TRICARE does not cover all expenses. In addition to deductibles, you might be on the hook for up to 25% of the cost of every covered prescription, doctor’s visit and hospital stay!
|TRICARE Pays**||Supplement Pays||You Pay|
|TRICARE Deductible||Individual $150 / Family $300||$0||$0||$150 / $300|
|Supplemental Plan Deductible||Individual $250 / Family $500||$0||$0||$250 / $500|
|Doctor Visits||In Network||All but $30 to $118||$30 to $118||$0|
|Out of Network||75%||25%||$0|
|Retail Network Pharmacy Co-Payments||Generic RX||All but $13||$13||$0|
|Brand Name RX||All but $33||$33||$0|
|Non-Formulary RX||All but $60||$60||$0|
|Other Out-of-Pocket Charges||Excess Charges||$0||100%||$0|
|Age of Retiree, Spouse, Widow(er)||Quarterly Rate with First Year Discount | Base Rate****|
|Under 40||$78.96 | $84|
|40 - 44||$84.60 | $90|
|45 - 49||$94.94 | $101|
|50 - 54||$119.38 | $127|
|55 - 59||$150.40 | $160|
|60 - 64||$166.38 | $177|
|Each Child||$62.98 | $67|
If you’re enrolled in TRICARE you can obtain this coverage. This includes the following individuals:
The supplement pays eligible out-of-pocket expenses, after any applicable deductible, as follows:
If you or your covered dependents received medical care for an injury or sickness during the six months before the date your coverage begins, coverage of that condition won’t start until the person has been enrolled in the plan for six months.
These conversations are fictitious and for illustrative purposes. Have additional questions? Call a TRICARE Supplement Insurance Plan Specialist at 888-214-0794.
Elliot: How does the TRICARE Supplement work with drug co-pays?
TRICARE Supplement: If TRICARE covers that prescription, your supplement plan will reimburse the co-pays after your deductibles are met.
Janet: My husband is going through a psychiatric treatment of about 39 treatments. A co-pay every time. How would we be reimbursed?
TRICARE Supplement: Co-payments are paid when a claim is submitted after a deductible(s) is met (if applicable). After the co-payments are paid, submit the claim to be reimbursed.
Mike: I am a Tricare Prime Retiree and have excess out-of-pocket expenses. How can this supplemental coverage help me? What are the costs of something like this?
TRICARE Supplement: The supplement is designed to cover excess out-of-pocket expenses! Call for more details or to request additional information.
Sam: Our son has been recently diagnosed as a Type 1 diabetic. We’re looking for insurance assistance for glucose monitors and insulin pumps. He is age 15.
TRICARE Supplement: We can definitely help your family! There is a six-month waiting period for pre-existing conditions†, but once that time has passed, we will pick up the portion that TRICARE does not pay.
Jim: I recently got a prescription and TRICARE didn’t pay any of it. Will my Supplemental Plan cover it?
TRICARE Supplement: TRICARE covers most prescription drugs approved by the Food and Drug Administration. Unfortunately, if TRICARE does not cover your prescription, your Supplemental Plan will not either.