Millions of active-duty families, retirees and their families should be paying attention to a new enrollment open season that starts Nov. 12 for Tricare health plans as well as new dental and vision benefits.
Some family advocates are concerned that the new annual enrollment season requirement for switching between Tricare Prime and Tricare Select may force some military families to be locked into a plan that they later find doesn’t suit their health care needs.
The health care open enrollment doesn’t affect those using Tricare for Life.
For others, the open enrollment season runs from Nov. 12 through Dec. 10. The choices take effect Jan. 1. For more information, or to switch plans, go to https://tricare.mil/bwe.
If families are satisfied with their Tricare health plan, they don’t have to do anything. But they can’t switch plans at any time during 2019, unless there’s a “qualifying life event,” such as making a move, marriage, the birth of a child, divorce, to name a few. Pregnancy, for example, is not a qualifying life event, according to Tricare officials.
This new practice of limiting enrollment periods “syncs us with the way industry has done this. We’re adopting the practice that most folks experience in the commercial sector,” said Patrick Grady, chief of the Tricare Health Plan.
Navy Vice Adm. Raquel Bono, director of the Defense Health Agency, said that by adhering to the single open season and the qualifying life events, health officials “can also begin to anticipate the needs of our patients more proactively.”
Health officials will have fairly stable information about how many patients are seeking care at each military medical facility and their needs. Bono said officials are also working to make the experience for beneficiaries more consistent across the military health system.
Before military health care reforms went into effect in 2018, beneficiaries could switch from Tricare Prime to Tricare Standard (now Tricare Select) at any time during the year, but they couldn’t switch back to Prime for 12 months. During the 2018 transition period, beneficiaries were given the option of switching back and forth between plans as they wanted, so that they could determine what best fits their needs.
This requirement to lock in a choice for a year could especially affect those who are enrolled in a military medical facility through Tricare Prime, said Karen Ruedisueli, government relations deputy director for the National Military Family Association.
“We’re really, really concerned about this,” she said, noting that patients will no longer have the option of switching plans if they have trouble getting access to care or have issues with quality of care, for example.
“You might be perfectly happy with what your care looks like in a [military treatment facility], but if the MTF commander changes, or if there’s a deployment of medical personnel out of that facility, your experience can change dramatically, and you would have no way of anticipating that,” she said.
“Yet, because you picked Prime, and you’re enrolled in that MTF, you would be trapped there. … It’s a huge system, and in any huge medical system you’re going to have people who have negative experiences with that system,” Ruedisueli said. “We’re not trying to say that military health care is bad. That’s not what we’re trying to imply. We’re trying to say that people should have the choice to get out of that system if they’re not satisfied with it.”
This open enrollment season for switching Tricare plans is not like the decisions most people in the civilian world face when they pick levels of health care coverage, Ruedisueli said.
“I don’t think this is intuitive to most people. It’s not like you’re choosing levels of coverage. Tricare coverage is pretty much the same across the board,” Ruedisueli said. “Your out-of-pocket costs differ a little bit between Prime and Select, but really what you’re choosing here is the venue where you’ll get your care, and how much flexibility you’ll have in your choice of providers."
In the civilian world, employees generally select the level of coverage and then choose a provider that accepts that health insurance plan. Employees also generally can make changes and go to a different provider who accepts the insurance at any time.
“[DoD] is not asking people to choose their level of coverage,” Ruedisueli said. "They’re asking them to choose where they want to get their care, and that’s locking people into one facility. It’s so far outside the norm of what is offered in commercial plans, that it doesn’t seem right to put military families in that situation.”
Regarding the experiences of beneficiaries, Bono said she wants to “make sure we have robust conversations so that we can identify those instances” where there are problems. There may be an issue with policies, or with the execution of policies at an MTF, “and we want to make sure we’re being consistent,” she said, during a recent phone call with reporters.
Right now, there’s no reliable way for families to communicate to officials in charge of making improvements that they’re having issues with their military treatment facility, Ruedisueli said.
"I think a much better measure of accountability would be allowing people to switch out if they’re that dissatisfied. They should be allowing people to make the move and then analyzing why they made the move from Prime to Select. To me, that’s a much greater measure of accountability.
“People shouldn’t have to fight to get their health care. It’s an even more difficult position for active-duty families to be in, because there’s this perception that you don’t want to rock the boat, and it’s not your place to question.”