Do I need health insurance if I have TRICARE?

Veterans and military families face unique challenges when understanding healthcare options once returning to civilian life. Military benefits do provide excellent coverage. But, many veterans and their families combine these benefits with other health insurance (OHI), too. But is that the best option for you?

Who, what, why, TRI?

Before exploring civilian insurance options, it's important to know what benefits you might already have. This prevents you from wasting money by doubling up on coverage. Your eligibility for different programs depends largely on your service history and retirement status.

TRICARE options

If you are retired from the military or meet certain requirements, you have options through TRICARE. TRICARE Select provides a fee-for-service option similar to a PPO, with greater flexibility in choosing healthcare providers. You'll pay premiums, annual deductibles, and cost-shares, but you won't need referrals for specialty care.

For those who prefer a managed care approach similar to an HMO, TRICARE Prime might be suitable. With Prime, you'll generally receive care from military treatment facilities or network providers. But, you'll need referrals for specialty care. The trade-off for these requirements is typically lower out-of-pocket costs compared to TRICARE Select. TRICARE Prime is the same coverage you had when you were active duty.

Both TRICARE options can work alongside civilian health insurance. In most situations, OHI will pay first, with TRICARE acting as the secondary payer to cover remaining costs, significantly reducing out-of-pocket expenses for you.

Veterans Affairs health care

VA healthcare differs substantially from TRICARE. Eligibility depends on factors including service connection, income, and discharge status. These determine your priority group within the VA system.

Many veterans don't realize that VA coverage isn't technically health insurance but rather a healthcare provider system. Unlike TRICARE, there are no monthly premiums, but you may have copayments.

When you have both VA benefits and private insurance, you gain freedom of choice. The VA generally serves as the primary payer for service-connected conditions. Then, your private insurance typically pays first for the rest. This dual coverage lets you choose whether to use VA or private coverage depending on provider availability, travel distance, and out-of-pocket costs.

Why consider additional civilian health insurance?

So while these benefits are indeed valuable, you might wonder why you’d consider additional health insurance.

TRICARE and VA healthcare have provider networks and coverage area limitations. OHI expands your options, allowing you to see additional providers.

Second, dependents ineligible for military benefits need coverage. While some dependents qualify for TRICARE, adult children or new spouses need alternative options.

Third, what about additional benefits like dental and vision care, wellness programs, telehealth services, or coverage for alternative therapies?

Finally, if you travel frequently, live in a limited military area, or want reduced wait times, OHI offers flexibility.

Marketplace plans

When transitioning from military service, you qualify for a Special Enrollment Period. This allows you to enroll in Marketplace coverage outside Open Enrollment. Use this opportunity to enroll if needed so you don't have coverage gaps.

For many Americans, including veterans, premium tax credits make Marketplace plans surprisingly affordable. VA healthcare benefits don't disqualify you from these subsidies, which can significantly reduce your monthly premiums. Many veterans are surprised to discover they qualify for substantial financial assistance.

Why get a Marketplace plan if you already have VA benefits? The access to a broader network of civilian providers. This approach gives you the freedom of choice for each healthcare need. For example, you might use VA facilities for certain specialists while relying on local civilian providers for routine care.

Employer group plans: Maximizing work benefits

If you're employed or your spouse has access to employer-sponsored health insurance, group plans offer several advantages worth considering.

Employer plans typically feature broader provider networks than military healthcare systems, giving you more options for care. They also often include family coverage, extending benefits to dependents unqualified for military health programs.

When you have both employer coverage and military benefits, they coordinate to maximize your protection. Your employer plan generally pays first, with TRICARE or VA benefits covering remaining eligible expenses. This coordination can essentially eliminate out-of-pocket costs for many services.

Many veterans also appreciate the additional benefits that come with employer coverage. These might include gym memberships, health coaching, or preventive care services.

Medicare and military benefits

For veterans approaching 65, Medicare steps into play, too.

If you're a military retiree eligible for TRICARE, you'll transition to TRICARE For Life when you enroll in Medicare Parts A and B. This program serves as wrap-around coverage, with Medicare paying first. Then TRICARE For Life covers most remaining costs. This essentially eliminates most out-of-pocket healthcare expenses.

For veterans using VA healthcare, Medicare provides complementary coverage. The two systems operate independently rather than the primary/secondary relationship with TRICARE. Medicare covers care from non-VA providers, while VA benefits cover VA-provided services. Having both gives you the flexibility to choose between both options for care.

What about prescriptions? VA prescription benefits are considered "creditable coverage". This allows you to delay enrollment in Part D with VA coverage will not result in penalties. However, some veterans choose to have both, depending on which program covers their drugs.

With Medicare supplements (Medigap) or Medicare Advantage plans, make your decision based on your specific situation. With TRICARE For Life, you generally don't need a Medigap policy since TRICARE supplements Medicare so well. However, if you primarily rely on VA healthcare, a Medicare Advantage plan might provide more benefits and network access.

Get yourself a strategy

These decisions can get difficult quickly. But with the right planning, great coverage at an affordable cost is achievable.

First, assess your current healthcare needs and preferences. Which healthcare providers do you want to see? What prescription medications do you take regularly? What specialist care is needed? What about your dependents? Do you travel?

Next, evaluate your current military benefits. Where do you find yourself looking for more coverage?

Then, work with an agent to explore OHI addressing these gaps. This might be a Marketplace plan with a broader network, an employer plan covering your entire family, or a Medicare Advantage Prescription Drug Plan.

Finally, consider the total financial picture, including premiums, deductibles, copayments, and potential tax advantages. Sometimes paying a slightly higher premium results in lower overall costs when out-of-pocket expenses factor in.

Personalized guidance for your situation

Every veteran's situation is unique, with variations based on service history, retirement status, health needs, and family circumstances. What works perfectly for one veteran family might not be ideal for another.

Professional insurance agents, like the folks here at Action Benefits, specialize in personalized guidance with these decisions. The goal isn't to replace your valuable military health benefits but to enhance them with complementary civilian coverage. We can help you understand how your benefits coordinate, identify potential gaps in coverage, and find cost-effective solutions to optimize your healthcare access.

Maybe you're transitioning from military service, or you've been out, but are starting a new job. You could be approaching Medicare age, or simply reviewing your current coverage. Taking Action can help you find the right balance between cost and coverage.