TRICARE Plans & Programs
SECURE FOR RETIREES IN KOREA
SECURE FOR RETIREES IN KOREA
The TRICARE Overseas Program (TOP) www.tricare-overseas.com is the DOD’s health care program that covers retirees, their family members, and other eligible beneficiaries in the overseas region. TRICARE Overseas is not a TRICARE Plan, it is a "Region" i.e. my TRICARE plan is TRICARE For Life living in the TRICARE Overseas region. TOP is the program that manages this region.
As a retiree your TRICARE, whether it be TRICARE Select of TRICARE For Life, can be used just about anywhere in Korea. In fact. many Korean medical facilities even bill TRICARE direct through their International Help Centers as they are TRICARE Network Providers. Those that are not on the network, you can still use and then file claims to TRICARE yourself. You will pay 100% upfront, and then get reimbursed 75% with your claim.
Dial From Korea Cell Phone Toll-free: 080-429-0880
Commercial: 011-65-6338-9277
From U.S. Toll-free: 1-877-678-1208
Global 24 Network Service Team: +63-2-8687-8656
The TOP program allows you the flexibility to see any provider "IN" or "OUT" of the TRICARE Network, anywhere in Korea, whether TRICARE For Life or TRICARE Select. You will always have a 25% cost share. TRICARE pays/reimburses 75%, after the deductible has been met, and you pay the remaining 25%. There is a Catastrophic Cap, which adjusts slightly year to year, that is around $3,000.00, so your out of pocket costs will be limited to that cap. Once that Catastrophic Cap is met, TRICARE will pay/reimburse you 100%. As an example, your webmaster had a major stroke in 2017 spending almost 6 weeks at Ajou University Medical Center in Suwon (world-class) that racked up a $90,000 bill - I paid $3,000 out of pocket, TRICARE paid the rest. No complaints here.
Many get confused when asking about TRICARE and refer to TRICARE Overseas as a TRICARE plan. TRICARE Overseas is a Region, not a plan. When talking with a TRICARE representative it is important to understand the terms so all involved are talking the same language and nothing is lost in translation.
TRICARE For Life (TFL) is a Medicare wraparound program, a Medicare supplement, and keeps TRICARE alive for retirees after 65. Congress initially wanted to stop TRICARE all together once you hit 65, but this plan was the alternative to keeping, which you can read about on our TRICARE For Life and Medicare page.
When CONUS TFL is secondary to Medicare and follows Medicare rules.
When overseas (no Medicare), as we are in Korea, TFL is primary and operates like TRICARE Select requiring no Tricare referrals.
TRICARE Plus is a PROGRAM, not a plan, and it is only offered at certain MTF's as determined by each MTF Commander, usually based on the ability to support the program or not. The TRICARE Plus Program allows retirees to register at their hospital of record and be assigned a PCM. You must be enrolled in TRICARE Select or have TRICARE For Life to register, and of course the program must be offered at that location. TRICARE Plus registration is unique to each base. Availability for the Plus program changes often, so check with each MTF's TRICARE office. POCs listed below. Currently Osan AB is the only MTF we are aware of that still supports the Plus program, although you must wait for an empty position to open before you can join the plan. USAG Humphreys still supports those grandfathered into the Plus Program, but does not assign anyone to it anymore. If you are already registered into PLUS, and you already have a PCM, AND you are turning 65... you will not lose your PCM. Contact the TRICARE office at Osan, 0505-784-2273, and talk with them to make sure nothing gets missed. The key to this working out that there is NO BREAK in your TRICARE service during the transition to 65.
If you are under the age of 65, and are not eligible for TRICARE For Life under disability conditions (occurs under 65), retirees and their family members overseas are enrolled in TRICARE SELECT.
Yes, there are in fact two different non-TFL plans: PRIME and SELECT, but as a retiree overseas you cannot enroll in PRIME, thus TRICARE Select is your only option until qualifying for TFL. To learn more about TRICARE Prime visit the TRICARE website tricare.mil/Plans/HealthPlans/Prime
After a divorce, unremarried former spouses may be eligible for TRICARE coverage if falling under one of these two rules:
To learn more about Former Spouses go to the TRICARE Former Spouses website at tricare.mil/Plans/Eligibility/FormerSpouses
By TRICARE Communications NEWS |Sep 20, 2022
newsroom.tricare.mil/Articles/Article/3163752/how-divorce-impacts-your-tricare-benefits
FALLS CHURCH, Va. – The divorce process can create intense emotions. You might feel frustrated or confused during this time. Thinking about your TRICARE benefits may be the last thought on your mind. However, it’s something you must consider. “TRICARE won’t pay for services or supplies provided to anyone who isn’t eligible for TRICARE, so it’s important you understand how your TRICARE coverage may change for you, your children, and your ex-spouse,” said Shane Pham, TRICARE policy and program analyst at the Defense Health Agency. “If a former spouse or a stepchild who wasn’t adopted loses eligibility in a divorce and continues to get care, TRICARE can recoup those payments which adds an extra layer of difficulty during an already challenging time.” Read Q&A to learn more about how divorce affects your TRICARE health benefits at newsroom.tricare.mil/Articles/Article/3163752/how-divorce-impacts-your-tricare-benefits
Dental services are limited at Military Facilities in Korea, almost almost non-existent for retirees. The military facilities are just not manned to handle it, so they don't offer the services.
geha.com/en
GEHA is the largest benefits association for federal employees, retirees and their families. It overseas FEHB, FEDVIP, PSHB.
Note on disenrolling in GEHA: call BENEFEDS Contact number 1-877-888-3337 (International +1-571-730-5942), which allows you to talk with an automated system (a machine) and cancel using just your SSN.
