This conversation delves into the complexities of military healthcare, focusing on TRICARE options available to active duty and reserve members, as well as their families. The discussion covers TRICARE Prime, TRICARE Select, TRICARE Reserve Select, and TRICARE Young Adult, highlighting the benefits, costs, and considerations for each plan. The hosts emphasize the importance of understanding these options for both health and financial well-being, especially during transitions such as retirement.

Takeaways

• Understanding TRICARE options is crucial for military families
• TRICARE Prime is the default option for active duty members
• TRICARE Select provides more flexibility but comes with costs
• TRICARE Reserve Select is a cost-effective option for reservists
• Planning for healthcare in retirement is essential
• TRICARE Young Adult covers dependents who have aged out
• Costs vary significantly between TRICARE plans and groups. Consider your family’s specific health needs when choosing a plan
• It’s important to lay out medical needs to make informed decisions
• All TRICARE plans have low catastrophic caps for out-of-pocket expenses

Chapters

00:00 Understanding Military Healthcare Options

03:29 TRICARE Prime: The Default Choice

06:23 Exploring TRICARE Select: Flexibility vs. Cost

10:33 TRICARE for Reservists: A Competitive Option

11:52 Navigating the Gray Zone: Healthcare for Retired Reservists

15:15 TRICARE Young Adult: Coverage for Aging Dependents

17:15 Cost Breakdown: Understanding TRICARE Expenses

21:04 Making Informed Healthcare Decisions

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TRANSCRIPT

Mike Hunsberger (00:00)

Hey, Amy. So today we’re going to be talking about diving deep into the world of health care, primarily TRICARE and the other various things that military members deal with when they’re looking at health care. We’re actually going to split it up kind of in two sections. One kind of while you’re serving, what are the options and then what changes in retirement and then again, in ultimate retirement when you qualify for Medicare.

 

Amy (00:30)

great. I’m looking forward to this podcast and the next one, whether you’re active duty or reserves, making sure that you understand the options that you have for your family is important to your health and, and financial wellbeing. so let’s get started.

 

Mike Hunsberger (01:18)

All right, Amy. So today we’re talking about, again, all things health care for primarily this one active duty or reserve military while they’re still serving. What are those options that you have and how does all that work? Like I was saying before the podcast, before we started, you know, this

 

you know, thankfully my wife handled most of this because it really, you know, when you’re in, it’s like, Hey, we go to the military treatment facility, MTF, and you get seen and, you know, try to avoid going as much as possible typically. So, you know, I don’t have tons of experience in this, but you know, after working with clients and going through the retirement transition and seeing, you know, what those options are, you know,

 

got a little more educated on this. again, I’m looking forward to helping folks as they approach this and figuring out what are the right decisions regarding healthcare for them while they’re serving and then finally after also.

 

Amy (02:29)

Yeah. So, you know, big picture there’s, you know, let’s just run through the options, right? So while you’re on active duty, you’re covered by, you know, TRICARE Prime, you’re primarily seen by the MTF. But your family is also covered by TRICARE Prime. We’ll talk about kind of some nuances in between there. And then if your, if your family would like an option is TRICARE Select. So the active duty service member is always TRICARE Prime, probably getting seen in the MTF.

 

but even if not covered by TRICARE Prime, the family members can choose to be covered by TRICARE Select. We’ll talk about that in a minute. If you’re a reservist and you’re drilling, you have the option to be enrolled in TRICARE Reserve Select as long as you’re not covered by the Federal Employee Health Benefit Plan. And then we’re gonna talk about one more plan that’s just kinda out there, and that’s the cover dependent. So your younger dependents that have aged out of being covered under regular TRICARE, but

 

They are not quite ready to be out on their own policies. So that’s TRICARE Young Adult. So that’s the big overview of all the options that we’re going to cover today. Mike, you want to give us a big overview on TRICARE Prime or the HMO option?

