Editor’s Note: This article is part of MOAA’s 2020-21 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). A version of the guide appeared in the November 2020 issue of Military Officer magazine.
By MOAA Staff
Welcome to another installment of “You Ask, MOAA Answers” where we discuss some of the most commonly asked member questions. This video is brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). Make the most out of your MOAA member benefits and prepare for the future by going to MOAA.org/insurance.
Today we discuss medical insurance for servicemembers and their families.
Q. What are some of the restrictions of TRICARE Prime?
A. All care must be coordinated through your primary care manager, or PCM. If you need a referral, you must see your PCM to get one. A referral can take time to process, and you could wait months before an appointment with an available specialist at a military treatment facility or an off base civilian provider.
Q. What if I don’t want to wait for a referral?
A. Under TRICARE Prime, you will incur point-of-service, or POS, charges for any specialty care you receive without a referral. You should do your best to find a specialist who accepts TRICARE to reduce costs.
You have a $300 individual deductible, or $600 for a family, for nonemergency services received without a referral from your primary care manager. That won’t apply to your catastrophic cap. After the deductible is reached, you can expect co-pays that are typically 50 percent of the allowable TRICARE fee.
Q. What are my TRICARE Select options?
A. TRICARE Select is available to family members of active duty and some reserve component members, depending on activation status and other factors. It’s the most flexible TRICARE program – you choose which TRICARE-authorized providers you see. The “trick” is to find medical care providers that accept TRICARE.
TRICARE Select will begin charging an enrollment fee for military retirees beginning in 2021; $150 for individuals and $300 for families, per year. That will count against your catastrophic cap, and so will your annual deductible-$150 for individuals, $300 for families.
TRICARE Select co-pays are higher than TRICARE Prime. Get the full breakdown at TRICARE.mil/costs.
Q. Can spouses sign up for different programs?
A. Yes! Spouses may choose to enroll in a TRICARE Prime plan along with their servicemember, or they may prefer TRICARE Select. Families in some areas are eligible for the US Family Health Plan; visit TRICARE.mil/USFHP for details. Even after retirement, the retiree and the spouse may prefer separate plans.
Q. When do children age out of TRICARE?
A. TRICARE eligibility for dependent children ends on their 21st birthday, unless they are enrolled in school – then it lasts until they turn 23. TRICARE Young Adult coverage is available as a Prime or Select option to extend coverage to age 26, if the child remains unmarried. After that, dependents can purchase TRICARE Continued Health Care Benefit Program for up to 36 months.
Q. What if I have additional questions?
A. Understanding all the nuances of health care can be tricky. MOAA has subject-matter experts on hand to assist Premium and Life Members. Call (800) 234-6622 or email email@example.com and we can properly direct you to assistance.
If you have coverage-related questions, or questions about medical services, it is best to contact your health care service provider directly.
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