Wednesday, June 15, 2022

Does Military Pay For Health Insurance

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Guard Chief Wants Free Health Care For All Troops Activated Or Not

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The head of the National Guard Bureau wants free health care coverage for every guardsman, calling it an issue of both strategic and moral importance for the military force.

What happens if they get sick or injured when they come off orders? said Army Gen. Daniel Hokanson, chief of the bureau, during testimony before the House Appropriations Committee on Tuesday. Theyre doing the same job as their active or reserve counterparts, but they are treated differently.

One of my most pressing concerns is premium free health care for every guardsmen who serves in uniform.


The comments came during a congressional review of the National Guards spending priorities for fiscal 2022. Last year was the busiest for the Guard in the last eight decades, with more than 120,000 guardsmen deployed to overseas missions and domestic operations, including the pandemic relief effort.

But that increased workload has also brought increased attention to the benefits available to part-time troops.

While on federal active-duty orders for more than 30 days, guardsmen and reservists are eligible for the same medical coverage as active-duty troops. But service members activated for less than a month have fewer options, and have to pay for coverage on their own.

Establishing full-time health care for all National Guard troops nationwide could prove costly, however.

But lawmakers said they are open to the discussion.


Healthcare In Fire Is Affordable

Healthcare costs in America is truly a great burden for early retirees and regular retirees. But theres nothing we can do except to eat better, exercise more, save more, and invest more to help those who cannot.

After all, helping others is the American way. Ive honestly been considering relocating to Canada to reduce our healthcare cost burden. However, until we find ourselves in difficult financial times, we will hold off on this option.

High healthcare costs is one of the main reasons why the large majority of people pursing FIRE or writing about FIREe live in the heartland of America. But the reality is, half the American population lives on the more expensive coasts due to their jobs, family, desire for more diversity, or personal preferences. Not everybody feels comfortable relocating Kansas City to save on costs.

So long as your household earns below 400% of the Federal Poverty Limit, you will be able to get healthcare subsidies. However, the typical plan is usually a Bronze or a Silver plan with a high deductible. Were talking $10,000 $15,000 deductibles.

You must plan ahead for this expensive but necessary cost. Once you do, you will enjoy your early retirement lifestyle much more!

Continued Health Care Benefit Program

In the civilian world, companies offer their employees COBRA Health Insurance Coverage, which allows their employees to take their group health insurance with them when they leave their company. The only catch is the former employee is required to pay for the entire cost of the plan . COBRA benefits are usually good for 18 months.

The military doesnt have an exact COBRA program, but they offer something very similar to the Continued Health Care Benefit Program . Participants who are leaving the military health care system are able to buy into the CHCBP.

Program Eligibility: This program offers 18-36 months of benefits and is open to anyone who is leaving Tricare, including military members and their families, children who lose age eligibility for Tricare, divorced spouses, etc. This program is open to a wide variety of people, but there is a cost involved: the premiums for FY 2012 is $1,065 per quarter for individuals and $2,390 per quarter for families.

Here is more information about the Continued Health Care Benefit Program .

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What Is Tricare Standard

With TRICARE Standard, you can see just about any provider that has been authorized by TRICARE. You have more options in choosing your provider with TRICARE Standard. However, there may be more out-of-pocket costs associated with this plan.

It is important to remember that active duty service members cannot use TRICARE Standard, but family members can. This particular health coverage program is not limited to the United States and is available all over the world.

If you live in an area that is not serviced by TRICARE prime, TRICARE standard may be your only military coverage option.

With TRICARE standard, your doctor will not file your claims for you. You will have to pay your medical provider directly and then file a claim yourself to get reimbursed for the services. Although referrals for a specialist are not required, you may need a prior authorization.

Types Of Tricare Plans


With the TRICARE changes that took effect Jan. 1, 2018, TRICARE continues to offer several health plans. Plan availability still depends on who you are and where you live. Basic coverage is no longer automatic when you retire from the service.

The TRICARE website can help you select the plan thats right for you. You can even compare plans side by side. All plans meet or exceed the requirements for minimum essential coverage.

TRICARE also offers special programs, including:

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If You Dont Have Veterans Coverage

If youre a veteran who isnt enrolled in VA benefits or other veterans health coverage, you can get coverage through the Health Insurance MarketplaceĀ®.

Depending on your household size and income, you may be able to get lower costs on monthly premiums and out-of-pocket costs on private insurance. Or you may qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program .

Health Insurance In The Marine Corps

Health insurance is just one of the many benefits offered in the Marine Corps. The health insurance offered to Marines has many complexities and at times can be confusing, and with that comes a lot of questions from parents. When to take your recruit/Marine off your insurance? When does your recruit/Marines’ insurance take effect? What if your recruit/Marine is a reservist? Not only should Marines be aware of the benefits that are available to them, but their families should also be educated on them as well.