 

Mike Hunsberger (03:44)

Yeah, HMO is thrown around, health maintenance organization. It’s very common on the outside. But basically what it means is you have a primary care manager, the main doctor that you see, and they are responsible to coordinate your care. As you mentioned, all active duty members are covered by Tricare Prime, typically seen in the MTF.

 

And, you know, unless you’re stationed somewhere where there isn’t an MTF, then, you know, you might see a, you know, basically civilian provider that, you know, still acts as your PCM or primary care manager. you know, families may also be seen in the MTF. Sometimes their PCM is in a military treatment facility if the base is large enough and they have capacity.

 

This is, you know, I think becoming less common, you know, as we go just because of the demands and trying to kind of right size the medical teams that, you know, the military has. So, but those are, you know, usually the options for, you know, Medicare Prime. And again, you have your PCM.

 

If you need additional services, say you need to go to an orthopedist or a dermatologist, if that’s not available in the MTF, again, that PCM will make that referral out to somebody that can treat you for what you need.

 

Amy (05:27)

Yeah. And the trade off, know, because I think as most of us have experienced, it’s kind of a pain, right? You have to see your PCM for everything. You can’t go to the specialist you want to see. But essentially what you’re giving up in, I’ll say convenience, you’re gaining in affordability. So service members and while on active duty, there’s essentially no monthly premiums for Tricare Prime. So even if you’re

 

We haven’t used the term Tricare Prime Remote. That’s when you’re stationed away from a military treatment facility. Your care is still managed by Tricare, but you’re out of the military network and into sort of the broader Tricare network. So, you know, still while you’re on active duty, you’re not paying for Tricare Prime and there’s not copays and deductibles, things like that.

 

under Tricare, under Tricare Prime or Tricare Prime Remote. So, you know, kind of there’s that trade off, but, you know, and families do have an option. So we’ll talk about that in a minute. But for now, let’s go back to, you know, what you need to do to get enrolled while you’re on active duty to get enrolled in Tricare Prime. Let’s just walk through that because that might be confusing for people.

 

Mike Hunsberger (06:50)

Sure, know, enrollment is basically automatic and mandatory for military members, as we’ve stated. And then, you know, family members will actually default to Tri-Camp Prime, you know, for serving members. But they can switch, you know, during an open season or if they have a qualifying life event, like, you know, maybe a baby’s born.

 

or you get married, those are qualifying events that are kind of outside. And then, you know, we’ll talk more about this

 

in our next episode, but as you retire, you have 30 days to, you know, decide between TRICARE Prime and TRICARE Select after, you know, as you approach retirement.

 

Amy (07:41)

Yeah. So, you know, basically it’s the default. Tricare Prime is the default. Now, one thing that I’ll also add, so we talked about Tricare Prime Remote. So again, Tricare is still the manager. There are some areas across the country. So I’m here in the Northeast. So actually mid Atlantic. So there, my plan here and option for me here. So this is still a Tricare Prime plan.

 

but it’s administered by Johns Hopkins. And there’s a few plans like this across the country administered by, you know, sort of private contractors, if you will, works the exact same way. Meaning you still need referrals from your PCM, but you are in a different healthcare system. So you have that option as well. It works the same way. So if your service member, again, you’re going to be seen by the MTF or Tricare Prime Remote.

 

But during open season, your family members could select Tricare Prime or US Family Health Plan. So for different areas of the country, US Family Health Plan dash whatever the contractor is. So here in the mid-Atlantic, US Family Health Plan Johns Hopkins. So you also have those options out in the mid, you know, out west. They have the PAC med centers. I can’t remember what all of them are, but there are about five or six across the country.

 

So that’s basically the HMO sort of default active duty option. Mike, let’s talk about Tricare Select and the PPO option.

 

Mike Hunsberger (09:19)

Sure. yeah, care selects, like you said, more flexibility. Basically, you can go see any doctor that you want to. You know, if you think you need to go see an orthopedist instead of having to go see a primary care doctor first, you can go out and just go directly and see that orthopedist that you want to. So again, as you said, you’re trading off

 

flexibility for, but now you’re going to pay. There’s additional costs with that PPO, Medicare Select. So we’ll get into that when we talk costs, but that’s really the biggest piece of it.

