TriCARE vs. FEHB: How Military Retirees Can Get the Most Value Out of Their Healthcare Options

Key Takeaways

1. Military retirees have access to both TRICARE and FEHB, each offering unique benefits tailored to specific needs. Evaluating your healthcare priorities is essential for making the most informed decision.

2. Coordinating TRICARE with FEHB can provide enhanced coverage and cost savings, but understanding how these programs interact is key to maximizing value.

Understanding TRICARE and FEHB

As a military retiree, you hold a unique position when it comes to healthcare options. You have access to TRICARE—a program specifically designed for military families—and the Federal Employees Health Benefits (FEHB) program, which offers extensive coverage options. While this dual eligibility is a significant advantage, navigating these systems can feel overwhelming. Let’s break down what each program offers and how to make the most of your options.

What TRICARE Brings to the Table

TRICARE is a healthcare program tailored for military members, retirees, and their families. It covers a range of services, including hospital care, doctor visits, prescription drugs, and specialty care. The program comes with several plan options, such as TRICARE Prime and TRICARE Select, each catering to different needs and preferences.

Key advantages of TRICARE include:

• Affordable Coverage: TRICARE typically offers lower out-of-pocket costs compared to many private plans.

• Comprehensive Benefits: You’re covered for most medical services, including preventive care, surgeries, and mental health.

• Global Access: If you live or travel overseas, TRICARE’s global network ensures you’re covered virtually anywhere.

FEHB: The Federal Employee Advantage

The FEHB program provides federal employees, retirees, and their eligible family members with extensive healthcare choices. With over 200 plans to choose from, it’s a robust program that can be tailored to your specific needs. FEHB includes nationwide plans as well as regional HMOs (Health Maintenance Organizations).

Why Consider FEHB?

• Wide Network of Providers: FEHB plans give you access to a large pool of healthcare providers, making it easy to find care wherever you are.

• Customizable Plans: You can choose plans with specific features, such as lower premiums or higher coverage levels.

• Coordination with Medicare: FEHB integrates seamlessly with Medicare, making it a popular choice for retirees over 65.

Eligibility for Both Programs

Military retirees and their families are uniquely eligible for both TRICARE and FEHB, provided they meet certain criteria. To qualify for FEHB, you must have been eligible for the program as a federal employee and carried it into retirement. Meanwhile, TRICARE eligibility depends on your military service status and includes retirees, reservists, and their families.

Comparing TRICARE and FEHB

When deciding between TRICARE and FEHB, consider the following factors:

1. Cost

• TRICARE often has lower premiums and out-of-pocket costs. However, FEHB offers various plans with competitive pricing and premium contributions from the federal government.

2. Coverage

• While TRICARE is comprehensive, FEHB plans may include additional benefits, such as broader dental and vision coverage.

3. Provider Access

• TRICARE’s network is more limited compared to FEHB, which offers a wider range of providers, especially in rural or underserved areas.

4. Flexibility

• FEHB allows you to change plans annually during Open Season, whereas TRICARE offers fewer opportunities to switch plans.

Maximizing Your Coverage: TRICARE and FEHB Together

Using TRICARE and FEHB together can enhance your healthcare coverage. Many military retirees opt to keep both programs, allowing them to coordinate benefits and minimize out-of-pocket expenses. Here’s how to make this combination work for you:

Primary and Secondary Coverage

• If you’re enrolled in both TRICARE and FEHB, one program will act as your primary insurer while the other becomes secondary. Typically, FEHB takes the lead for active services, while TRICARE covers additional costs.

Prescription Benefits

• Both TRICARE and FEHB offer strong prescription drug coverage, but combining the two can significantly reduce copayments and out-of-pocket costs.

Travel Coverage

• If you frequently travel, TRICARE’s global network ensures you’re covered abroad, while FEHB plans offer extensive nationwide coverage.

Key Considerations for Medicare-Eligible Retirees

Once you turn 65, Medicare becomes a central part of your healthcare planning. Here’s how TRICARE and FEHB interact with Medicare:

TRICARE for Life (TFL)

• TFL acts as secondary coverage to Medicare, covering costs like copayments and deductibles. This makes it a cost-effective option for military retirees.

FEHB and Medicare

• FEHB plans coordinate well with Medicare, often covering services and medications that Medicare doesn’t. Retaining FEHB gives you the flexibility to switch plans annually, ensuring your healthcare evolves with your needs.

Choosing the Right Path

So, how do you decide which program is best for you? It boils down to your specific circumstances:

• Stick with TRICARE if you prioritize lower costs, international coverage, and simplicity.

• Opt for FEHB if you want broader provider access, more plan choices, and additional benefits like dental and vision.

• Use Both Programs if you want the best of both worlds, especially if you’re Medicare-eligible.

Tips for Making Your Decision

1. Evaluate Your Healthcare Needs: Think about the services you use most and any upcoming medical needs.

2. Compare Costs: Look at premiums, deductibles, copayments, and other out-of-pocket costs.

3. Review Plan Benefits: Focus on additional perks, such as wellness programs, vision care, or hearing aids.

4. Plan for Retirement: If you’re nearing retirement, ensure you meet the eligibility criteria for both programs.

5. Seek Professional Advice: A benefits counselor can provide personalized guidance to help you make the best choice.

Why Open Season Matters

Open Season is your annual opportunity to review and adjust your FEHB coverage. It typically runs from mid-November to mid-December. Use this time to:

• Compare plans and costs.

• Adjust your coverage based on changes in your health or family situation.

• Consider how FEHB coordinates with TRICARE, Medicare, or other coverage.

Looking Ahead

Healthcare needs evolve, and so do your options. Staying informed about changes to TRICARE and FEHB ensures you’re always getting the most value from your benefits. Regularly review your plans, consider your long-term health goals, and don’t hesitate to make changes when needed.

Finding the Balance for Your Healthcare

Balancing TRICARE and FEHB as a military retiree might seem complex, but understanding their strengths and how they can complement each other makes all the difference. Take the time to evaluate your needs, explore your options, and create a healthcare strategy that provides peace of mind for years to come.