Nearly 175,000 beneficiaries who are working-age military retirees and their family members who were enrolled in Tricare Select may soon find their health care coverage has been dropped, because they haven’t set up payment plans for the newly required enrollment fees.
By law, in order to continue coverage under Tricare Select, retiree sponsors were required to start paying new monthly enrollment fees as of Jan. 1, and they were required to set up a payment plan by Dec. 31 by allotment, bank account or credit card.
About 20 percent of this population, or 174,754 out of 872,886 beneficiaries, haven’t taken action to set up their payments, or to actively opt out, according to data provided by the Defense Health Agency. Payments haven’t yet been set up for 278,497 beneficiaries; but of those, 103,743 have actively opted out of setting up payments, thus effectively discontinuing coverage. Those beneficiary numbers include the retiree sponsor as well the retiree’s eligible family members enrolled in Tricare Select.
Anyone who is dropped from Tricare Select will have access to direct medical care only at a military treatment facility, and only if space if available. Claims for medical treatment after Dec. 31 will be denied, but coverage can be reinstated within 180 days if back enrollment fees are paid.
At the end of January, regional Tricare contractors will start sending out letters to these beneficiaries notifying them about their disenrollment, according to DHA spokesman Peter Graves. He said health officials expect “some number of those eligible” to request reinstatement. Contractors have also started sending emails to those who haven’t yet paid, he said.
“Overall, the numbers are very concerning, but we’re really not surprised,” because of traditional difficulties in communicating with beneficiaries, said Karen Ruedisueli, director of health affairs for the Military Officers Association, .
She said she was concerned that too many beneficiaries won’t find out their coverage has been dropped until their medical provider tells them when they go to seek care.
The enrollment fees are:
• for individuals: $12.50 per month or $150 a year
• for families: $25 per month or $300 per year
This doesn’t affect retirees who are in Tricare for Life, Tricare Prime, or those using a premium-based plan. Nor does it affect active duty families on Tricare Select, survivors of deceased active duty members, or medical retired retirees and family members.
Overall, payments had been set up for 68 percent of affected beneficiaries by the end of December, according to information provided by the Defense Health Agency.
But that varies by region. The overseas region has the lowest percentage of those who have set up payments, at 45 percent. In the Tricare East region, payments have been set up for 72 percent of enrolled beneficiaries. In Tricare West, payments have been set up for 64 percent of beneficiaries.
In 2021, for the first time, retirees and family members enrolled in Tricare Select, must pay enrollment fees in order to continue their coverage. If you haven’t responded to the Defense Department’s clarion call to contact your Tricare regional contractor to set up a payment process, you lost coverage as of Jan. 1, and you’ll soon find your health care claims are denied.
These are so-called “Group A” retirees and their dependents — working-age retirees under age 65 who entered the military before Jan. 1, 2018, their family members and survivors. Previously, these beneficiaries didn’t have to pay enrollment fees for Tricare Select, but a 2017 law required the Defense Department to start charging these enrollment fees by Jan. 1, 2021.
You'll probably be getting a phone call if you were disenrolled from Tricare Select as a retiree or family member.
All is not lost for those who realize their coverage has been dropped. Defense Health Agency officials have set up a process to allow retirees and their family members to reenroll after they’ve been dropped from Tricare Select, and have extended the grace period for reenrolling to 180 days. The retiree sponsor must call the regional Tricare contractor to request reinstatement of coverage for themselves and their family members. They must also pay enrollment fees dating back to Jan. 1, 2021. Claims that have been denied will be paid by Tricare once the sponsor reinstates coverage.
Tricare officials have also directed the Tricare regional contractors to make at least three phone calls to households whose coverage was terminated because they didn’t set up their payments. They’ll call the home phone, cell phone, work phone, speaking to an adult in the household, letting them know their coverage has been terminated and what they can do to reinstate the coverage
Of the previously enrolled beneficiaries, 12 percent have specifically opted out of setting up payments, effectively choosing not to continue with Tricare Select coverage.
That varies by region, too. Of the overseas population, about 6 percent have actively opted out. In the East region, 11 percent have opted out; in the West region, 15 percent opted out.
It remains to be seen how many others who haven’t set up payments have simply decided not to continue their Tricare Select coverage, possibly because they have other health insurance.
|Tricare East||Tricare West||Overseas|
|# of Group A Tricare Select beneficiaries enrolled in 2020||590,372||226,767||55,747|
|# who have set up enrollment fee payment arrangements||423,330||145,878||25,285|
|% of those who have set up enrollment fee payment arrangements||72%||64.3%||45.2%|
|Source: Defense Health Agency|
MOAA’s Ruedisueli said she’s particularly concerned about the lower numbers of those living overseas who set up payments — 45 percent. This population may be a harder group to reach to communicate about the new requirement, she said.
But overall, she said, “We know it’s always tough to communicate to beneficiaries….Now we have the pandemic that’s disrupted everybody’s lives, making it even harder to get through to folks.” There’s also the possibility that some who have been deferring medical care won’t find out they’ve been dropped until after the six month reinstatement period has ended.
“Our perspective is that military retirees have without a doubt earned this Tricare benefit after decades of service and sacrifice. Losing Tricare coverage right now especially is an unreasonably harsh policy, if they failed to get communication on a new enrollment fee,” Ruedisueli said.
However, she said, “We do feel that [Defense Health Agency] and the contractors seemed to do a good job of trying to get the word out. The folks who were informed felt they were being pummeled by the messaging. But there’s just a group that was very difficult to reach, and we need to acknowledge that, and make sure they’re not locked out of Tricare this year.”
She applauded the agency’s decision to extend the reinstatement period to six months, but notes that last year MOAA asked officials to extend it to one year. She said DHA officials have said they will reconsider extending the grace period further based on enrollment numbers.
“MOAA fought this enrollment fee when it was proposed in 2016, because it fundamentally changes the health care coverage protections that career service members earn. No longer are you covered by Tricare no matter what. Now there’s this requirement to pay a fee,” Ruedisueli said.
Congress did grandfather in the current population so that retirees wouldn’t have to start paying the Tricare Select fees until three years after the Tricare reform law was enacted. And the original fees were reduced by two-thirds from the original proposal, from $450 per year for an individual to $150; and from $900 per year for family coverage to $300.