En español | Between Nov. 12 and Dec. 10, service members and their families will be able to choose the Tricare insurance program that best suits their needs, a first for the military’s health care program.
While open enrollment periods for health insurance plans are a familiar practice for civilians, “this is the first time our service member beneficiaries will have the opportunity to look at the details of the plans and make a choice depending on what’s best for them as an individual or a family,” says Patrick Grady, acting chief of the Tricare Health Plan. It’s also an opportunity to change enrollment, from individual to family, for example.
Those who are currently 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 2019.
Those who might want to make a change can explore the differences between the two basic plans that were introduced in 2018. Both Tricare Prime and Tricare Select divide beneficiaries into two groups: Group A if your enlistment began before Jan. 1, 2018; Group B if your enlistment began on or after Jan. 1, 2018. For help deciding which plan is better for you, answering this questionnaire can help you understand your options. Whichever group you belong in, Grady says service members should first review their information in the Defense Enrollment Eligibility Reporting System (DEERS). “DEERS is our eligibility source,” Grady says. “Make sure all your information is correct.” That means that details like addresses and beneficiaries are up to date.
Tricare Prime is a managed care option, with a primary care manager (PCM) 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 copay depending on the service provided. The PCM will make referrals when necessary and help get the proper authorization. Tricare Prime is available in two separate regions: The East Region is managed by Humana Military, and the West Region by Health Net Federal Services. Copays for in-network providers range from $20 for a primary care visit to $30 for a specialist. 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.
Tricare Select, a preferred provider option (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 range from $21 to $41, depending on whether the service member is in Group A or Group B, and whether the provider is in or out of network. 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, whether in Group A or B. For all others, the cap is $3,000 for those in Group A and $3,500 for Group B beneficiaries.
Once the open enrollment period ends, Tricare enrollees can only switch their plans if they have what’s called a “qualifying life event” (QLE) such as moving, having a baby or getting married. 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 further details, you can go to the Tricare website. “Members can really dig into the details of all of these plans there,” Grady says. Enrollment can be completed online, by telephone to the regional coordinator or by mailing the enrollment form to the regional coordinator.
Dental and vision plans
There are also some changes this year to the dental and vision plans available to members of the military and their families. Retired service members who have dental insurance through the Tricare Retiree Dental Program will no longer have that option after Dec. 31. During open enrollment season, they must enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP) for dental insurance. If they have a Tricare plan, retirees can also opt for vision insurance.
Family members of active duty men and women still will receive dental care through the Tricare dental plan and also will be eligible for FEDVIP vision coverage. FEDVIP gives a choice between 10 dental carriers and four vision carriers, Grady says. “This hasn’t been offered in the past,” he says. See Tricare.benefeds.com/InfoPortal/indexAction for additional information.
While this year may turn out to be a learning curve, Ryan Guina, founder of the Military Wallet website and a member of the Air National Guard, says the new open enrollment process will offer advantages for both Tricare and its service members. “I hope this will help the organization better manage their benefit programs,” Guina says. “And that members will take the time to educate themselves about the coverage and costs of each plan, and run the numbers.”