Health Insurance Question

[❤ mollymouser ❤]

We've never had more than one health insurance carrier at a time.

CURRENT: My husband is in the military and we have Tricare Prime. (He has no copays. I have copays for RXs and presumably some other things I've never used. No copays for doc visits, lab work.)

WHAT'S HAPPENING: He is retiring from the Military as of Jun 01. We will be signing up for the Tricare for retirees and will pay $647 annually for family coverage.

NEW EMPLOYER: His new employer will pay the health insurance premiums for both of us. (Blue Cross Anthem) There is a $5600 deductible. (ouch)  This is the only plan that they offer, and they charge some employees for all/part of this coverage.

So ... we will have health insurance with Blue Cross as primary and Tricare as secondary. Does this mean that for the first $5600 of treatment, we submit the claims to Blue Cross, and then they don't pay it as we've not met the deductible.... so it's then submitted to Tricare who then pays in based on Tricare's coverage? (As I understand Tricare retiree coverage, there will be some copays.)

Do I have this straight or am I off about this? (Please be gentle as I'm a bit stressed and I'm overthinking everything.)

[Mardi Gras Audrey]

That is correct. I have a similar setup (employer insurance as primary, tricare as secondary).

The claims will be submitted to anthem first. Anthem will process and get “you” the negotiated rates because u are under the deductible. The claim will then be submitted to tricare as coordination of benefits.

You have to make sure it is submitted to anthem first and tricare can see it was. Tricare will pay as a secondary as long as you have complied with anthem’s rules and they see the claim was submitted to anthem first.

Make sure you tell tricare about the other insurance. If you don’t, then they can get really stupid about what rules you need to follow ; I have tricare prime and would need referrals and a tricare pcp. Because I have employer insurance.”, all that is out the window and they just want to see I complied with my primary insurance rules. If I don’t comply with the primary’s rules and the primary rejects the claim, tricare rejects it too.

You can get into weird situations where neither pays if u don’t follow the primary insurance rules. That happened to my DH (he has tricare prime as primary and my employer as a secondary. Didn’t get a referral. From tricare to see a specialist do they denied the claim. My employer plan denied it as the secondary since it was denied by tricare. It was fun cleaning that up)

[Mardi Gras Audrey]

Are you guys going to have an HRA or FSA attached to the anthem Insurance? If so, make sure it isn’t turned on to automatically pay from that account. If it automatically pays from that account, tricare may not get billed and the $$ they would have paid will be coming out of that account instead.

That was one of the issues we ran into. My employer plan gives me an HRA of $2200 per year ($4400 deductible). When it was activated, The deductible would be getting paid out of that instead of billing to tricare. So this was costing $$. This was especially important because our kids aren’t on tricare and I use the HRA money for their stuff under the deductible and their coinsurance once the deductible is met.

Our employer plan let me turn the automatically using that off and I have to pay for the kids stuff and then get reimbursed while my stuff goes to tricare. The only thing they couldn’t was the rxs, so tricare never gets a bill for my rxs. For yours, ask the pharmacy to put both insurances in and run it as a coordination of benefits. I know Cvs and Walgreens can both do that

[azucena]

Audrey told you most of it.  It may be obvious but you'll want to fill out the paperwork for each medical office to set Anthem primary, tricare secondary.  Then, you'll need to watch the EOBs and bills process to make sure that's actually happening.  IME, having two coverages caused more billing problems and phone calls but it was still worth it to save $$.

If his new employer is paying all of the premium for both of you, then the $5600 deductible is not bad at all.  Not many employers are covering full premium for the employee much less spouse anymore.

Congrats on this next stage of life for the both of you.  I always like to hear how you're doing as your life is so different from mine

[The Walk of the Penguin Mich]

I might be inclined to ask if you can get other compensation for health insurance from his new employer.  

One of the things I have discovered is that the primary/secondary insurance screws up more often than not.  One 2 year period, I had both insurances insisting that the other was primary.  We finally had to get one of our state legislators involved as I was getting threats of being sent to collection for non payment.  I started paying, and when it all shook out, I only was reimbursed about 1/3 of what I paid.  Luckily, my only charges that year were mammograms and a couple of prescription visits, but I was still out about $400.

[stillmovingforward]

What mich mentions is what we went through also. It's just easier to have only one insurance. My DH used to get an extra dollar or two added into his hourly wsge for not using insurance. I covered us.

