Post-Army health insurance: TRICARE and civilian coverage

By The Department of Defense Office of Financial Readiness

Leaving the structure and familiarity of the Army doesn’t have to be daunting, especially when it comes to navigating the world of civilian healthcare. Some of the biggest adjustments Soldiers face as they retire are related to health insurance and medical care, but brushing up on your health care knowledge pre-transition can help smooth the way.

Until now, you’ve received most or all of your care at military treatment facilities. You likely pay little or no out-of-pocket expenses for prescriptions, co-pays, and deductibles. At the same time, you probably don’t have many choices when it comes to selecting your providers.

Things will be a little different as a civilian, as this Soldier for Life Podcast explains.

TRICARE and Retirement

If you’re retiring, you will remain eligible for space available care at military clinics, hospitals and pharmacies. TRICARE has several plans, depending on your age and

location, including:

• TRICARE Prime, the plan you’re probably most familiar with.
• TRICARE Select, a fee-for-service plan that will give you more provider choices.
• TRICARE Prime Option — US Family Health Plan, a community-based option available at six regional, nonprofit health care systems.
• TRICARE For Life, a default plan that provides wraparound coverage if you have both Medicare Part A and Part B.

In addition, TRICARE has Retired Reserve, overseas, and young adult options. You may also be able to obtain dental and vision benefits via the Federal Employees Dental and Vision Insurance Program.

However, coverage doesn’t automatically continue after retirement. To avoid a break in coverage, you must reenroll within 90 days of retirement, although you may request retroactive enrollment for up to 12 months. Otherwise, you can enroll during a TRICARE Open Season or after a qualifying life event (QLE), such as marriage, divorce, birth or adoption of a child or loss of other health benefits.

To see if something is covered or not covered, you can visit TRICARE’s Covered Services page. Keep in mind that you may have to pay annual enrollment fees, and your out-of-pocket costs — premiums, office co-pays, deductibles, etc. — will be higher than your active-duty Army medical expenses.

TRICARE and Separation

Some Soldiers who separate from the Army before becoming eligible for retirement may still qualify for short-term health insurance from TRICARE:

• The Transitional Assistance Management Program provides 180 days of premium free health care benefits for eligible new veterans.

• The Continued Health Care Benefit Program provides premium based coverage equivalent to TRICARE Select for eligible new veterans for up to 36 months.

Civilian Insurance

Compared to many civilian insurance programs, TRICARE offers excellent coverage at reasonable rates. However, you could be eligible for competitive health, dental, and vision benefits from your new employer or from a spouse’s employer. Consider comparing plans to determine which coverage best meets your family’s needs. Make sure to look up your preferred providers in each plan directory to see if they’re in network.

Common civilian medical plans include:

• Exclusive Provider Organizations: Nonemergency services are only covered if you use doctors and hospitals in the plan’s network.
• Health Maintenance Organizations: HMOs often provide integrated care that focuses on wellness and prevention, but limit nonemergency coverage to doctors who work for them.
• Points of Service: You pay less if you use hospitals and providers in the plan’s network. You must obtain a referral from your primary care doctor to see a specialist.
• Preferred Provider Organizations: Providers in the plan's network cost less, but you can still use out-of-network doctors, hospitals, and providers for an additional cost.
• High-Deductible Health Plans: High-deductible plans have higher deductibles than traditional insurance plans, but lower monthly premiums. You pay more before insurance kicks in.

If you have a family member with a chronic or severe illness that requires many out-of-pocket expenses, depending on cost, it may make sense to enroll in two plans. Your civilian insurance would serve as your primary coverage, and TRICARE would become secondary. While you would spend more on monthly premiums, it could eliminate some or all of your co-pays.

On the other hand, some civilian companies will pay you a stipend if you decline their health benefits.

You could use this to cover a portion of your TRICARE enrollment fees. If you need help deciding what health coverage makes the most sense financially, check with a trusted personal financial manager or counselor. Reach out to your nearest installation and make an appointment with an expert who can help you budget for retirement health care.

As you reach new milestones and complete your service’s financial readiness training, look to the DoD Office of Financial Readiness (FINRED) and your service for trusted additional resources. You can follow @DoDFINRED on Facebook, Instagram, LinkedIn, X, and YouTube, and download the free DOD financial education app, Sen$e, for financial tips on the go.