I am a 51-year-old retiree currently enrolled in Tricare Prime. With four children in their 20s — and aging out of Tricare — my wife and I are thinking of switching to my company’s policy so that all four of our children may be covered until age 26. That would be less expensive than trying to cover all 4 individually under the new Tricare Young Adult program. In about six years, my wife and I would switch back to Tricare Prime after our children are over 26. What can we do to make this transition as smooth as possible?
As a retiree, your eligibility for Tricare, and by extension the eligibility of your family, remains in place regardless of whether or not you use Tricare as your primary insurance. In the presence of other health insurance, the law requires that Tricare always be last payer. So in the scenario you outline here, your company’s insurance would be the primary payer and Tricare would act as secondary payer, if necessary. To avoid the annual Tricare Prime enrollment fee during that period, you simply must disenroll from Prime for however long you are covered by your company’s insurance. Disenrollment is done through the Tricare managed-care contractor for your Tricare region.
When you disenroll from Prime, your coverage automatically shifts to Tricare Standard. When you want to go back to Prime, simply contact the Tricare managed-care contractor for your Tricare region and indicate your desire to re-enroll.
Beneficiaries may voluntarily disenroll from Tricare Prime once per fiscal year (Oct. 1-Sept. 30) without being locked out. If you disenroll for a second time in a fiscal year, you are not allowed to re-enroll in Prime for 12 months. (There is an exception to this lockout rule for family members of active-duty personnel in paygrades E-1 to E-4.)
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