 

Amy (10:05)

Yeah, yeah. so PPO is preferred provider organization. So there is still a network and there is a difference. So you can pick any anybody that you want. But if you pick a provider that’s out of network, it’s going to cost more. If you pick a provider that’s in network, it’s going to cost less. But because you have a choice, it costs. So there are premiums and they’re out of there are out of pocket costs associated with Tricar select for some families.

 

They’re more than happy to pay those out of pocket costs because it offers them the flexibility to access more immediately and more easily access the kind of specialists that their families need. We’ll get into costs in a little bit, but definitely need to understand that what you’re giving up in terms of saving money, you gain in flexibility, but also likewise, you’re gaining flexibility. So therefore you’re going to pay a little

 

for it.

 

Let’s move on, Mike, to the reserve side of things. So this plan is for drilling reservists. So TRICARE Reserve Select. Can you tell us about that?

 

Mike Hunsberger (11:17)

All right. So if you’re a reservist, you know, ready, ready to serve, not the, you know, inactive ready reserve, but you’re not on active orders for more than 30 days. They’re not covered by, like you said, the federal employee health benefit. You can select, you can opt into Tricare Reserve Select. And, you know, that’s it’s similar, but there are a few differences. So you want to hit

 

Kind of what the general difference is, Amy.

 

Amy (11:52)

Sure. Yeah. So if your employer doesn’t offer health insurance or they don’t cost share, it’s very expensive, Tricare Reserve Select is a pretty competitively priced health insurance option for reserve families. So reserve families can find a lot of savings. So if your reserve is listening to this podcast and you didn’t realize that you have a Tricare option, definitely recommend that you check it out because you could be saving money. Doesn’t mean you will.

 

It’s an option, not a requirement. So if your health, if your employer plan is amazing and inexpensive, that’s great. Use that one. But if you’re either in between jobs or your employer doesn’t share cost, it means there’s a good chance your health insurance is expensive and TRICARE Reserve Select might be a better option. Now it is a little bit unique. The reserve situation is a little bit unique in that when you retire from the reserves,

 

your option for Shricare Reserve Select goes away. Mike, do you want to talk to us about gray zone retirees and how their healthcare works?

 

Mike Hunsberger (13:00)

Sure.

 

Yeah, like you said, that Tricare Reserve Select goes away at retirement. And unfortunately, you’re not eligible for full Tricare until age 60. So if you’ve got a gap, you retire at 44, what are you going to do for those 16 years? Well, depending if you’re working, have other insurance, that’s definitely an option. But if not,

 

maybe you’re self-employed or something else, there is a Tricare Reserve retiree which can bridge the gap. Although it’s definitely not as affordable as the Tricare Reserve select that you have access to while you’re serving. So again, you’re going want to look at the costs on that and figure out if that’s the best or if it’s

 

an employer plan or possibly even the, you know, healthcare or the ACA using that for healthcare marketplace to find a plan. So definitely do your homework if you’re in that situation, that gray area between reserve retirement and actually turning 60 and becoming eligible for Tricare.

 

Amy (14:20)

Yeah, and I mean, this is a huge planning factor too. So it’s not something that you want to just let happen. You definitely want to be looking out and planning your retirement. We’ve talked about that in other episodes, but this is a critical element to plan for so that you understand when your employer coverage could pick up or when your health exchange coverage might pick up. Or if you really have no other option than TRICARE Reserve retiree.

 

One other sort of plan, it doesn’t fit well between the two episodes. So we’re just going to cover it here. So essentially again, TRICARE Young Adult, this is for your younger dependents who have aged out of your TRICARE plan being able to be covered by your TRICARE plan. But they are either don’t have access to health insurance, another place, or it’s much more expensive. Although TRICARE Young Adult is a little bit expensive.

 

So Mike, do you wanna talk us through a little bit more about TRICARE Young Adult?

