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TRICARE: Retiree Benefits

TRICARE: Retiree Benefits. August 6, 2003 Atlanta. Introduction. TRICARE is the DOD worldwide health care program for AD and retired uniform service members and eligible beneficiaries In this session you will learn how the program will serve you and your dependents as a retiree

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TRICARE: Retiree Benefits

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  1. TRICARE: Retiree Benefits August 6, 2003 Atlanta

  2. Introduction • TRICARE is the DOD worldwide health care program for AD and retired uniform service members and eligible beneficiaries • In this session you will learn how the program will serve you and your dependents as a retiree • Friend or foe?

  3. Map • TRICARE Basics • Options for Participation • Costs • Pharmacy • Dental • Supplemental Policies • Care at MTFs

  4. TRICARE Basics • TRICARE is a large insurance program that serves millions everyday through a network of regional contractors • www.tricare.osd.mil/ • Eligibility to participate in TRICARE is identified through DEERS (Defense Eligibility & Enrollment Reporting System) • Must stay current in DEERS in order to receive benefits • TRICARE always pays last

  5. T R I C A R E DEERS

  6. TRICARE Options – Two Distinct Periods • Before age 65: • PRIME (HMO) • Standard • Extra • After age 65 • TRICARE becomes TRICARE for Life • TFL is second payer to Medicare

  7. Before You Reach Age 65

  8. TRICARE Prime • The HMO option– requires enrollment and selection of a Prime participating provider who is the gatekeeper to specialty care • Annual Enrollment fee: • $230/$460 • No deductible • Small co-pay for outpatient and inpatient care

  9. TRICARE Standard • Is the default option and gives you the most choice/flexibility for specialty care • No enrollment fee but out of pocket expenses can be significant • Annual deductible ($150/$300) • Outpatient cost-shares are 25% of the allowable • Non-network providers can charge up to 115% of the allowable • Larger inpatient cost-shares

  10. TRICARE Extra • Like a PPO – no enrollment; is provider driven • No enrollment fee but out of pocket expenses can be significant • Annual deductible ($150/$300) • Outpatient cost-shares are 20% of the negotiated fee • Larger inpatient cost-shares

  11. Cost Summary – Retiree < 65

  12. Catastrophic Cap • The most you will ever pay out of pocket in any fiscal year (Oct 1 – Sept 30) for TRICARE approved health care as a retiree/family is: $3,000

  13. Age 65 And/or Medicare Eligible

  14. TRICARE For Life • Must be 65 or older and enrolled in Medicare parts A & B or eligible through disability • All providers who participate in Medicare are authorized participants in TFL • Loophole allows providers only to opt out of TFL; hospitals who accept Medicare must accept TFL as second payer • TFL becomes the second* payer to Medicare for inpatient and outpatient services

  15. TRICARE For Life • Reduces out of pocket expenses to near zero for covered services *If you have OHI, TFL pays third or last

  16. TFL Costs www.troa.org/TFLProfilesite/benefits/index.asp

  17. Becoming Medicare Eligible • Eligibility begins on 1st day of birth month (or 1st day of previous month if birth date is mm/01/yyyy) • Enroll through SSA – pack a lunch • Must elect Medicare B coverage in order to use TFL

  18. Pharmacy Benefits • Simplified system utilizing network pharmacies, mail order, or military treatment facilities • Must have a valid ID card (current enrollment in DEERS) • Cost is either $0, $3, or $9 unless you use non-network pharmacy

  19. Dental Benefits • No subsidized dental insurance • Delta Dental offers a policy for retirees • Advantages if you enroll within 3 months of retirement • Requires 24 months of participation and then renewable annually • 1-888-838-8737 • May receive dental care at MTFs where the benefit is offered (PHS subsidizes)

  20. TRICARE Supplemental Policies • Commercial products • Costs vary depending on benefits • More coverage = more cost • Remember that you are insuring against a maximum of $3,000/year out of pocket expense for TRICARE approved health care • www.champussupplements.com/

  21. Use of MTFs - Priorities • Active Duty • Active Duty family member enrolled in TRICARE Prime • Retirees/family members and survivors enrolled in Prime • Family members of active duty not enrolled in Prime • All other eligible including retirees and family not enrolled in Prime

  22. Questions? My Contact Information: CAPT Kitty MacFarlane 770-488-1883 Kjm8@cdc.Gov

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