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TRICARE Supplemental: Everything active and retired military members need to know

There's a way that TRICARE members can get help paying their out-of-pocket medical costs. It's called TRICARE Supplemental health insurance.

While TRICARE is like any other health insurance plan and covers you for healthcare services from civilian providers, TRICARE Supplemental health insurance covers healthcare costs that you would otherwise have to pay yourself.

Let's first talk explain TRICARE. TRICARE is Affordable Care Act (ACA)-compliant health insurance plans for active duty and retired military members and eligible family members. Those eligible for TRICARE include:

  • Uniformed service members, including active duty and retired members of the military.
  • Spouses and eligible children of uniformed service members.
  • Retired military members and their spouses and eligible children.
  • Former spouses, who have not remarried, and eligible unmarried children of active duty or retired service members who have died.
  • Spouses and unmarried children of reservists and National Guard who are on active duty for more than 30 cTricareSupplementalonsecutive days or have died on active duty.
  • Medal of Honor recipients and their families.

All TRICARE plans offer the same Essential Health Benefits like any other ACA-compliant plan. So, you're covered at a minimum for:

  • Outpatient care including chronic disease management
  • Emergency care
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services and devices
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children

TRICARE pays for much of your healthcare costs, but there are often out-of-pocket expenses and deductibles. That's where TRICARE Supplemental comes in. You must be enrolled in TRICARE to get TRICARE Supplemental.

TRICARE Supplemental: What it covers, what it doesn't and how to decide on a plan

TRICARE Supplemental is not a health insurance plan like TRICARE, Medicare, Medicaid or a plan you get from an employer. Those types of plans are primary payers and cover you to see a doctor, receive services from a hospital or as an outpatient and get needed prescriptions.

TRICARE Supplemental is a secondary payer that helps cover out-of-pocket costs like deductibles, copayments, and coinsurance. It isn't an ACA-eligible health plan. You get that already from TRICARE. Instead, TRICARE Supplemental is similar to Medicare Supplemental plans. You can think of it as a safety net so you won't get whacked with unplanned out-of-pocket costs.

Here's what TRICARE Supplemental pays for:

  • Up to 100% of copayments and coinsurance for TRICARE
  • Up to 100% of outpatient deductibles
  • Up to 100% of out-of-pocket costs for covered services
  • Up to 100% of doctor visits, pharmacy, and hospital copays

Let's look at a scenario in which TRICARE Supplemental would help you. Let's say you go to a specialist and have a minor procedure. TRICARE covers its portion, but you still have a $200 bill for copays, coinsurance, and other charges.

If you had only TRICARE, you would have to pay the $200, but if you have TRICARE Supplemental it would help you with those costs.

The same goes for prescriptions.TRICARE Supplement can pick up that $20 copay you have to fork over every time you get a refill.

TRICARE Supplemental can be a wise choice for anyone with out-of-pocket medical expenses, but is especially beneficial if you have high out-of-pocket costs or regularly use medical services.

We've told you what TRICARE Supplemental covers. Now, let's look at what it doesn't cover:

  • Any healthcare services not covered by TRICARE.
  • Any healthcare services rendered before enrolling in TRICARE and TRICARE Supplemental.
  • TRICARE Prime enrollment fees.

Whether TRICARE Supplemental makes sense for you depends on your situation and how much you and your family spend on out-of-pocket healthcare costs. You'll want to figure out how much you're spending on out-of-pocket healthcare costs and whether TRICARE Supplemental's premiums will be more than offset by those out-of-pocket costs.

There are multiple TRICARE Supplemental plans, so you want to make sure the plan is right for you. When deciding on a plan, the Department of Defense's TRICARE site offers questions to ask yourself, including:

  1. Are there different premium rates based on military status or age?
  2. Can premium payments be increased? Under what conditions?
  3. Is there a deductible to pay before the supplement pays?
  4. Is there a maximum limit on benefits (lifetime, annual, etc.)?
  5. Is there a pre-existing condition clause? If so, how long is the waiting period?

How to obtain TRICARE Supplemental coverage

You must have TRICARE coverage to get TRICARE Supplemental. Multiple military associations and private companies offer TRICARE Supplemental, including USBA, Military Benefit Association, Armed Forces Benefit Association and the Veterans of Foreign Wars.

You can still get TRICARE Supplemental after you leave the military and have another career. Some employers offer TRICARE Supplemental to their retired and active duty military personnel.

Costs of TRICARE Supplemental coverage

The actual cost of TRICARE Supplement can vary greatly depending on the plan, your age, the deductible, and the number of beneficiaries. You could pay less than $200 annually if you're under 50 and choose a high deductible or you might pay more than $600 if you're between 55 and 65 and pick a low deductible option. Adding children to your plan also adds to the cost of premiums.

When deciding on a plan, it's important to know the plan's out-of-pocket caps. For instance, if the annual cap is $3,000, that means the supplemental plan will pay up to $3,000 for out-of-pocket costs.

How much money can you save? Let's say you have a supplemental plan with a $3,000 cap and it has a $100 deductible that you have to pay before the supplemental plan starts kicking in money. Your annual premiums cost $800. In this scenario, you could save up to $2,100 by having a TRICARE Supplement plan if you reach your cap.

There are many types of TRICARE Supplemental plans and regular TRICARE plans so you will want to get quotes for plans that are available for your specific situation. Also, pay attention to what each plan covers. You may find that a plan that costs the least doesn't pay nearly as much of the costs as the more expensive options. Some plans may have caps for hospitalization costs or other services. You'll want to know that before signing on. Read into what each offers and costs and make the decision based on the data.

Is TRICARE Supplemental insurance for you?

Insurance decisions are always specific to your situation. If you already have TRICARE coverage, you'll want to see how much you're spending on out-of-pocket costs. If you find healthcare is costing you more than before, you may want to look into a TRICARE Supplemental plan.

If you decide to look into a supplemental plan, don't go with the first one you see. Instead:

  • Figure out how much you're spending on out-of-pocket healthcare costs
  • Predict what kind of healthcare services you and your family may need this year
  • See how much the plan spends on out-of-pocket costs
  • Research multiple plans and narrow down your search
  • Check about annual caps, including payments for specific services, such as hospitalizations
  • Figure out if you will save in the long run by getting TRICARE Supplemental

Once you go through this process, you'll know whether a TRICARE Supplement insurance plan is right for you and which one will benefit you the most.