 

Mike Hunsberger (15:20)

Yeah, so basically it extends coverage, but again, it’s not free. So it’s really available up till 26 for your dependents. It typically applies after you’ve either aged out of high school if they don’t go to college or if they’ve gone to college, they can still be covered under

 

you know, directly under TRICARE, but then after they get out. a lot of this, you know, this option came because of some of the health care changes on the civilian side that extended and required plans to cover dependents until the age of 26 or give you that option to do that. So one complaint that, you know, you hear a lot about TRICARE young adult is the cost because it is, you know,

 

relatively expensive, especially when you consider how it’s happening on the civilian side. So I know there’s been pushes like, we need to get this equivalency between what civilian insurance plans have to do for young adult dependents and what TRICARE does. so far, has not wound its way through.

 

through Congress to get approved to have the same coverage.

 

Amy (16:48)

Yeah, yeah. Well, let’s shift gears a little bit and let’s start talking about the costs and kind of how the costs work. starting, you know, kind of from big picture, TRICARE costs are one, the first thing you need to know is you’re going to be in a group. So either group A or group B and your costs are associated with what group you fall into. If you are group A,

 

then your initial enlistment occurred before January 1st of 2018. If after that, then you’re in group B. So there are different costs for based on when you came into the military. After the grouping consideration, the next consideration is an annual enrollment fee. You might think of this like a premium, Tricare calls it annual enrollment fees. These are sometimes often billed monthly.

 

It’s based on whether you’re an individual or an individual plus one, meaning you’re a family or individual plus 20, you’re still a family. And then after the annual enrollment fee, then there are the costs that are for out of pocket things. So we don’t want to get too far into the weeds with what things cost, but Mike, just for context, maybe you can call out some of the costs associated with.

 

Tricare Prime, so the annual enrollment fee and then some of the out-of-pocket costs and whether there’s an out-of-pocket cap.

 

Mike Hunsberger (18:19)

Sure, so while you’re serving, there is no kind of enrollment fee for Tricare Prime for either of the groups. There is an annual catastrophic deductible for each part of the plan and or for each group for, you know, Tricare Prime A groups that’s up to $1,000 per family and for Tricare Prime Group B that’s

 

to $1288 per family. again, the catastrophic cap means if you do have other costs that aren’t covered for some reason under Tricare Prime, once it hits $1,000, as long as you’re still going through the PCM and doing those things, of the rest of the costs will go. Tricare will pick those up.

 

Amy (19:15)

So for TRICARE let’s talk about the enrollment fees. So no enrollment fees for prime, but if you choose to have that flexibility, then there is an annual enrollment fee. So if you’re just for context, in group A, it’s about $365 a year, which is very inexpensive for health insurance. And it’s about, you know, between 11 and $1,200 per family per year for.

 

for group B family. So more expensive, but still a very good deal for health insurance compared to your peers and compared to what you might be able to get to, you might be able to find elsewhere. You do have to have, you do have to meet your annual deductible. Again, this is gonna depend on your group. It also depends on your pay grade. So,

 

A deductible means that you’re going to cover all of the cost of the visit to the specialist up to a certain amount before TRICARE will start to pay anything. So that’s what a deductible is. They’re relatively low still for both group A and group B, but you do need to know that you’re going to pay that annual enrollment fee and then you’re going to pay at least the deductible.

 

From there then there’s a variety of out of pocket costs that might be associated. So it could be a copay for a primary care visit anywhere from say 27 bucks, maybe 30 bucks. If you’re going to a specialist, it’s gonna be more expensive, maybe upwards of 38 or 50 bucks or something. So all of this, you can find all of the details when you.

 

when it’s time for you to do an analysis, you can find all of the details on the TRICARE website under costs. For now though, Mike, let’s keep talking about cost and give people context for reserve select.

 

Mike Hunsberger (21:18)

All right, so we’ll talk about Tricare Reserve Select. Again, there is a premium for this. Or if you’re just covering the member, it’s $53.80 per month. If it’s a member and a family, it’d be almost $274.48 per month, so almost $275 per month. There are deductibles that go with that.