FEDVIP is a voluntary (you pay for) dental insurance plan. Even though the title says "Federal Employees", it is also for Retirees, Family Members of Retirees, and Survivors, . You can enroll during open enrollment season in November. To enroll outside of open season, you must fall into one of three categories as listed on their website at benefeds.gov/programs. There are several different programs to select from. If you have questions regarding enrollment, please call BENEFEDS Customer Service
In Korea, more common than not, retirees use dental and vision services on the local economy. Korea provides excellent doctors and services at very reasonable prices (fractions), and is very convenient since there are so many. This is by far the most common way of receiving services, primarily because it's the easiest to obtain.
Retirees in Korea have several possible options to refill their prescription medications. These options range from free refills at a US military medical facility to mail-order to paying downtown on the economy and a TRICARE claim or paying out-of-pocket and eating the costs, not the obvious choice of course.
VA IS NOT AN OPTION since there is not a VA clinic in Korea.
Prescriptions can be filled and refilled at military pharmacy's in Korea with no fees. The MHS Genesis Patient Portal also now includes an online Refill option similar to the one TRICARE Online had.
BLUF: This doesn't really apply to those living overseas due to the unavailability of Medicare, but it is still good to know.
Your TRICARE prescription drugs plan is considered creditable coverage. This means the TRICARE prescription drug plan is at least as good as any Medicare Part D prescription drug plan. If you're enrolled in a TRICARE plan, you have TRICARE prescription drug coverage/ If you still want to buy a Medicare Part D prescription drug plan, you can. If you buy a Medicare Part D prescription drug plan, TRICARE pays last after Medicare and other prescription drug coverage. Visit tricare.mil/pharmacy to learn more about your TRICARE prescription drug coverage.
Prescriptions written by local Korean hospitals, if they are a TRICARE affiliated facility here in Korea, will be honored at the on-base military hospital. As an example, if you have a script written from Ajou Medical Hospital, and the meds prescribed are available at the Osan AB Pharmacy, Osan will fill your meds. Same at Brian Allgood Hospital at Humphreys. The pharmacy will first translate the written prescription to make sure they have the medication, and if so, they will honor the script. If however, the meds prescribed are not available on-base, you have two options: go downtown and pay, or get in to see a base doctor and see if there is an alternative medication.
You can send in a TRICARE claim for prescriptions you purchase at downtown Korean pharmacies. If you receive your meds at one of the preferred hospitals like Ajou however, their International Service Center you work with will include the meds in the TRICARE claim they submit. But, if you need a med they don't carry or are out of, and you have to purchase "outside" you have to submit a claim for it yourself.
Express Scripts® manages ALL medications under TRICARE. This includes home delivery, retail pharmacy, and even on-base prescriptions. Some think Express Scripts® relates only to mailed prescriptions, but that is not the case. Being integrated like this across the three delivery methods makes it very easy for them to switch from one method to another.
Mail Orders: Express Scripts® Pharmacy express-scripts.com mails prescriptions only to U.S.-based addresses, to State Department Pouch Mail, and APO/FPO/DPO addresses.
Important Note: Once turning 65 and TRICARE For Life, downtown Korean retail pharmacies are no longer covered by TRICARE for expense claims, so using a mail order becomes more worthwhile vs depending on the local economy. This of course is not relevant if using an on-base pharmacy at an MTF.
TRICARE claim: Visit any local Korean pharmacy off base, pay out of pocket and then file a TRICARE claim. The alternative however, is to buy off base and DON'T file a claim if your cost out-of-pocket is less than the pharmacy copayment. Drugs in Korea are generally a fraction of their US price, so this happens often for many retirees.
Pre-existing Prescription from CONUS PCM: If you have a prescription issued from a stateside PCM, you can get it filled at a US military pharmacy here in Korea (Osan, Humphreys etc). Using Osan as the example, you need only register with the TRICARE office in the Osan hospital to use the Osan Pharmacy. If the pharmacy has your medications, they will fill it.
51st Medical Clinic Pharmacy Osan AB: DSN 784-2185, Commercial 0505-784-2185
News | TRICARE Communications | Nov 2023
newsroom.tricare.mil/News/TRICARE-News/Article/3591310/getting-tricare-prescriptions-overseas
DEDUCTABLE: The amount you pay before your TRICARE coverage starts to pay. Until you meet the maximum of your deductible, you pay 100% of your medical bill. For retirees (who almost all fall under Group A) deductibles for 2023 are $351.96 per individual and $703.92 per family. Deductibles are annual, thus they start all over every January 1st.
CO-PAY: Once you meet the initial deductible as described above, TRICARE begins paying 75% of your medical bills. Co-pay is the 25% TRICARE does not pay. You pay that co-pay of 25%. This continues throughout the calendar year until you reach the Catastrophic Cap.
CATASTROPHIC CAP: Once your deductible and co-pays equal, or exceed, the catastrophic cap amount, then you pay nothing! TRICARE pays if all within that year. The catastrophic cap for retirees under TRICARE For Life is $3,000
And again as a reminder: When January 1st rolls around, it all starts over for that next year
TRICARE Costs and Fees 2023: tricare.mil/-/media/Files/TRICARE/Publications/Misc/Costs_Sheet_2023.pdf
Knowing Your 2023 TRICARE Plan’s Catastrophic Cap: newsroom.tricare.mil/Articles/Article/3265784/start-2023-knowing-your-tricare-plans-catastrophic-cap
EOB - Explanation Of Benefits: A TRICARE explanation of benefits (EOB) is not a bill. It's an itemized statement that shows what action TRICARE has taken on your claims. You may receive a monthly EOB statement detailing all the claims you had in the past month. You should keep your EOB statements with your health insurance records. Read more at tricare.mil/PatientResources/GoPaperless/EOBOnline