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Between Nov. 8 and Dec. 13, service members and their families will be able to choose the Tricare insurance program that best suits their needs within the military’s health care program.
Those who are now enrolled in a Tricare plan and happy with their benefits don’t need to do anything. Anyone who does not actively switch will remain in the same plan for 2022.
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Enrollment fees for Tricare Prime and Select beneficiaries rose based off the cost-of-living adjustment (COLA), announced in October. In 2022, the annual enrollment fees for individuals will range from $158 to $392 and $317 to $784 for families. Active-duty enrollees do not have an enrollment fee. You can review Tricare costs for 2022 here.
For retired and disabled veterans, the adjustment will mean more money in their monthly benefit checks.
Those who might want to make a change can explore the differences between the two basic plans introduced in 2018. Both Tricare Prime and Tricare Select divide beneficiaries into two groups: Group A if your enlistment began before 2018; Group B if your enlistment began on or after Jan. 1, 2018. This questionnaire can help you understand your options and decide which plan is better for you. Whichever group you belong in, service members should first review their information in the Defense Enrollment Eligibility Reporting System (DEERS). DEERS is the eligibility source that makes sure all information is correct, including addresses and beneficiaries.
The HMO option
Tricare Prime is a managed care option, often referred to as a health maintenance organization (HMO), with a primary care manager responsible for an individual’s medical care. While this plan is mandatory for active service members, their families can opt for either Prime or Select.
Members of Prime can see any Tricare-authorized provider, who will charge a copayment depending on the service provided. The care manager will make referrals when necessary and help get the proper authorization.
Tricare Prime is available in two regions: Humana Military manages the East Region and Health Net Federal Services manages the West Region. In-network copays will range from $22 for a primary care visit to $33 for a specialist in 2022.
Maximum out-of-pocket expenses are similar for both plans: $1,000 for active-duty family members in Group A and $1,120 for Group B. For all other retirees and their families, the cap is $3,000 or $3,921 for those in Group A and Group B, respectively.
A point-of-service option allows family members to visit a specialist without a referral for an additional cost. Tricare Prime may have fewer out-of-pocket costs, but provider choices are limited.
The PPO option
Tricare Select, a preferred provider organization (PPO), is available everywhere in the United States and offers more flexibility for family members. Beneficiaries can see any provider they choose, both for primary and specialist care.
Copays for a primary care in-network visit range from $16 to $32, depending on whether the service member is active duty and in Group A or Group B. You can compare plans at the Tricare website.
Maximum out-of-pocket expenses are similar for both plans: $1,000 for active-duty family members in Group A and $1,120 for Group B. For other retirees and their families, the cap is $3,706 and $3,921 for those in Group A and Group B, respectively.
Once the open enrollment period ends, Tricare enrollees can switch their plans only if they have what is called a “qualifying life event” (QLE), such as having a baby, getting married or moving. In cases such as those, you will have 90 days from the date of the event to make a change.
For more information on enrollment fees for these plans and additional details, you can go to the Tricare website. Enrollment can be completed online, by calling the regional coordinator by phone or by mailing the enrollment form to the regional coordinator.