Choose a health care plan that meets your needs - Getting out, military health issues - Navy Times

Choose a health care plan that meets your needs

One of the first things on a new retiree’s checklist after leaving active duty is getting health care.

One of the first steps to doing that is to make sure the Defense Enrollment Eligibility Reporting — the gateway to military benefits — reflects the change in your status from active duty to retiree. You can check on and update your DEERS record by calling (800) 538-9552.

For those who retire near a military medical facility, the health care issue is not so complex — although you need to keep in mind that military downsizing over the past 15 years or so has cut the number of military treatment facilities, and those that remain in operation are devoted first to active-duty health care, with retirees a good distance down the priority list.

Many retirees will look to stay with Tricare, which has some of the lowest fees of any health insurance plan in the nation.

Tricare has three basic plans. Prime is similar to a civilian Health Maintenance Organization that provides the lowest out-of-pocket costs, in return for the requirement that enrollees use only doctors who are part of the designated network. Enrollees are assigned a primary-care physician who supervises all medical care and authorizes referrals for specialty care. Enrollees pay an annual enrollment fee and pre-established co-payments depending on the type of medical care received.

Tricare Extra is similar to the Preferred Provider Option. It offers a choice of civilian physicians and specialists from a list of health care providers. Individuals and families often choose this if their regular physician is not a member of the network or if they live too far from a military hospital.

In Tricare Standard, the government shares the costs of health care. For using this network of preferred physicians and specialists, the government will pay an additional 5 percent of medical costs incurred (85 percent for dependents of active-duty members and 80 percent for retirees).

If you and your family were previously enrolled in Tricare Prime under your active-duty status, everyone needs to re-enroll in Tricare Prime under your new retiree status. Beneficiaries can contact their regional contractor or overseas lead agent to find out if Tricare Prime is offered in their retirement ZIP code.

If a Tricare-eligible beneficiary is eligible for Medicare, entitled to Part A and enrolled in Part B, DEERS must be updated to reflect Medicare parts A and B status for the beneficiary to retain Tricare coverage. When a beneficiary turns 65, the medical section of the military ID card may also need to be updated.

When considering post-service health care options, new retirees need to take into account what they might be able to get through their private-sector employers.

Private businesses as well as some state governments are weighing the cost of subsidizing Tricare for their military retiree-employees as a way to cut their own benefits costs. In Texas, which has the third-highest number of retired military veterans in the nation, many private corporations are exploring the cost savings of having their retired military workers use Tricare; the company would then pick up the cost of a Tricare Supplement policy.

However, Pentagon officials are quite worried about that trend because it drives up their own health care costs, which are now approaching $40 billion a year. That’s why defense officials are pushing hard for Congress to approve new Tricare fees and deductibles for “working-age” retirees younger than 65.

While nationwide health care costs have soared over the past decade, Tricare fees have not changed since 1995 — which is why private-sector employers are so willing to subsidize Tricare coverage for their military retiree workers; it’s extremely inexpensive for them.

Tricare Supplements are offered by most military associations and by some private firms and is designed to reimburse you for your medical care bills, co-payments and deductibles, after Tricare pays the government’s share of the cost. Each supplemental policy has its own rules on pre-existing conditions, eligibility for family members, deductibles, mental health limitations, long-term illness, disabilities, and allowable charges.

Retirees need to be smart about getting good insurance coverage at economical prices. Assuming that most retirees will want to stick with Tricare, here is a checklist of questions to ask when shopping for a Tricare supplemental policy.

Checklist

When considering Tricare supplemental health insurance, ask yourself these basic questions to guide you toward the best buy for your needs:

1. Must I meet a deductible before the plan begins to pay, and if so, what is it?

2. Is there a maximum limit on benefits?

3. Is there a pre-existing condition clause?

4. Is there a waiting period before the policy becomes effective?

5. Will the plan cover amounts beyond what Tricare allows?

6. Does the plan pay for services that aren't covered by Tricare?

7. Does the plan specifically not cover certain conditions?

8. Must certain kinds of care be approved before getting treatment?

9. Is inpatient care covered?

10. What about outpatient or long-term care coverage?

11. Will the plan pay the Tricare outpatient deductible?

12. Will the plan pay my cost-share under the Tricare diagnosis-related group payment system?

13. Does the plan offer reduced or adjusted premiums if I participate in managed healthcare plans, such as Tricare Prime or Tricare Extra?

14. Will the plan cover Tricare Prime enrollment fees or co-payments?

15. Does the plan convert to a Medicare supplement? If so, must it be in force as a Tricare supplement for any specified length of time before conversion?

16. Will the plan cover me overseas?

17. How will the plan require premium payments? Monthly? Quarterly?

18. Can premium payments be increased?

19. Does the plan offer rates based on military status (active or retired), or based on an age scale?

20. Does coverage continue for surviving spouses at no charge?

21. What are the time limitations, if any, for claim filing?

22. If I am a smoker, does the plan have higher rates?

Alex Keenan is a retired command master chief petty officer who served 28 years in the Coast Guard. E-mail him at retired@atpco.com.