Editor’s note: This is one in a series of pieces that make up the Military Times 2018 Benefits Guide. Read or download the entire e-book here.
Unlike other military benefits, the Tricare program has undergone a major overhaul for 2018. As beneficiaries sort out which plan suits their health care needs — and how much more they might be paying for medical visits and prescriptions — here’s a look at how it works, and what your options are:
What it is: Tricare is a health care program for almost 9.4 million beneficiaries that offers 11 different options, with choices depending on the status of the sponsor and the geographic location.
Eligibility: Active-duty members; military retirees; National Guard and Reserve members; family members (spouses and children registered in the Defense Enrollment Eligibility Reporting System) and certain others, including some former military spouses and survivors, as well as and Medal of Honor recipients and their immediate families.
Tricare beneficiaries who were eligible for and/or enrolled in Tricare as of Dec. 31, 2017, were automatically enrolled in their respective plans Jan. 1. Because 2018 is a transition year, Tricare beneficiaries are allowed to make changes to their enrollment all year, to help beneficiaries adjust to making their health care choice.
Those entering the military on or after Jan. 1, or changing status (i.e., from active duty to retired) should make sure they and their eligible family members are enrolled in the Tricare program of their choice. Those who don’t enroll may only receive care at a military clinic or hospital on a space-available basis, and medical care by civilian providers wouldn’t be covered.
The details: Tricare offers two core options: Tricare Prime and Tricare Select. Select replaced Tricare Standard and Tricare Extra in 2018.
All active-duty members are required to enroll in Tricare Prime; they pay nothing out of pocket. Active-duty families can enroll in Tricare Prime without an enrollment fee. Prime beneficiaries are assigned a primary care manager (provider) at their local military treatment facility or, if one is not available, they can select a PCM within the Tricare Prime network. Specialty care is provided on referral, either to specialists at a military facility or a civilian provider, by the PCM.
Tricare Select is similar to a traditional fee-for-service health plan. Patients can see any authorized provider they choose, but pay a deductible and co-pays for visits. Patients pay lower out-of-pocket costs when they receive care from a provider within the Tricare network.
Get more details on each plan here.
FREE DOWNLOAD: 2018 MILITARY TIMES BENEFITS GUIDE
Action items: Beginning this year, beneficiaries must take action to enroll in a Tricare plan in order to be covered for civilian health care. Those who don’t enroll will only be able to get health care at a military clinic or hospital on a space available basis.
That didn’t apply to beneficiaries using Tricare as of the end of 2017. They were automatically enrolled in the corresponding plan for 2018. For example, those in Tricare Standard or Tricare Extra were automatically enrolled in Tricare Select, the new plan which replaced those two.
Go here to enroll in a plan, or for instructions on how to enroll via phone.
CHANGING YOUR PLAN
Because of the changes to the Tricare program in 2018, beneficiaries can switch between plans, allowing them to decide which best meets their needs. That grace period ends Dec. 31; after that, enrollees can change plans only during open enrollment periods or within 90 days of a “qualifying life event.”
Examples of such an event:
- Marriage, divorce or annulment.
- Birth or adoption of a child.
- Death of sponsor, spouse or child.
- Placement of a child by a court in a member’s home.
- Change in sponsor status, such as moving from active duty to retiree.
- Moving to a new ZIP code.
- Loss of eligibility, such as due to age, Medicare, etc.
- Loss or gain of other insurance.
- Change in eligibility status, such as a dependent child marrying an active-duty service member.
To change your plan, contact your contractor.
West Region: 844-866-9378 or online.
East Region: 800-444-5445 or online.
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.