Military Insurance: Understanding Tricare and TriWest

Navigating the world of military insurance, such as Tricare and TriWest, can be a bit overwhelming and confusing for medical providers and beneficiaries. In this blog post, we will shed light on the different types of military insurance, clarify their coverage areas, and offer insights into how providers can participate in these programs to better serve our esteemed military personnel and veterans.

Tricare West: Coverage for Active Military, Retirees, and Reservists

Tricare West is one of the primary insurance programs provided to active military members, retirees (those who served 20 years and retired with benefits), and reservists. Managed by Health Net Federal Services, Tricare West offers comprehensive coverage for beneficiaries, including hospital and clinic services. However, the provider panels for Tricare West can be restrictive, primarily focusing on locations near military bases or areas where beneficiaries are most likely to seek healthcare services.

For providers near a military base, joining Tricare West’s network can be an excellent opportunity to serve military personnel and their families who might prefer nearby care options. However, if your practice is not close to a base, becoming a non-network participating provider can still allow you to treat Tricare West beneficiaries with similar coverage for both in-network and non-network providers.

TriWest: Coverage for Veterans

TriWest, on the other hand, is for individuals who have served in the military but did not retire after 20 years. These former military personnel are eligible for medical benefits and often seek healthcare outside the United States Department of Veterans Affairs (VA) system. TriWest serves as a gateway for these veterans to access care from civilian healthcare providers, offering them more convenient options.

As a medical provider, contracting with TriWest enables you to treat veterans who may prefer to seek medical attention outside of VA facilities, especially if your practice is more accessible or specialized in certain areas of care.

Tricare for Life: Dual Coverage with Medicare

Tricare for Life is designed for eligible beneficiaries for Tricare coverage and Medicare. Typically, this includes individuals over 65, those with disability benefits, and others. With Tricare for Life, beneficiaries have dual coverage, allowing them to utilize both Tricare and Medicare benefits.

For medical providers, understanding the distinction between Tricare for Life and regular Tricare is crucial when billing claims. Non-network providers for Tricare for Life still receive significant coverage, with Tricare reimbursing 100% of the allowable maximum. However, non-participating providers can charge up to 15% more, which the beneficiary would pay.

Making Sense of HMOs and Select Plans

These military insurance programs often have HMOs (Health Maintenance Organizations) and Select Plans, further complicating matters. Providers should familiarize themselves with the various plans available in their area and understand their coverage to ensure smooth billing and proper care coordination.

Contracting and Credentialing Considerations

If you wish to participate in military insurance programs, initiating the contracting and credentialing process early is essential. Some programs may take up to 120 days to finalize contracts, so starting early ensures your practice can serve military beneficiaries without unnecessary delays.

Military insurances, such as Tricare and TriWest, provide essential healthcare coverage for active military personnel, veterans, and their families. As medical providers, participating in these programs is an honorable opportunity to support those who have served our country selflessly. Understanding each program’s nuances, coverage areas, and the contracting process can help your practice provide top-notch care to these deserving individuals. Regularly check with the respective insurance companies for program updates and changes. Together, we can ensure that our military personnel and veterans receive the best healthcare experience they deserve.