MOAA’s TRICARE Toolkit provides insight and tips for navigating your TRICARE benefits. Have a question or suggestion for an upcoming column? Email email@example.com. Read other TRICARE Toolkit columns at MOAA.org/tricaretoolkit.
TRICARE beneficiaries know that when seen outside of a military treatment facility (MTF), a coinsurance payment is incurred until you and your family reach the catastrophic cap (CC). The 2022 CC for active-duty families is $1,000 in Group A and $1,058 in Group B; for TRICARE Reserve Select, it is $3,000 for retirees on TRICARE Prime (Group A), $3,706 if enrolled in TRICARE Select (Group A), and $3,921 if enrolled in TRICARE Retired Reserve.
If you and/or your family reach or come close to the TRICARE CC every year, you should consider procuring supplemental insurance. A supplement is not a qualified health care plan under the Affordable Care Act, but it helps reduce unexpected out-of-pocket expenses, which can include doctor visits, hospital stays, surgeries, prescription drug copays, and excess charges up to 15% of the TRICARE allowable covered expense.
MOAA sponsors — through Association Member Benefits Advisors (AMBA) — the MEDIPLUS® TRICARE Supplement Insurance Plan, which offers a variety of options. The typical plan, for those under 65, includes a monthly premium and deductible (after meeting the TRICARE Select deductible), after which the supplement picks up most of your remaining covered medical expenses. Plans can cover both inpatient (hospitalization) and outpatient expenses, inpatient only, and TRICARE Prime in and outpatient supplement for those not using an MTF.
[RELATED: Your 2022 TRICARE Costs]
For those age 65 and over and enrolled in Medicare, TRICARE For Life acts as your supplemental insurance.
Premiums are based on age (five-year increments) and smoking/nonsmoking status, and they are tiered by chosen deductibles. Your supplement can cover one individual or the entire family. One 2021 price example for a nonsmoking family of three (member and spouse each 45 years old) with an $800 family deductible: Premium $55.71 per month. That adds up to maximum out-of-pocket TRICARE Select costs broken down by:
- TRICARE enrollment, $300;
- TRICARE deductible,$300;
- MEDIPLUS annual premium, $669; and
- MEDIPLUS deductible, $800.
This is a total out-of-pocket expense of $2,069 instead of the TRICARE Select CC of $3,500.
TRICARE coverage and costs are based on a calendar year. MEDIPLUS® coverage and costs become effective the first day of the month after you receive your coverage certificate. You may coordinate with Mercer to sync your supplemental coverage to the calendar year.
Have More Questions About Your Health Care Benefit?
MOAA's TRICARE Guide answers some commonly asked questions.