First it’s important to understand the different coverage options offered to Marines. The three main coverage options to concern yourself with are TRICARE Prime, Standard, and Extra. Reservists are also given the option of TRICARE Reserve Select . Active duty Marines are only given the option of TRICARE Prime. With TRICARE Prime you are assigned a primary care manager . The PCM will handle the majority of the Marines’ health needs and will provide a referral to a specialist for anything beyond that. So basically the Marine/recruit will see the local Battalion Aid Station , and if there are any medical needs beyond their capabilities they will send him/her to the Naval Hospital.

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The Tricare Young Adult Twist

One situation in which carrying other health insurance may make sense is if you have one or more kids who are no longer eligible for regular Tricare coverage, but are not yet 26. If you are considering covering them under Tricare Young Adult, they would almost always be covered under your other health insurance, possibly at no additional charge. This could change the math entirely, particularly if you have multiple kids in that gap.

Cost Of Retired Military Healthcare


Your healthcare costs as a retired military veteran depend on your status and your TRICARE health plan. To determine your cost, use the TRICARE Compare Costs Tool.

Using the tool and drop-down menus, select your plan, status, and when you enlisted or were appointed, in that order. Then click on the View Costs link. This will generate a chart showing costs, including enrollment fees, deductibles, copays, and more.

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Asking Military Retirees To Pay A Bit More For Health Care Is Reasonable

SIMPLY UNSUSTAINABLE. That is Defense Secretary Robert M. Gatess assessment of the spiraling cost of the health-care system for military personnel, retirees and their families. Mr. Gates is correct and he is correct to press for modest increases in premiums paid by those covered by the system, known as Tricare. Health-care costs consume one-tenth of the base-line defense budget more than $50 billion a year. Costs have tripled since 2001 and are projected to grow to $64 billion by 2015. As the Center for American Progress points out in a new report, the Pentagon is spending as much on health care as on the war in Iraq.

The country owes an enormous debt to service members and their families. Providing good health insurance at a reasonable cost is part of repaying that debt. Active-duty troops receive free health care, and their families receive care at little or no cost, depending on the coverage they choose. Wounded, disabled and needy veterans receive care through the Department of Veterans Affairs. That is as it should be.

But retired personnel and their dependents, who account for the majority of costs, can reasonably be called on for more. Premiums for Tricare Prime, an HMO-like program, have not been raised since it began in 1995 the cost is $460 a year for family coverage. Its no surprise that retirees often choose Tricare over other group insurance and are using its services at an increased rate.

How Much Will Tricare Pay After Your Other Health Insurance

The first step is to submit your claim to your OHI. Its super important to follow the rules of your OHI. If your OHI denies a claim for any reason, including a lack of referrals, Tricare will generally also deny the claim.

Once your claim is paid by your OHI, it is then forwarded to Tricare.

If the provider was a Tricare network provider, or a participating non-network provider , Tricare will pay the smaller dollar amount of these three calculations:

  • billed amount minus the OHI payment, so no balance remaining
  • amount TRICARE would have paid without OHI, little to no balance remaining
  • amount beneficiary owes after the OHI paid , so no balance remaining

If the provider was a non-participating provider , Tricare will pay the smaller dollar amount of these three calculations.

  • 115 percent of the allowed amount minus the OHI payment
  • Amount TRICARE would have paid without OHI
  • Amount beneficiary owes after the OHI paid

Its important to understand that non-participating providers may only bill a Tricare beneficiary up to 115% of the Tricare allowed amount. If the OHI paid more than 115% of the Tricare allowed amount, Tricare will not pay any remaining portion, as the charge is considered paid in full and the provider may not bill the beneficiary.

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Special Enrollment Period On The Marketplace

A special enrollment period is a time outside of the open enrollment period during which you and your family have a right to sign up for health coverage. In the Marketplace, you qualify for a special enrollment period 60 days following certain life events that involve a change in family status or loss of other health coverage. Job-based plans must provide a special enrollment period of 30 days. If you dont have a special enrollment period, you cant buy insurance inside or outside the Marketplace until the next open enrollment period. Not all special enrollment periods are the same length, so visit for details.

The Continued Health Care Benefit Program

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The Continued Health Care Benefit Program extends at least some medical benefits to former military spouses, regardless of the length of the marriage. In other words, if you don’t meet the 20/20/20 or 20/20/15 rules, you may still qualify for health care through CHCBP.

Enrollment in CHCBP protects spouses from a lapse in coverage when they transition from military health care plans, such as TRICARE, to new civilian health plans. Spouses enrolled in CHCBP will receive temporary health care coverage following the loss of military benefits. CHCBP benefits are similar to TRICARE benefits. The main differences are that former spouses have to pay in order to participate, and they won’t have access to military treatment facilities or pharmacies. CHCBP may also provide former spouses coverage for preexisting conditions that aren’t covered by a new employer’s benefit plan.

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Limits To Pensioner Coverage

Pensioners are not eligible to receive coverage for certain provisions under the Plan.

A pensioner who lives outside of Canada and is not covered under a provincial or territorial health insurance plan is eligible for Comprehensive Coverage, but is not covered under the Out-of-Province Provision or the Hospital Provision, specifically.

