Do you have Tricare? Do you also have other health insurance such as an employer-sponsored plan, medicare, or VA coverage?
Things can be confusing when you have multiple types of health insurance. Let's look at how exactly things work in that situation.
What Exactly Is Other Health Insurance?
Other health insurance is just what it sounds like - insurance you have in addition to Tricare. It may be employer sponsored insurance or government insurance, like medicare or medicaid.
VA healthcare can also be considered other health insurance, depending on what you are being treated for.
Who Pays The Claim?
If you have other health insurance it will almost always be billed before Tricare.
Your other health insurance is your primary coverage and pays your medical claims before Tricare. Tricareis considered secondary coverage.
After your doctor, hospital, or pharmacy is paid by your other health insurance they will file a claim with Tricare or send you a bill for any remaining costs. If you get the bill, you should send it to Tricare.
Exceptions To The Other Health Insurance Rule
The only exception to this rule is if you have other federal insurance.
Other federal insurance includes medicare, medicaid, VA healthcare, or Indian Health Service coverage. If you are covered by one of these plans they pay before Tricare first. If you are treated for a non-covered condition, Tricare pays first.
Medicaid and Tricare
Medicaid is a state and federally run health insurance program for low-income adults, children, pregnant women, elderly adults, and people with disabilities.
By law medicaid is the "payer of last resort", that means it usually only pays when the person has no other health insurance. If you have Tricare and are eligible for medicaid (or have a family member eligible for medicaid), Tricare will pay first, and if there are any costs left to you, medicaid will pay them.
You may have family members eligible for medicaid if they are severely disabled, or require a lot of expensive medical treatment.
VA Health Coverage and Tricare
Depending on your healthcare priority group, and what you get treatment for, you may have to pay a copay, or you may get free care from the VA.
If you have Tricare and aren't entitled to free care from the VA based on your healthcare priority group, or you aren't being treated for a service-connected disability, you will have to pay a copay.
If you have other health insurance through a private policy, it will pay the copay, if you don't have other health insurance, Tricare will normally pay the copay.
Reporting Other Health Insurance
Sounds confusing? It can be.
The best thing to do is to let your doctor know ahead of time exactly what your situation is. The doctor most likely has 2 or 3 fulltime employees just trying to figure out health insurance and billing. If you give them all your information up front, they will take care of it for you.
You can also update your information on the Tricare website:
- Online: Fill out and submit your region’s other health insurance form or enter the information on the Beneficiary Web Enrollment website.
- By phone: Call your applicable TRICARE contractors.
- In person: Go to your military hospital or clinic, or a uniformed services ID card office.