TRICARE Supplemental Insurance
What Is TRICARE Supplemental Insurance?
If you are a member of the military or your health coverage comes from a relative's military health policy, the TRICARE program probably provides your main source of health insurance. While TRICARE covers many illness and hospitalization bills for military members with drastically reduced premiums compared to a civilian health insurance policy, the program does not cover every health-related bill and often only covers a portion of the costs of hospitalization, surgery or prescription medication for military members and their families.
A supplemental health insurance plan can cover the remaining costs of your medical bills after TRICARE has made its payment. Some supplemental health insurance policies pay for all of the remaining costs, while others only cover a portion. Supplemental health insurance plans vary greatly and are often called "add-on" coverage, because they essentially add coverage to your existing TRICARE plan.
It is important to understand the difference between supplemental insurance and a separate secondary health policy. A supplemental plan will only issue payment for a claim after TRICARE makes its payment, so it does not function as standalone health insurance. If your TRICARE health insurance policy ends, your supplemental policy is usually rendered invalid.
You should also understand that TRICARE does not provide or directly interact with your supplemental insurance. Military associations and private for-profit organizations offer add-on coverage with varying cost structures and benefits. Common types of supplemental health insurance for a TRICARE health plan include:
- Civilian health expense coverage. This add-on will often pay for most or all of outpatient or inpatient care for civilians on a TRICARE plan. There is usually a small per-visit co-payment and occasionally a higher co-payment for emergency room visits.
- Mental health coverage. This add-on pays for inpatient and outpatient mental health services, again with a small deductible.
- Ambulance and hospitalization costs. This supplemental coverage takes on the costs of ambulance transit and various hospitalization charges, including room and board.
- Surgery costs. This pays for a large portion of surgery co-payments and coinsurance that TRICARE may not cover fully.
- Excess charges. Some simpler plans base their coverage around excess charges and have few restrictions on specific types of claims, although these plans generally require proof of a TRICARE payment before issuing claim payment.
- Prescription medicine coverage. As implied, this pays for part of the costs of prescription medication. This type of coverage carries a deductible, which is usually lower for generic medications than for name-brand medications.
Supplemental health insurance providers have extremely different coverage terms and requirements. Some types of coverage only apply to active duty or retired military members. When shopping for supplemental insurance, you should closely examine listed percentages and out-of-pocket maximums.
Both active and retired members of the military can use TRICARE, and their immediate families can usually get coverage through the program. Supplemental coverage added to your TRICARE insurance policy will often apply to the other family members listed on your policy.
Qualifying For Supplemental Insurance
In order to qualify for TRICARE supplemental insurance, you will have to fill out a brief form and pay a monthly premium along with your normal health insurance premium. You cannot be turned down for TRICARE supplemental health insurance because of a preexisting condition. However, if you have a preexisting condition, the plan may limit your ability to file a claim related to the condition for a certain period.
As mentioned above, some types of supplemental insurance are only available for active duty military members, retired military members and civilians. These types of restrictions are legal and can affect a policy's coverage, so before paying for any supplemental plan, be sure to understand how different types of coverage will affect the individuals on your TRICARE health plan.
Deciding Whether Or Not To Purchase TRICARE Supplemental Insurance
When evaluating any type of add-on health insurance coverage, families should consider the annual costs of the additional premiums and the potential costs of going without the supplemental plan.
TRICARE's payments often cover only a portion of large hospital bills, especially for civilian plan members. Many military members have full additional health insurance plans from their spouses, but military members who do not have second policies almost certainly need some form of supplemental insurance to avoid heavy costs that their close family members might incur.
Both active and retired military members should evaluate multiple supplemental plans to determine whether the added premiums are worth the additional security that add-on coverage provides. If you are considering a supplemental insurance plan, here are a few important questions to ask:
- Will the premium increase? Many plans become more expensive as beneficiaries age. Check to see whether the plan has locked premiums and understand how payments might increase over time.
- What are the deductibles? As mentioned earlier, most plans have varying deductibles for different types of coverage. Understand the limitations of your deductibles.
- What factors might drive your premiums higher than the listed averages? For instance, many supplemental plans charge higher premiums to smokers. Some plans may have higher premiums for military members living overseas.
- How are beneficiaries covered? This is particularly important if you have newborns or college-aged children. If your children do not live at home, the supplemental insurance plan may not cover them in the same way, and you will often need to add newborn children to your TRICARE plan before your supplemental insurance will cover them. This is often difficult if you are living abroad.
- How will preexisting conditions affect coverage? If your plan has a preexisting condition clause, make sure that you understand how the clause will limit your coverage and how long it will last.
You can often make this process easier by working with an insurance agent. An impartial agent can assess the benefits of different plans and explain how they relate to your family, reducing your risk of paying for a plan that does not provide enough coverage.