Jeremy. I think that covers it. It's really where you are
assigned depending on the area that you're in. The Prime Service area
is built around the MTF, so you may have an MTF PCM or you may have a PCM out in
the private sector network and that is a PCM by name, so you'll be assigned to
a specific provider and they would be the
gatekeeper that you would go to for your primary care and to receive any referrals
for specialty care.
If you live in a PCA but the
MTF doesn't have capacity for retirees, can you
still enroll in Prime? That speaks directly to what
Jeremy just mentioned, so you can be in MTF and
a Prime Service Area and your primary care manager is
not necessarily at that MTF. That information will be
clarified depending on the capacity of the
MCF in that area. Can you change the type of
TRICARE Select Prime Plus? Yes, of course you have
the opportunity to change what type of TRICARE you have
with the retirement QLE.
You can do it at that time,
but if the question is, if you want to change
it afterwards, then your opportunity to
make those changes is during open season or
if you experience another QLE and you can find
the list of QLEs. That one is on
tricare.mil/life event. Do you have to wait to enroll
until your effective retirement date, or can you do this
while on terminal leave? You can absolutely do this
while on terminal leave. What you need to be able
to start this process is for your retirement
date to be in DEERS. Okay, then this is the
multipart question, too. If I enroll within the 90
days of my retirement, when is the first
payment effective? He officially retires on
September 1, can he enroll now, or does he have to wait until
September 1 to sign up? Just like the last question,
you can definitely go ahead and do the enrollment, and it would be effective
your retirement date and same goes
for your payment.
Your payments would be
effective that date. Okay, and then
another question. I'm not clear on the difference
between enrolling within three months of retirement and
retroactively enrolling within 12 months of retirement. What's the downside of enrolling
retroactively within 12 months? The downside of enrolling
retroactively is that you would have a break in your coverage in
terms of what you actually want to go be seen, so if you enroll
within those 90 days, there's no breaking coverage and all of your cost
that are out-of-pocket or any co-payment that you
pay will be based off of that retired plan
that you picked.
If you wait the 12 months,
any care that you seek during the interim
is going to be as if you do not have
TRICARE coverage and then, it's not until you
make that decision and you take action for a plan that all of those
get reprocessed. Basically, it just
changes how much money is coming out of your pocket. This is Jeremy. I just
want to make that maybe a little bit more
clear on the things. Unless you are one of the people
that is a gray area reservists retired that's transitioning
to your full retirement, if you're in one of
the other categories you will not get those retroactive claims paid. We have that specifically set
up for the gray area reservists because there are delays in the
processing of their retirement paperwork quite often so if you're a normal
retiring from active duty or any of the
other statuses except for that specific
area of reservist, then you would have a
break in coverage where you would not
have TRICARE coverage and it would not be eligible to be
retroactive for the 12 months.
Jeremy, hang on, because
there's a question that's very similar. Are you on the hook
for health care costs between the time of
effective retirement date and the time you actually enroll
in an eligible TRICARE plan? For example, you retire
on 1 January 2022, you visit urgent care
on 1 February 2022 and enroll on 31 March 2022. Ultimately, in that scenario,
you would be covered. You would enroll with
retroactive back to 1 January. What may happen during
that interim is if you got received a bill
on 1 February for that, you might have
to pay up front and then file with TRICARE
to get reimbursed once you obtain TRICARE again. We don't recommend
leaving a gap, but you would be
eligible as long as you enroll within your QLE
that's applicable to your plan, normally in 90 days
for the retired reservist up to 12 months after
turning age 60.
As long as you follow
that then retroactively, you will get the claim
paid under the TRICARE and up to the TRICARE allowed
rules and everything, but you may end up
having to pay up front and file for reimbursement
in that scenario. Thank you. For active duty retiree, will
I need to live in a PSA if I select TRICARE Prime. Yes. The only exception to that
would be if you received a drive time waiver, so there
are a couple exceptions, but the reason that you
need to live in a PSA for TRICARE Prime is
to make sure that we maintain all of our
access to care standards. If you are interested
in TRICARE Prime and you do not live in a PSA, you would need to contact
the contractor to see if there was a possibility
of a drive time waiver based on your address
and then if not, you would need to pick one of
the other TRICARE options.
This person is confused
on guard retirement. I'm retiring from
the Guard as an AGR. Would I fall under
reserve select? I think this would require
clarification on if they are before age 60 or after so
if they are before age 60, they could have TRICARE
retired reserve, that's TRR, and then once they reach age 60, then they have the
other option, such as Prime and Select. Jeremy, is there anything
you want to add to that one? No, that's exactly accurate. If it's a gray area
retiree under age 60, non-regular retirement, then
they would have TRR. If they are over age 60 and they are going directly
into full retirement, then they could
transition directly to TRICARE Prime
or TRICARE Select. Okay, if you change TRICARE
plans during the year because of QLE. Example, you're going from
TRR coverage to Select when turning 60. Do you have to pay another
deductible under the new plan? If you've already
met the deductible for the TRR for the year? If you switch plans, your
deductible is based off of the plan that you're
now in and that reset at the beginning of the year,
if I have that correct.
Jeremy, is there
something you want to add or clarify for that one. That should get credited across
if there's a difference between the plans that you're
switching to and you… for example, meet the
deductible within the first few months
within one plan but it's less than the deductible
on the other plan then you'd continue paying out at the new plan
until you met that. Overall, you're going to
be subject ultimately or protected ultimately by the catastrophic
cap in either of those cases when you make a plan change. And just one other
clarification for that, if you meet your cat
cap for the year and that's why you're
still on active duty. When you retire, your cat cap changes over to the
retiree cat cap, which is higher and so, the
same scenario that you continue paying towards
that catastrophic cap and it won't reset
until January 1.
It does not reset simply
because you have moved from active duty status
to retiree status. I'm the sponsor soon to be
retired from active duty at age 62 with two dependents. Do my dependents and I all need
to be on the same TRICARE plan or can we be on different plans? No, you do not need all
on the same TRICARE plan. You can see what makes
sense for your family and puzzle together what works. And then this is going
to be our last question. Once enrolled, do you need
to re-enroll every year? No, you only need to take
action on an annual basis if you are making changes. If you are continuing
in the same plan, you don't need to take additional action. Is that correct then, Jeremy? That is correct. In almost all cases, you
do not need to take action.
This is an opportunity that
I'd like to take to hammer on keeping your addresses
up-to-date and gears and your phone numbers
up-to-date as you move around. As if there are the rare
occasions such as happened in 2021 where we instituted
new fees for statute, so we did have enrollment requirements where people didn't
need to take action on their accounts to stay
enrolled so it's rare that was expected
to be a one off, but if something like
that is to happen again in the future, part of
that is notifying everyone through letters and
telephone calls, so just encouraging everybody on the line to
please make sure that you keep your
DEERS addresses and phone numbers up-to-date so
we're able to reach you.
With that, Zelly, do you
have any closing thoughts? I just like to say thank you
for everybody's time today and thank you to my colleagues
for helping with… we hope that this
webinar has been helpful and that you're now
equipped to make informed and timely decisions
regarding TRICARE coverage for you and your
families after your military retirement and congratulations
on that milestone and thank you for your service. And I just want to thank Zelly
and her team for sharing their invaluable experience
and expertise. I'd also like to thank
all of our attendees for participating in
today's webinar. If you find yourself
having questions after the webinar is
over, you can email MOSWebinars@militaryonesource
.com and we'll send those
questions over to the presenter for answers. This concludes today's
webinar and what happens to your TRICARE coverage
after retiring.
Thank you..
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