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Old 11-08-2007, 02:38 PM   #1  
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Joined APC: Jul 2007
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Smile Base Plan vs Buy Up Plan w/Tricare Standard (or other secondary insurance)


I spent quite a few hours earlier in the week researching the new health care plans.

I spoke with Anthem, Tricare and my current doctor's insurance manager at length.

Thought I'd pass along my take with regards to the Bae Plan vs the Buy Plan, for those folks who have Tricare Standard at no cost as part of their military retirement.

It may also apply to those who have other "secondary payer" health insurance through another job or their spouses health insurance (however, those deductibles and how those insurance companies pay out secondary claims may differ).

(Disclaimer: If you don't have secondary insurance it appears the Buy Up Plan is best for most people.)

As some other posters have already noted, when comparing the Base Plan to the Buy Up Plan it's pretty easy to see you are making a tradeoff decision of increased monthly premiums of $65 per month ($100 base plan vs $165 buy up plan --- for Employee & Family) vs. the differences in the In-Network deductible & non-preventative coverage ($250 individual/$750 family/90% base plan vs $0/$0/100% buyup plan).

When you consider your buy-up premiums are paid with pre-tax money, your actual annual cost of the extra premiums are $65 x (1-tax rate) x 12 months.

...i.e. at a 33% tax rate --- $65 x (1-.33) x 12 = $515

On the simplist level, you are getting rid of the base plan $750 family deductible and the 10% cost share of non-preventative care for only $515 --- a good deal!

However, if you have Tricare Std you can eliminate all of your co-pays, a good portion of the base plan deductible, and a large part of the 10% non-preventative cost share burden by simply filing with Tricare Standard as "second payer" --- especially if you schedule preventative health care visits early in the year.

The Tricare Standard deductible are $150 per person and $300 per family.

If you schedule preventative visits (i.e. adult or child annual physicals) early in the year, Anthem will pay 100% coverage --- with possibly a $20 copay. (Note: Anthem will pay preventative visits at 100% w/out application of the deductible)

Tricare will then process the claim and consider all payments made by Anthem as applying to your annual deductible.

Once your Tricare deductible is satisfied ($150 individual/$300 family), Tricare will pay your copays and pay 80% of the Tricare allowable charges up until you satisfy your Anthem deductibles ($250 individual/$750 family) at which point Anthem becomes "primary again" and covers 90% of the non-preventative costs.

At this point and beyond,Tricare should cover the other 10% and your co-pays as "secondary payer", and then you should have zero out-of-pocket costs the remainder of the year.

Using this method, I believe the "worse case" scenario is that you pay the first $300 in the Tricare deductible and then 20% of the costs before the $750 Anthem deductible is satisfiedl (20% x 450 = $90).

Thus, "worse case" your costs will be paying $390 out of pocket each year....cheaper than the increase in premiums of $515, even when you consider the tax benefits.

In reality, if you schedule preventative visits early in the year before you have a non-preventative vist, you will most likely wipe out most of the Tricare $300 deductible and end up paying even less.

Just thought I'd share this analysis with others --- would be interesting to hear what most retired military pilots are choosing.

A'o Aloha

Last edited by DLax85; 11-08-2007 at 03:15 PM. Reason: typo/clarity
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