Choosing a TRICARE Supplement Insurance Plan is not a matter of selecting from five interchangeable options. The supplement must match the TRICARE program you are already enrolled in, and the details that affect your decision go beyond the deductible shown in a comparison chart.
The Uniformed Services Benefit Association® sponsors five TRICARE Supplement Insurance Plans. Each option is designed to cover the remaining cost-shares and copayments left after TRICARE pays its share. A supplement does not replace TRICARE, and it does not cover a service simply because you incur an out-of-pocket expense. The service must be covered under TRICARE and meet the supplement’s terms.
Start With Your Current TRICARE Program
Your existing TRICARE coverage determines the best supplement for you. While the basic matches are straightforward, there are important differences to consider.
If You Are Enrolled in TRICARE Prime
The TRICARE Prime Supplement Insurance Plan is available to eligible retired Members, retired Reserve Members, spouses, dependent children, and eligible surviving spouses who are enrolled in TRICARE Prime. The Prime supplement plan has no deductible.
No deductible doesn’t mean everything is covered under Prime. The supplement does not pay the TRICARE Prime annual enrollment fee or the Point-of-Service deductible. Benefits are also subject to the plan’s terms and applicable limits.
If You Are Enrolled in TRICARE Select
The TRICARE Select Supplement Insurance Plan is intended for eligible retirees and eligible family members enrolled in TRICARE Select. It has a calendar-year supplement plan deductible of $250 per person or $500 per family.
The TRICARE Select outpatient deductible and the supplement plan deductible are separate. Expenses applied to the TRICARE outpatient deductible do not satisfy the supplement’s $250 individual or $500 family deductible. Once you meet the applicable deductibles, the supplement can help pay covered inpatient and outpatient cost-shares, subject to the policy terms.
If You Are an Active Duty Family Member
The TRICARE Active Duty Family Member Supplement Insurance Plan is for eligible spouses and dependent children covered by TRICARE through an active-duty Member. The service member on Active Duty is not eligible for supplement coverage but may enroll eligible dependents. The supplement plan has no deductible.
If You Are Enrolled in TRICARE Reserve Select
The TRICARE Reserve Select Supplement Insurance Plan is for members of the Selected Reserve and their eligible family members who are covered by TRICARE Reserve Select.
A key eligibility restriction is easy to miss: the Member cannot be eligible for, enrolled in, or covered under the Federal Employees Health Benefits Program, including coverage through a family member. The Member must be covered under the supplement before the Member can enroll a spouse or dependent child.
If You Are Enrolled in TRICARE Retired Reserve
The TRICARE Retired Reserve Supplement Insurance Plan is for eligible retired Reserve members and eligible family members enrolled in TRICARE Retired Reserve. It has a calendar-year supplement plan deductible of $250 per person or $500 per family. As with the Select Supplement, expenses used to satisfy the applicable TRICARE outpatient deductible do not satisfy the supplement plan deductible.
What Supplement Plans Are Designed to Help Cover
Depending on the plan, benefits may help with covered inpatient and outpatient cost-shares after TRICARE pays, including cost-shares for doctor visits, emergency room care, same-day surgery, and prescription medications.
Applicable TRICARE and supplement deductibles must be met before certain benefits are payable. Covered cost-share benefits are generally limited by TRICARE allowed or negotiated amounts and are payable until the applicable TRICARE catastrophic cap is reached, subject to plan terms and conditions.
The Select, Active Duty Family Member, Reserve Select, and Retired Reserve Supplements also include an Excess Benefit for covered expenses above the TRICARE allowed amount, up to the applicable Legal Limit. Complete benefit provisions vary by plan.
Five Questions to Answer Before You Apply
- Which TRICARE program covers each person right now? The supplement must correspond to that program.
- Is anyone becoming eligible for Medicare? Eligibility generally requires applicants to be under age 65 and not eligible for Medicare. If you are age 65 or older and ineligible for Medicare, you may qualify with a copy of your Social Security Notice of Disallowance of Benefits.
- Does a dependent meet the plan’s eligibility rules? Age, student status, TRICARE Young Adult enrollment, and the Member’s own enrollment can affect eligibility.
- What out-of-pocket costs do I pay before my supplemental insurance starts paying? Account for any TRICARE deductible and the separate supplement plan deductible for certain plans.
- Are the services you expect to use covered by TRICARE and the supplement? Review exclusions and limitations rather than comparing deductibles alone.
Enrollment Timing Can Affect Pre-Existing Conditions
You cannot be turned down for coverage, although a pre-existing condition may initially limit benefits. In general, an injury or sickness for which a covered person received medical care or treatment during the six months before the effective date is not covered until the supplement has been in effect for six months. Covered expenses related to new conditions are covered immediately, subject to policy terms.
The pre-existing condition limitation is waived when a Member requests the matching supplement within 30 days after the related TRICARE coverage begins or within 63 days after termination of active-duty service.
Confirm Availability and Current Details
TRICARE Supplement coverage is not available in Alaska, Colorado, Maine, New Hampshire, Puerto Rico, Utah, or Washington. Rates are based on age and may increase when an insured person enters a new age category. Rates or benefits may also change on a class basis.
Each plan includes a 30-day right to examine the Certificate of Insurance. You may return the Certificate for a full refund if you are not completely satisfied, provided no claim has been made.
Review the plan summaries and application options on the USBA TRICARE Supplement Insurance page, or call a USBA TRICARE Product Specialist at 877-297-9235, extension 554, Monday through Friday from 9:00 a.m. to 4:00 p.m. Central Time.
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