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 2020.
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 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, 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 separate regions: Humana Military manages the East Region, and Health Net Federal Services manages the West Region. 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.
The PPO option
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 $20 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 in Group A and $1,028 for Group B. For all others, the cap is $3,000 for those in Group A and $3,598 for Group B beneficiaries.
Once the open enrollment period ends, Tricare enrollees can switch their plans only if they have what’s 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 further details, you can go to the Tricare website. Enrollment can be completed online, by telephone to the regional coordinator or by mailing the enrollment form to the regional coordinator.
To enroll in Prime or Select
- Online. Click Manage Health Benefits, log in, then select Beneficiary Web Enrollment (BWE) from the menu. The option is for stateside health care plans only.
- By phone. Call your Tricare regional contractor. Information can be found on the Tricare regions page.
- By mail. Download and print the form.
Dental and vision plans
Retired service members do not qualify for dental insurance through the Tricare Retiree Dental Program.
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 also can 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. See the Benefeds portal for additional information.
To enroll in FEDVIP online
- Go to benefeds.com and verify your eligibility.
- Create a My Benefeds account.
- Compare, select and enroll in a plan for you and family members.
- Confirm your plan choice. If you have enrollment questions, call toll-free 877-888-3337.
Editor's note: Aaron Kassraie updated this article, originally written in 2018, with 2019 information.