TRICARE Your Military Health Plan

Transcription

1 TRICARE Your Military Health Plan Options for the Retired Tweener Mr Chuck Watkins, Ret, Ret 1

2 Terminal Leave TRICARE Prime or Prime Remote AD benefit remains in effect until day of retirement Cannot enroll with another MTF or switch to civilian PCM If you move to a new area while on leave: Coordinate care via current MTF PCM Family members have the option to change to a new PCM 2

3 Which Plan? If age <65, eligibility for TRICARE Prime Retired Benefit begins the day you retire If you don t reenroll in Prime, you default to TRICARE Standard coverage You cannot refudiate Standard coverage, ever (e.g., to use Canadian social medicine) If age >= 65, TRICARE for Life (if enrolled in Medicare Part B) 3

4 A Great Prime-Like Option: US Family Health Plan Available in six U.S. areas: Johns Hopkins Medicine MD, DC, and parts of PA, VA, WV Martin s Point Health Care ME, VT, NH, and northern NY Brighton Marine Health Center MA, RI, and northern CT St. Vincent Catholic Medical Ctrs NJ, plus parts NY, PA, and CT CHRISTUS Health Parts of TX and LA Pacific Medical Centers Puget Sound You waive rights to MTF care* and TRICARE pharmacy (including mail order) 4

5 TRICARE Prime Retired Option Available only in Prime Service Areas Near MTFs and in other high military population densities Check for your new ZIP code TRICARE Prime Remote is not available to retirees Re-enroll NLT 20 th of prior month to retain uninterrupted Prime coverage Application and payment must be received by managed care contractor NLT 20 th of prior month 5

6 Which Plan? Retired AD Prime Prime Standard Availability ~Global Prime Service Areas Global Catastrophic Cap (Max/Year/Family) $1,000 $3,000 + POS $3,000 Enrollment Fee $0 $230/$640 $0 MTF OPV $0 $0* $0* Network OPV $0 Out of Network OPV w Referral $12 ($0 prev hlth) $0 $12 20% negotiated cost after deductible satisfied 25% allowable charges after deductible satisfied ($150/$300) AD: Not allowed; 50% of allowable charge Out of Network FMs: 50% of allowable (15% higher) after annual OPV w/o Referral charge (15% higher) after same as above deductible met (POS) annual deductible met ($300/$600) ($300/$600) ER $0 $30 same as above Inpatient $0 $11/day ($25 minimum) $535 per day or 25% of billed charges for institutional services (whichever less) + 25% of separately billed services

7 Enrolling in TRICARE Prime Retired Paper: TRICARE Service Center Easier: Google Beneficiary Web Enrollment If no CAC card, use MyPay.gov login and password to access this site 7

8 Enrolling in TRICARE Prime Retired Enrollment fee ($230/$640 per year) Unchanged since 1985, but will likely be tied either to our COLA or to Medical Inflation Index Can have it automatically deducted from retired pay (i.e., untaxed income) Primary Care Manager Civilian PCM or MTF PCM (Space-A rare for retirees in most areas) 8

9 When You Travel Enrollment portability (e.g., Snowbirds) Can transfer enrollment twice per enrollment year as long as return is to original region Split enrollment Can have family members enrolled in multiple regions for one enrollment fee Overseas you re covered by TRICARE Standard and can choose your Provider Prime is not available to retirees overseas 9

10 Good News at Age 65: TRICARE for Life Type of Service Medicare Pays TRICARE Pays You Pay Covered by Both Medicare's authorized amount Remaining amount Nothing Covered by Medicare only Medicare's authorized amount Nothing Medicare deductible + cost-share Covered by TRICARE only* Nothing TRICARE authorized amount TRICARE deductible + cost-share Covered by neither Nothing Nothing Total charge * No Medicare and no TRICARE Prime Retired coverage overseas, but both Standard (and TFL) will pay TRICARE authorized amount 10

11 TRICARE for Life: Selecting a Provider U.S. TRICARE-authorized providers Medicare-participating: Accepts Medicare rate Medicare-nonparticipating: May bill up to 115% Opt-out provider: Medicare pays nothing; TRICARE pays 20% Overseas: No Medicare, so TFL is 1 st Payer See any host nation provider MTF care: Space-A only 11

12 Bad News at Age 65: Medicare Part B Costs 6Xs More Than TRICARE Prime Individual Tax Return Joint Tax Return Premium/ Year/ Person* <$85,001 <$170,001 $1,385 $85,001 $107,000 $170,001 $214,000 $1,856 $107,001 $160,000 $214,001 $320,000 $2,652 $160,001 $214,000 $320,001 $428,000 $3,448 above $214,000 above $428,000 $4,243 *Premiums change (i.e., increase) each year 12

13 Updating DEERS Information Update contact information: By phone: Online: Google Beneficiary Web Enrollment Only the sponsor can add/delete a family member with proper documentation: In person: Visit ID card-issuing facility By mail to: DMDC Support Office in Seaside, CA 13

14 TRICARE Pharmacy Options MTF free, but not worth valuable retirement time TRICARE Mail Order Pharmacy: Generics, $3 for 90-day supply Brand Name, $9 for 90-day supply Retiree Tip: Includes Levitra, 20 tabs--a years supply!!! Non-formulary, $22 for 90-day supply TRICARE retail network pharmacy Same price schedule, but for just a 30-day supply Non Network Pharmacy (I m unaware of any) Pay up-front and file a claim Reimbursement rate??? 14

15 TRICARE Retiree Dental Program Basic group coverage, self-funded Two preventive cleanings/exams/year, $0 copay Other services: $50/$150 annual deductible $1000 annual single incident max benefit $1200 annual max benefit $1500 lifetime max orthodontic benefit Rates vary by location, ~2X AD Family rate We pay $793/year 15

16 TRICARE Retiree Dental Program (cont.) Enrollment required Initial 12-month commitment and 12-month waiting period for full coverage If you sign up within 120 days of retirement, 12- month waiting period is waived TMA recommends you sign up 30 days prior to retirement to ensure coverage is in place Use term TRICARE Retired so they send claims to Delta Dental vice Met Life Additional details: 16

17 Supplemental Insurance Lots of offers from MOAA and others My Opinion: OHI complicates your life Why bother to insure against a possible $3K loss?

18 PP4121BET03095W

19 PP4121BET03095W My Retirement Path 28 years ADAF, retired Dec years Defense Contractor HQ USMC (TQM) TMA (Communications Research) 6 years TMA Civil Servant, deferred retirement Feb 2010 Currently trade stock options 3 hrs/day Intend to be first in line to take social security at age 62

20 PP4121BET03095W Recommendations Work tax-free your last two months by retiring in Feb/March Fully fund your TSP/401k one final year ($22K + employer match) Some states (e.g., Virginia) allow low income fed and state employees to deduct all earned income without regard to unearned income Opportunity to rollover a traditional IRA to Roth IRA Do a once-in-a-lifetime 100% age-related inservice rollover from TSP to fund more rewarding investments. Rollover residual when you retire. Retire early and often