Military Families Are Finding New Ways to Balance TriCare and FEHB Coverage for Better Benefits

Key Takeaways:

1. Combining TriCare and FEHB can help military families optimize their healthcare benefits and reduce out-of-pocket costs.

2. Understanding how these programs work together allows you to make informed decisions during Open Season and life transitions.

Navigating the Complexities of TriCare and FEHB

Balancing TriCare and FEHB coverage can seem like a daunting task for military families. Both programs offer distinct benefits, but their overlap can sometimes lead to confusion. The good news? With the right strategies, you can maximize coverage, minimize costs, and gain peace of mind.

What Makes TriCare and FEHB Unique?

TriCare and FEHB (Federal Employees Health Benefits) provide comprehensive health coverage, but they cater to different needs:

• TriCare

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  is available to military personnel, retirees, and their families, offering affordable healthcare with global coverage.

• FEHB is designed for federal employees and retirees, providing a wide range of plan options tailored to diverse healthcare needs.

Understanding the strengths of each program is the first step toward leveraging them effectively.

Who Qualifies for Both?

Military retirees who transition to federal employment, as well as certain family members, may qualify for both TriCare and FEHB. If you’re in this group, you have the unique opportunity to coordinate benefits from both programs. This dual eligibility can be particularly valuable during life transitions such as retirement or a spouse’s job change.

The Case for Dual Coverage

Why consider keeping both TriCare and FEHB? Here are some compelling reasons:

1. Enhanced Coverage: Combining plans can fill gaps, ensuring you’re covered for a broader range of services.

2. Cost Sharing: FEHB can act as secondary coverage, reducing your out-of-pocket expenses.

3. Global Access: TriCare’s international network complements FEHB’s domestic focus, ideal for families who travel frequently.

However, dual coverage isn’t for everyone. Weigh the pros and cons based on your family’s specific needs.

Timing Matters: Open Season and Beyond

The federal Open Season typically runs from mid-November to mid-December each year. This is your chance to:

• Enroll in FEHB if you’re newly eligible.

• Switch plans to better coordinate with TriCare.

• Add or remove family members from your coverage.

Changes made during Open Season take effect on January 1. It’s crucial to review your options carefully and act within this window.

Outside of Open Season, Qualifying Life Events (QLEs) such as marriage, childbirth, or a job change may allow you to update your coverage.

Making TriCare Your Primary Coverage

For many military families, TriCare serves as the primary insurance. Here’s why:

• Low Costs: TriCare’s premiums and copays are typically lower than FEHB plans.

• Specialized Care: TriCare offers tailored programs for military-related health needs.

• Eligibility Continuity: TriCare remains available even after retirement, ensuring consistent coverage.

If TriCare is your primary coverage, FEHB can step in to cover additional costs, such as copayments, deductibles, and services not fully covered by TriCare.

Using FEHB as Secondary Coverage

FEHB’s role as secondary insurance can be a game-changer. Here’s how it works:

1. Coordination of Benefits: FEHB picks up where TriCare leaves off, reducing or eliminating your out-of-pocket expenses.

2. Additional Services: FEHB plans often include dental, vision, and other supplemental benefits that may not be fully covered by TriCare.

3. Provider Flexibility: FEHB expands your network of healthcare providers, offering more options for specialized care.

Key Considerations for Retirees

If you’re a military retiree transitioning to federal employment, understanding how your benefits change is critical. Here’s what to keep in mind:

• FEHB Enrollment: To maintain FEHB in retirement, you must enroll while employed and carry it for at least five years before retiring.

• TriCare for Life (TFL): Once you turn 65 and enroll in Medicare Part B, TFL becomes your primary coverage, with FEHB offering secondary benefits if retained.

• Costs and Savings: Evaluate how keeping both programs impacts your budget. FEHB premiums may increase over time, but the added benefits can outweigh the costs.

Managing Costs Effectively

Healthcare costs can add up, but strategic planning helps you stay ahead:

1. Review Plan Options Annually: FEHB plans and TriCare benefits may change. Regularly compare costs, coverage, and networks to ensure you’re getting the best value.

2. Leverage Preventive Care: Both TriCare and FEHB emphasize preventive services. Utilize these benefits to avoid higher medical costs later.

3. Budget for Premiums and Copays: While TriCare offers low-cost coverage, FEHB premiums vary. Plan for these expenses in your monthly budget.

Tips for Seamless Coordination

Coordinating TriCare and FEHB doesn’t have to be complicated. Follow these tips for a smoother experience:

• Keep Documentation Organized: Maintain records of your coverage, claims, and correspondence to simplify coordination.

• Inform Your Providers: Let your healthcare providers know about your dual coverage to ensure proper billing.

• Contact Customer Service: Reach out to TriCare and your FEHB plan’s customer service for assistance with complex claims or coverage questions.

Common Questions Answered

Do I need both TriCare and FEHB? Not necessarily. While dual coverage can offer enhanced benefits, it’s not essential for everyone. Assess your healthcare needs and financial situation before deciding.

Can I drop FEHB and re-enroll later? Generally, you can only re-enroll during Open Season or after a QLE. If you’re a retiree, dropping FEHB permanently forfeits the option to re-enroll.

How does Medicare impact my coverage? When you become eligible for Medicare, TriCare for Life takes over as your primary insurance, with Medicare Part B acting as secondary. FEHB remains an option for added benefits.

Maximizing Benefits for Your Family

Every family’s healthcare needs are unique. To get the most out of TriCare and FEHB:

1. Consider Family Members’ Needs: Ensure your dependents’ healthcare providers accept your plans and that their medical needs are covered.

2. Use Online Tools: Many FEHB providers and TriCare offer online tools to compare coverage, estimate costs, and find network providers.

3. Seek Advice: Consult with a benefits counselor or HR representative to understand how your coverage options align with your family’s needs.

Preparing for the Unexpected

Life is unpredictable, and healthcare needs can change rapidly. Here’s how to stay prepared:

• Emergency Coverage: Know how your plans handle emergency care, especially if you’re traveling or living abroad.

• Plan for Life Events: Marriage, childbirth, and retirement can all impact your coverage. Update your plans promptly during QLEs.

• Revisit Your Strategy: Regularly reassess your coverage to ensure it still meets your needs.

The Bottom Line on Balancing TriCare and FEHB

Balancing TriCare and FEHB coverage can unlock significant advantages for military families. By understanding how these programs complement each other, you can ensure robust healthcare for yourself and your loved ones. Take the time to review your options during Open Season and throughout the year—the effort pays off in better benefits and peace of mind.