[nidena]

Feb 14, 2022 22:01:09 GMT -5 stillmovingforward said:

What mich mentions is what we went through also. It's just easier to have only one insurance. My DH used to get an extra dollar or two added into his hourly wsge for not using insurance. I covered us.

To add to this...

If you stick with Tricare, you won't have to worry about new paperwork should he switch jobs.

And Express Scripts is awesome for prescriptions...though they're running out of a few things right now which isn't surprising considering the supply chain and production issues in various places of the country/world.

[vonna]

As one who has only used tricare, I am wondering why you would want another health insurance?  Things didn't change that much when we went from active duty to retiree.  We use the prime option.

[Opti]

This is a major benefit!


will pay $647 annually for family coverage. 

[The Walk of the Penguin Mich]

Feb 16, 2022 7:12:23 GMT -5 Opti said:

This is a major benefit!


will pay $647 annually for family coverage. 

Actually, it is likely when OP’s husband went into the military, he was promised free healthcare for life.  

So while this is a very nice benefit, paying for healthcare (and this is only him and his wife, military dependent healthcare gets cut off, for me it was when I graduated college at 22, guessing 26 now?) is a benefit they were promised that has been eaten away.  It isn’t free anymore.  

[nidena]

Feb 16, 2022 12:56:47 GMT -5 The Walk of the Penguin Mich said:

Feb 16, 2022 7:12:23 GMT -5 Opti said:

This is a major benefit!


will pay $647 annually for family coverage. 

Actually, it is likely when OP’s husband went into the military, he was promised free healthcare for life.  

So while this is a very nice benefit, paying for healthcare (and this is only him and his wife, military dependent healthcare gets cut off, for me it was when I graduated college at 22, guessing 26 now?) is a benefit they were promised that has been eaten away.  It isn’t free anymore.  

Nah.  They stopped promising that in the late 80s/early 90s.  I knew when I joined at the turn of the century that I'd be paying for healthcare when I finished my 20.  As a single, I pay $300/year and my copays are $20 for regular and $31 for specialists unless I go to the VA Hospital.  And Express Scripts prescriptions are, generally, $12 each.  I, myself, can't complain.  Not to mention education benefits that (at the present time) have been changed to never expire.  A whole lot cheaper than the civilian flipside for sure.

[The Walk of the Penguin Mich]

Feb 16, 2022 23:00:30 GMT -5 nidena said:

Feb 16, 2022 12:56:47 GMT -5 The Walk of the Penguin Mich said:

Actually, it is likely when OP’s husband went into the military, he was promised free healthcare for life.  

So while this is a very nice benefit, paying for healthcare (and this is only him and his wife, military dependent healthcare gets cut off, for me it was when I graduated college at 22, guessing 26 now?) is a benefit they were promised that has been eaten away.  It isn’t free anymore.  

Nah.  They stopped promising that in the late 80s/early 90s.  I knew when I joined at the turn of the century that I'd be paying for healthcare when I finished my 20.  As a single, I pay $300/year and my copays are $20 for regular and $31 for specialists unless I go to the VA Hospital.  And Express Scripts prescriptions are, generally, $12 each.  I, myself, can't complain.  Not to mention education benefits that (at the present time) have been changed to never expire.  A whole lot cheaper than the civilian flipside for sure.

The OP’s DH has nearly 39 years of service in, so he entered in the early 80s before the benefits were cut.  I remember my dad being utterly livid about this.

[nidena]

Feb 17, 2022 0:15:08 GMT -5 The Walk of the Penguin Mich said:

Feb 16, 2022 23:00:30 GMT -5 nidena said:

Nah.  They stopped promising that in the late 80s/early 90s.  I knew when I joined at the turn of the century that I'd be paying for healthcare when I finished my 20.  As a single, I pay $300/year and my copays are $20 for regular and $31 for specialists unless I go to the VA Hospital.  And Express Scripts prescriptions are, generally, $12 each.  I, myself, can't complain.  Not to mention education benefits that (at the present time) have been changed to never expire.  A whole lot cheaper than the civilian flipside for sure.

The OP’s DH has nearly 39 years of service in, so he entered in the early 80s before the benefits were cut.  I remember my dad being utterly livid about this.

Oh!  Yeah, he probably did get that spiel then.

I think what is most interesting is that they had already reached the tipping point for total number of veterans in the late 1990s so the costs would be at or near to their highest at that time.  They didn't NEED to change the cost of it.

But, hey, how else are they going to pay for their new toys like the F35, right, which are customized for each branch and have helmets that cost more per unit than 10 years of my military pension?