Health Care for Retirees
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As a retiree you have several health care benefits to choose from. These include VA provided medical benefits, TRICARE and other supplemental health care insurance options.
Retirees and their families remain eligible to use civilian health care facilities under TRICARE. TRICARE eligibility remains in force until you are 65 years old. Upon reaching age 65, TRICARE ends, and you become eligible for TRICARE for Life.
Retirees Can Receive Care at VA Facilities - Retirees are eligible for Department of Veterans Affairs (VA) medical care on a space-available basis. There are many limitations and eligibility requirements. VA medical care should not be relied on as your only source of health care.
TRICARE After Leaving the Service
After you retire, but prior to your 65th birthday (or medicare eligibility), you remain eligible for regular TRICARE just like you had on active duty.
These programs are:
1. TRICARE Prime: A health maintenance organization-type managed care program for which retirees are required to pay an annual enrollment fee. Enrollees are assigned a primary care manager, who determines the most appropriate, available source of care€”either a military treatment facility or a civilian network provider. Enrollees pay little or no co-payment, and usually are not required to file claims for their care.
2. TRICARE Extra: A preferred provider organization-type program; no enrollment is required, however care has to be provided by a TRICARE network provider. You will be responsible for paying the annual deductible and cost shares at a reduced rate. The network provider will file your claim.
3. TRICARE Standard: A fee for service option that requires an annual deductible and cost shares after the deductible has been reached. Under TRICARE Standard you are responsible for filing your claim.
You may have to switch between your current program and another depending on availability of TRICARE at your new home after you leave the service. You should contact your Health Benefits Advisors/Beneficiary Counselor and Assistance Coordinators (BCAC) at MTFs or stop in at your TRICARE Service Center for more assistance. Locate the BCAC for your state.
Dental Care After Retirement
Once you retire, you lose eligibility to TRICARE dental. To retain dental insurance you have to enroll in the TRICARE Retiree Dental Program (TRDP). The TRDP provides comprehensive dental coverage for Uniformed Services retirees and their family members. Under contract with the U.S. Department of Defense, the Federal Services division of Delta Dental Plan administers the TRDP.
The TRDP is a voluntary dental benefits program with enrollee-paid premiums. Covered services under the TRDP are offered worldwide.
TRICARE For Life
If you or a family member become entitled to Medicare Part A, whether due to a disability or when you turn 65, you are eligible for TRICARE For Life (TFL). There are no TFL enrollment fees, but you are required to pay Medicare Part B premiums. When using TFL, TRICARE is the second payer after Medicare in most cases. Get more information about TFL.
When you reach age 65 (or otherwise become eligible for Medicare) you must enroll in Medicare as described above. Most people over 65 also sign up for Medicare Part D, which is the Medicare Pharmacy benefit along with Part B, the medical insurance benefit. With your TRICARE Pharmacy eligibility it may not be in your best financial interest to purchase Medicare Part D. If you have TRICARE, you don’t need to join a Medicare Prescription Drug Plan. However, if you do, your Medicare drug plan pays first, and TRICARE pays second.
When you become eligible for Medicare Part D:
- You'll receive a letter in the mail.
- It will explain how your TRICARE prescription drug plan works with Medicare Part D.
For most TRICARE beneficiaries, there is almost NO advantage to enrolling in a Medicare prescription drug plan. Before deciding whether or not to enroll in a Medicare prescription drug plan, you should compare it with your TRICARE prescription drug plan. Be sure to compare:
- Monthly premiums
- Drug coverage
If you do decide to enroll in a Medicare prescription drug plan:
- TRICARE will pay second after Medicare
- You can enroll during your Initial Enrollment Period or the Open Enrollment Period each year
- The Open Enrollment Period is November 15th - December 31st, with prescription drug coverage beginning the next January 1st
If a sponsor dies after retiring from active duty (either regular or a medical retirement), surviving family members remain eligible for TRICARE with the same health plan options and costs they had before their sponsor passed away.
Surviving spouses remain eligible for TRICARE unless they remarry and children remain eligible until they age out or lose eligibility for TRICARE for other reasons.
Contact your TRICARE regional contractor for assistance.
Supplemental Health Insurance for Retirees
One short stay in the hospital could offset the cost of several years of supplemental health insurance. Even though you are covered by TRICARE, a supplemental insurance policy is a good idea for retirees. Here's why:
- TRICARE does not cover all costs.
- TRICARE has a yearly deductible to be paid.
- TRICARE has a yearly cap on non-covered expenses; the cap is extremely high, and you are responsible for the cost of non-covered items up to that amount.
If you are covered by health insurance with your new employer, you may use TRICARE as your supplemental insurance for that policy. Check with your TRICARE advisor concerning your particular circumstances.
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