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Tricare Help: No requirement to give up Prime

May. 29, 2014 - 12:53PM   |  

Q. When my husband retired from the Coast Guard in 2012, we enrolled in Tricare Prime. I have since taken a job that offers insurance for which I would have to pay a monthly premium. Can I stick with Prime, or do I have to take my employer’s insurance?

Q. I’m a military retiree and a current federal employee. My family uses Tricare Prime. I have no other coverage. Should I sign up for a federal health care plan or can we use Tricare after I retire from federal service? People have told me to make sure I am enrolled in a federal plan five or more years before I retire or we will be out in the cold.

A. From a cost perspective, the Defense Department would dearly love to see retired Tricare beneficiaries and family members who have access to employer-sponsored health coverage use that coverage instead of Tricare. And from time to time, there is talk within official Washington about reducing or eliminating Tricare benefits for “working age” retirees and family members under 65 who have access to other coverage through an employer.

However, at this time, Tricare retiree beneficiaries with access to coverage through a private employer are under no obligation to stop using their Tricare benefits. Once they qualify for military retirement benefits, retirees and their eligible family members have lifetime access to Tricare coverage — usually Prime or Standard for those younger than age 65, and then Tricare for Life at age 65 when they become eligible for Medicare.

The bottom line: Military retirees who feel Tricare meets their family’s health care needs can continue using Tricare as long as they wish. That said, retiree beneficiaries may sign up for “other health insurance” anyway, without affecting their Tricare eligibility. For most people, this would amount to being overinsured, and their costs would be higher, but some people like the security of extra coverage.

By law, Tricare generally must be last payer to all other health insurance. So OHI coverage would pay first on any health care claims, then Tricare would act as a backup second payer if necessary.

Q. I’m 20 years old and covered under my father’s sponsorship in Tricare Prime. I recently became pregnant and the baby is due Sept. 25. However, I turn 21 on Aug. 19. I was hoping to be under my father’s coverage throughout the pregnancy. Once I turn 21, will I be ineligible for coverage when the baby is born?

A. Unless you are a full-time college student at the time you turn 21, your eligibility for “ordinary” Tricare coverage under your father’s sponsorship will indeed end.

After turning 21, you have the option to enroll in the relatively new Tricare Young Adult, which you could use until age 26 as long as you remain single and do not have access to employer-sponsored health coverage through a job of your own. However, TYA is not free; it requires enrollment and payment of monthly premiums.

Since your baby is due in just a few months, if you decide to go with TYA, you should do so quickly to avoid a break in coverage. More details on TYA are here: www.tricare.mil/Welcome/Plans/TYA.aspx.

Write to tricarehelp@militarytimes.com. Include the word “Tricare” in the subject line and do not attach files.

Answers by RallyPoint

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