The Hospital Provision provides hospital coverage equivalent as far as possible to the coverage available to Canadian residents covered by a provincial/territorial health care plan. This provision covers expenses such as standard ward accommodation, nursing services, laboratory procedures, and other services that are covered by provincial/territorial plans.

Pensioners are still covered by the Hospital Provision, but it is important to remember that this provision provides reimbursement only for hospital room and board expenses beyond standard ward charges , and not for any services rendered in a hospital. For pensioners residing outside Canada, the Hospital Provision covers hospital charges up to the maximum specified in the Summary of Maximum Eligible Expenses for each day of hospitalisation. Therefore, pensioners who are living abroad should obtain coverage for emergency medical services from other providers.

How Do Early Retirees Get And Pay For Health Insurance

Thinking of retiring under the Biden administration? Its not a bad bet given taxes are going up and there is going to be a wider social safety net. However, how do early retires get and pay for health insurance?

After all, health insurance is expensive. My family of four personally pays $2,300/month for unsubsidized health insurance. And its cost goes up at last 5% a year.

Affordable health insurance is one of the most important considerations all early retirees must calculate before leaving their day jobs. The typical cost of a healthcare plan is about $20,000 for 2020. And the employer usually subsidizes 60% 100% of the employees cost.

If you are not prepared to pay for you and your familys full healthcare costs, then retiring early and living the FIRE lifestyle may be difficult. However, there are several solutions that will make having affordable health insurance cheaper.

Let me share my thoughts as a father who left the workforce in 2012 and has never returned. I have a wife who is also retired and a young son we both take care of.

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One Other Thing To Consider

There is one other thing to consider when deciding whether to use OHI with Tricare: What is your mental and emotional capacity for dealing with paperwork and other issues? In theory, OHI and Tricare are supposed to work together smoothly, and sometimes that works out. But sometimes it doesnt. If you cant stand dealing with insurance issues, or you just dont have time, then that might push you towards sticking with Tricare alone.

Every situation is different, and theres no right answer for everyone. You have to consider the coverage and costs of your other health insurance, and the coverage and costs of Tricare, how theyll work together, and your familys medical needs. In a vast majority of cases, Tricare beneficiaries find that there is no good reason to take the outside health insurance. Dont make a decision without thoroughly understanding how it all works!

Tricare Standard And Extra

Military Retirement Pay

This program gives more flexibility than TRICARE Prime, but could result in addition costs. You do not need to enroll in advance to use TRICARE Extra. Under this program, you see any , present your ID Card and receive medical care.

  • The TRICARE Authorized Providers have a contract with the military to limit costs to designated amounts. Under TRICARE Extra, active duty family members pay an annual deducible :
  • See link for costs updates – TRICARE COSTS

For retirees and retiree family members , the program costs a little more, though the annual deductible is the same. Visit the TRICARE Standard and Extra Costs webpage for all cost details.

Under TRICARE Extra, the medical provider fills out the TRICARE Claim Forms for you, and they receive direct payment from TRICARE for their portion. You simply pay them your portion of the costs.

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Military Spouse And Family Healthcare

Active-duty military families — regardless of which branch of service their spouse serves in — receive benefits through the military’s healthcare, which is called Tricare. While Tricare is technically not an insurance company, it often operates a lot like one, helping military families receive healthcare and pay medical bills.

There are two kinds of Tricare that active-duty families, medically retired families and families of activated guardsmen and reservists can use: Tricare Select and Tricare Prime. You can learn about the differences between them here.

If you are a non-activated guard or reserve family, you can still use Tricare under the programs designed specifically for you. Learn more about them here.

Military retiree families can also receive Tricare. They use this set of Tricare programs.

Dental insurance is provided to military families through United Concordia . You can learn more about United Concordia dental coverage here.

Tricare Plan Summary: Eligible Beneficiaries Coverage And Costs

TRICARE has four main benefit plans: TRICARE Prime, TRICARE Standard, TRICARE Extra, and TRICARE for Life . The TRICARE Pharmacy Benefits Program, the TRICARE Dental Program, and the Extended Care Health Option provide supplemental benefits to the main plans.


TRICARE Prime essentially functions as a health maintenance organization plan, where beneficiaries have a designated primary care provider who manages care and facilitates referrals to specialists. There is no annual deductible, but there is an annual enrollment fee this fee is applied to the annual catastrophic out-of-pocket limit. For FY2015, the fee is $278 for individuals and $556 for a family. Active duty service memberswho are required to use TRICARE Primeand their families are exempt from paying the annual enrollment fee. Active duty family members using TRICARE Prime also receive care at no cost, unless using the Point-of-Service option. Retired service members and their families pay nothing for clinical preventive services, but they do owe a $12 copay for outpatient visits. In FY2014, 4.9 million individuals were enrolled in TRICARE Prime, including 1.6 million retirees and their family members.

TRICARE Standard


TRICARE for Life

Extended Care Health Option

Pharmacy Benefits Program

Catastrophic Out-of-Pocket Caps

Defense Health Care Costs: Long-Term Trends

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