Retiree Health Care - Military Careers, Retirement - Navy Times

Retiree Health Care

All retirees and their dependents retain eligibility to be treated in military hospitals and clinics when they turn 65. But care is provided on a space-available basis, and getting an appointment is increasingly difficult as installations around the country continue to close. Therefore, most retirees are seen at civilian facilities using Tricare, the military’s managed-care insurance program.

Tricare for Life

Tricare offers retirees several insurance plans, depending on their age, with costs and options for provider care that vary widely.

Retirees 65 and older can see civilian doctors and have Tricare pay for part of the cost under the Tricare for Life program. Tricare for Life is essentially a version of the basic Tricare Standard program; these retirees cannot use Tricare Prime. Retirees must be enrolled in Medicare Part B to use Tricare for Life, even though Medicare does not offer coverage outside the U.S. for retirees living abroad.

Retirees under age 65 can choose to be covered under one of the other Tricare plans — Standard, Prime, Prime (Remote) or Extra. However, some aspects of these programs change when beneficiaries move from active-duty to retired status. For example, Tricare Prime has no enrollment fee for active-duty beneficiaries, but it does have a fee for retirees under age 65 and their family members.

Details on how benefits under the various Tricare plans change when moving from active-duty to retired status are online at http://www.tricare.mil/Factsheets/viewfactsheet.cfm?id=347.

The retiree first submits the cost of treatment to Medicare. What Medicare does not pay is sent to Tricare. When benefits are covered by Tricare but not Medicare, Tricare pays for the services. Overseas, Tricare is the primary payer. For claims to be paid, retirees must keep their personal data current in the Defense Enrollment Eligibility Reporting System, or DEERS.

Tricare Retiree Dental Program

Military retirees and their families are eligible to join the Tricare Retiree Dental Program, administered by Delta Dental of California.

It provides dental coverage to enrollees in the 50 states, the District of Columbia, Canada, Guam, Puerto Rico, the U.S. Virgin Islands, American Samoa and the Commonwealth of the Northern Mariana Islands.

Contact: Delta Dental, (888) 838-8737; http://www.ddpdelta.org; http://www.tricare.mil/Factsheets/viewfactsheet.cfm?id=90.

Tricare Pharmacy

Under the Tricare Pharmacy program, the cost of drugs for retirees depends on several factors. For example, a 90-day supply of a generic drug ordered through the Tricare Mail Order Pharmacy Program is $3, while the same drug purchased at one of the more than 54,000 participating Tricare retail pharmacies is $3 for a 30-day supply.

Brand-name drugs cost $9 for a 90-day supply through the mail or $9 for a 30-day supply at a network retail store.

Some brand-name drugs that are not part of the Defense Department’s official formulary are placed on a third price tier, for which a 30-day supply from a retail outlet or a 90-day supply through the mail costs $22.

Retirees using out-of-network pharmacies face deductibles of $150 for an individual and $300 for a family, along with co-payments of $9 or 20 percent of the cost of the drug, whichever is greater.

Military retirees and their family members who turned 65 on or after April 1, 2001, must have Medicare Part B to use Tricare’s retail and mail-order pharmacy programs. Military retirees and their family members who turned 65 before April 1, 2001, are not required to carry Part B to use the pharmacy benefits.

Starting Jan. 1, 2006, the new Medicare prescription drug coverage known as Part D became available to everyone with Medicare Part A and/or Part B except those living overseas or serving prison sentences.

In nearly all cases, Tricare/Medicare beneficiaries will see no advantage in purchasing Medicare Part D coverage if they have Tricare. The exception may be for those with limited incomes and assets who qualify for Medicare’s extra help with costs for prescription drug plans; such individuals may benefit by enrolling in a Medicare prescription drug plan.

Contact: (877) 363-6337; http://www.tricare.mil/Factsheets/viewfactsheet.cfm?id=299.