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Accessing Health Insurance During and After Active Duty

Health insurance can be confusing, especially if you’re new to the service or to health insurance in general....

Health insurance can be confusing, especially if you’re new to the service or to health insurance in general.

Let’s take a closer look at some plans most commonly available to those who are active military or veterans, and their spouses.

Tricare: A Home Base for Military Health Care

health insurance paying for doctor visitFor active-duty military personnel and their families, military health insurance runs through the government’s Tricare program.

Tricare connects military members and some retirees and veterans, along with their dependents, to government-sponsored health insurance.

Tricare currently has 11 different plans, but not all plans are available everywhere and to everyone. So you can’t always choose the plan you like best.

About Tricare’s Plans

Active duty military members must enroll in a Tricare Prime plan, for example. Families of active-duty members can choose between Tricare Prime and Tricare Select:

  • Tricare Prime: These plans work a lot like a Health Maintenance Organization, or HMO. HMOs, manage costs by limiting which doctors you see and requiring your care manager to be involved in your health care decisions. To subscribe to Tricare Prime, you must serve in an area the plan serves. Alternative Prime plans are available for service members stationed overseas or in remote areas.
  • Tricare Select: These plans work more like a Preferred Provider Option (PPO) which means members benefit from staying in the military’s network of health care providers, but they can go out of network for medical care if they want. Going out of network usually results in more out-of-pocket expenses.

About Tricare’s Costs

  • Tricare Prime: These plans have no out-of-pocket costs for premiums or co-payments if you stay in-network. As a result,   military personnel can do their jobs without worrying much about health insurance. The patient would be responsible for occasional charges such as getting prescription medications delivered. The patient would be fully responsible for costs if he or she chose to seek care out of network.
  • Tricare Select: Patients pay deductibles ranging from $51 to $308 and copayments for health care ranging from $15 to $61. Prices increase out of network as they would with any PPO plan.

Alternative Tricare Plans

Within the structure of Tricare Select and Tricare Prime plans, the military also offers the following plans for special circumstances:

  • Tricare For Life: Helps supplement Medicare Part A and Part B coverage for subscribers 65 and older.
  • Tricare Young Adult: For young adult dependents of military members; financed by premiums paid by the patient/family.
  • U.S. Family Health Plan: Available only in specific areas, subscribers can use non-profit health centers rather than military-based providers.
  • Tricare Reserve Select: A special premium-based plan for members of the Reserves.

If you’re not sure which plan to choose, Tricare now has an online tool to help you narrow your choices.

How to Enroll or Change Plans

The military holds open enrollment each fall, usually for about five weeks from mid-November to mid-December, during which you can enroll in a plan or change plans.

You can also enroll or change plans within 90 days of a Qualifying Life Event such as retirement, discharge, becoming a parent, getting married, relocating, or being promoted.

Steps to Enroll or Change Plans

Enrolling or changing your enrollment always should begin with making sure your Defense Enrollment Eligibility Reporting System (DEERS) profile is up to date.

You can then enroll online or by phone using the Tricare Web site during Open Season. If you miss Open Season but have a Qualifying Life Event, you can request special enrollment by phone.

Transitioning From Military Health Insurance

Tricare is essentially an employee-based health insurance plan for employees of the U.S. armed services.

As with any work benefit, Tricare won’t be available when you leave the military unless:

  • You’re Retiring: Active duty retirees can usually continue using a Tricare plan as long as they live in an area the plan serves. Retirees can also access care through the VA.
  • You’re Injured: Veterans with service-related injuries (or illnesses) can usually stay on a Tricare plan to help provide continuity in their ongoing care.
  • You’re an OEF / OIF / OND Vet: Combat veterans from post-9/11 operations in Iraq and Afghanistan (Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn) will get free medical care for five years after discharge. (Family members are not included in this plan.)

Others leaving the military will transition to the Department of Veterans Affairs (VA) for medical coverage.

You should start the process of transitioning to veterans health insurance before leaving the military by getting in touch with your Tricare plan coordinator.

Non-Military Health Insurance Options

Of course, you can always get coverage through a civilian employer or by buying your own private policy through the Affordable Care Act or on your own.

Many former service members combine private insurance with care from the VA.

And, like anyone who meets the age or income requirements, veterans can access care through their state’s Medicaid or Medicare programs as needed.

As your time in uniform comes to an end, think ahead so you can build the best health insurance network for yourself and your family.

If you need more time, consider using Tricare’s Continued Health Care Benefit Program which lets you access your old Tricare plan for 18 to 36 months after you’ve left the military.

However, you have to pay the full premiums to keep this temporary coverage.

Pros and Cons of Private Health Insurance

Fortunately, veterans don’t have to choose between veterans health insurance and a private health plan. You can combine health plans to create a more thorough network of coverage.

Private plans have their advantages and disadvantages:

Pros of private health care:

  • More control over health plan options
  • Larger networks of care providers
  • Ability to get premium tax credits through the ACA of 2010
  • More affordable if accessed through an employer

Cons of private health care:

  • Expensive without tax credits or help from an employer
  • Confusing to buy
  • Multiple layers of payment: deductibles, copayments, premiums

If you’re shopping for a private health insurance plan to supplement your veterans or Tricare benefits, you may benefit from finding an independent insurance agent in your area.

Bottom Line: Be Prepared and Ask for Help

Knowing how the best insurance plans work will help you stay ahead of changes as your career in uniform progresses.

Military life can change quickly. The market for health insurance is volatile, too. But you don’t have to be an expert on Tricare, the VA, or the private health insurance landscape to keep up.

Instead, you can log into Tricare if you still have access to your account and ask for help transitioning to veterans health insurance or a private plan.

If you’re already separated from the military, check with the VA or go through a military-friendly agency like USAA.

You know what you need: health insurance for you and your dependents. Unless you know you’re on the right track, ask for help.