 

And that is, you know, again, sort of depends on rank, but, you know, above E5 and above is $193 per individual or 386 per family. And then the annual catastrophic cap for Tricow Reserve Select is $1288, basically the Group B costs. So.

 

You know, definitely an option, but as we talked about, you want to make sure you’re chopping around before you decide that that’s right for you if you’re if you’re still serving in the reserves.

 

Amy (22:27)

Okay, so for TRICARE Young Adult, it’s a very unique program, but just to give you context of cost. So cost for an individual for TRICARE Prime, it is a monthly premium. So we were talking about annual enrollment fees before. This is a monthly premium. It’s $727. Now that’s for the TRICARE Prime Group B version of this.

 

There is a select option under TRICARE adult as well. It is actually a little bit cheaper though. However, you could probably expect out of pocket costs to be much more expensive. So that kind of brings us to, know, how do you make this healthcare decision? You know, it’s a default decision when you’re in active duty, you’re going to be in TRICARE prime. You don’t have to think about it if you don’t want to. But if you’re a reservist, if you’re a young adult who’s aged out of TRICARE,

 

you have some considerations. So Mike, do you want to start walking us through some of the considerations for how to pick up land?

 

Mike Hunsberger (23:32)

Sure. So one of the big things is where are you living? If you’re on base and have access to the military facilities, that makes it relatively easy. We talked a little bit about if you’re off base, why you’re still active duty. But again, for your family, what’s convenient? How do you figure out what?

 

know, doctors in the local area are there to serve and can you find a PCM, you know, that isn’t, you know, 45 minutes away type thing that’s covered under Tricare Prime. What else, Amy?

 

Amy (24:18)

Yeah, so then it comes down to, know, so besides, you where are you, who’s available, what are the network, what doctors are in the networks. You know, now a big driver might be your actual health needs. So, you know, if you have family member, have a special needs family member, they have certain needs. If you have a spouse working through cancer, they have certain needs.

 

so it really kind of depends on your health conditions. now if it’s, you know, if it’s something like cancer or a special needs child, like probably the cost goes out of, out the window a little bit, you probably categorize that as a, as a lower priority. but if it’s normal, you know, what I’ll call kind of normal stuff where it’s maintenance and things like that, you know, where maybe you need, a spouse needs a lot of physical therapy or something.

 

Then it’s a good idea to just, you know, make a list of all the reasons that your family tends to see the doctor, as well as all the prescriptions, because we didn’t talk about prescription costs associated with these plans, but they all have their own prescription costs associated with them. And once you make a list of all of that, then figure out, you know, what does it probably cost for each plan, given what you think your family’s going to experience in terms of medical needs.

 

Not always predictable, right? You can’t predict when you’re going to end up at an urgent care clinic or an emergency room or something like that. But you probably have a good idea. You know, if you have little kids, there’s a good chance you’re going to end up in an urgent care clinic because they only get sick on the weekends when things are closed, right? So those, I literally like to kind of lay all that out when I’m helping clients make their, make their decisions. I really like for them to kind of give me some ideas without getting too personal about what’s going on. But give me some ideas on what kinds of

 

doctors they see what kind of prescriptions and then figuring out which plan ends up being leased out of pocket considering premiums and copays.

 

Mike Hunsberger (26:26)

Yeah, and then, you know, finally you hit on some, you know, the financial piece, once you lay that all out, you know, come up with the number and see if it works again. All the plans have relatively low catastrophic caps. So, you know, looking at that, it could make sense, like you said, for those if you need that specialized care and you know, you can get to that, you know, that that

 

Catastrophic cap is it going to be too too, you know honoris to get to then You know, it could make sense to just go with the the tricarc selects You know in that Situation just if there are better options To be able to see the doctors you want to see that are in that network and and you can get in easier. So

 

Amy (27:21)

Yeah. Well, I think that’s a good place to wrap up on TRICARE while you’re serving. So hopefully listeners learn some things about TRICARE. No more information. Next time we’re going to be covering TRICARE when you transition in retirement, which I think probably people might have even more questions. So we’ll head into that next time