Military Families Are Discovering New Ways to Make TriCare and FEHB Work Together Seamlessly

Key Takeaways

1. Combining TriCare and FEHB can maximize your family’s healthcare coverage, ensuring fewer gaps and more comprehensive benefits.

2. Understanding eligibility, enrollment periods, and the unique benefits of each plan allows military families to make informed decisions about their healthcare.

Navigating Dual Coverage: A Guide for Military Families

As a military family, you have unique healthcare options that offer robust coverage. TriCare and the Federal Employees Health Benefits (FEHB) program provide extensive benefits, but understanding how to make them work together can feel overwhelming. Don’t worry—this guide simplifies the process so you can optimize your family’s healthcare coverage.

Why Consider Dual Coverage?

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• Minimize Out-of-Pocket Costs: Secondary coverage often reduces co-pays, deductibles, and other expenses.

• Expand Provider Networks: Access more doctors, specialists, and facilities.

• Ensure Continuity of Care: Dual coverage can prevent gaps in care, especially during life transitions.

Understanding TriCare Basics

TriCare is the healthcare program for military members, retirees, and their families. With several plan options, it provides extensive coverage, including:

• Primary Care: Routine checkups and preventive services.

• Specialty Care: Access to specialists without referrals for some plans.

• Pharmacy Benefits: Prescription coverage through a robust network of pharmacies.

Eligibility for TriCare depends on your military status, and enrollment may be automatic for active-duty members. For retirees, maintaining eligibility requires paying a premium.

The FEHB Advantage

The FEHB program offers healthcare plans to federal employees, retirees, and their families. With a wide selection of plans, FEHB provides:

• Flexibility: Options range from Health Maintenance Organizations (HMOs) to Fee-for-Service (FFS) plans.

• Nationwide Coverage: Most plans cover services across the country, ideal for families on the move.

• Dental and Vision Add-Ons: Access to FEDVIP for expanded coverage.

FEHB’s enrollment periods and contribution structures make it a valuable asset for federal employees transitioning from active-duty military service.

Comparing TriCare and FEHB: Key Differences

Understanding the nuances of each program helps you determine how they can work together. Here’s a quick comparison:

Making Them Work Together

The magic happens when TriCare acts as secondary insurance to FEHB. Here’s how to ensure seamless integration:

1. Coordinate Benefits

TriCare functions as a wraparound plan, covering costs left by FEHB. For instance, if FEHB covers 80% of a medical bill, TriCare often picks up the rest. This coordination significantly reduces your out-of-pocket costs.

2. Choose Compatible Plans

Not all FEHB plans coordinate well with TriCare. Select one that aligns with your healthcare needs and allows smooth integration with TriCare’s benefits.

3. Keep Your Documentation Updated

Ensure your FEHB and TriCare enrollments are current, especially during life changes like retirement or relocation. Accurate documentation helps avoid claim denials.

Enrollment Tips for Dual Coverage

Open Season Matters

FEHB Open Season typically occurs from mid-November to mid-December each year. During this period, you can:

• Enroll in a new FEHB plan.

• Adjust your current coverage.

• Add eligible family members to your plan.

Qualifying Life Events (QLEs)

Outside Open Season, certain events allow enrollment or changes, such as:

• Marriage or divorce.

• Birth or adoption of a child.

• Retirement or leaving federal service.

Maintaining TriCare Eligibility

For retirees, keeping TriCare coverage requires enrolling in a premium-based plan, such as TriCare Retired Reserve or TriCare for Life. Active-duty families are automatically covered under appropriate TriCare plans.

Costs and Savings

Combining TriCare and FEHB offers financial advantages:

• Premiums: FEHB premiums may seem higher, but secondary TriCare coverage often offsets additional costs.

• Deductibles: TriCare’s wraparound feature can eliminate or reduce FEHB deductibles.

• Prescriptions: Use TriCare’s pharmacy network for significant savings on medications.

Common Challenges and Solutions

While dual coverage is advantageous, you may encounter obstacles. Here’s how to address them:

Claim Denials

Occasionally, claims may be denied due to errors in documentation or coordination. To resolve this:

• Verify your coverage details with both TriCare and FEHB.

• Contact customer service for assistance.

• Appeal denials promptly if necessary.

Confusion Over Coverage

Navigating two plans can be confusing. Simplify the process by:

• Keeping a detailed record of your benefits.

• Using online tools and resources offered by both programs.

Limited Provider Networks

If TriCare’s network doesn’t cover a provider, FEHB’s extensive options often fill the gap. Choose providers who accept both plans whenever possible.

Planning for Retirement

Retiring from the military or federal service introduces new healthcare considerations. Here’s how to prepare:

Transitioning to TriCare for Life

Once you become eligible for Medicare at age 65, TriCare for Life (TFL) becomes your secondary insurance. Ensure seamless coverage by:

• Enrolling in Medicare Parts A and B.

• Keeping your TriCare eligibility current.

• Reviewing how TFL coordinates with FEHB.

Evaluating FEHB Options

Retirees can continue FEHB coverage into retirement. To optimize benefits:

• Review plan options during Open Season.

• Consider plans with lower premiums if TFL acts as secondary coverage.

Budgeting for Healthcare

Plan for premiums, co-pays, and other costs. Combining TFL and FEHB often minimizes these expenses, but careful budgeting ensures financial readiness.

Leveraging Additional Resources

Take advantage of available tools to simplify the management of dual coverage:

• Plan Comparison Tools: Evaluate FEHB plans for compatibility with TriCare.

• Customer Support: Contact TriCare or FEHB administrators for personalized guidance.

• Workshops and Seminars: Attend sessions focused on military and federal benefits.

Staying Informed

Healthcare policies change over time. Stay updated on TriCare and FEHB rules by:

• Subscribing to newsletters from your benefits office.

• Checking official program websites regularly.

• Consulting with a benefits advisor during major life events.

Your Path to Seamless Healthcare

Combining TriCare and FEHB ensures your family’s healthcare needs are met with minimal hassle. By understanding each program’s strengths and leveraging them effectively, you can enjoy peace of mind and robust coverage.