Health care open season is about to get underway for military beneficiaries who are eligible for Tricare or the Federal Employees Dental and Vision Insurance Program, known as FEDVIP.
And there’s a new benefit for military families this year, the Dependent Care Flexible Spending Account, which allows families to set aside money before taxes for dependent care expenses. Families sign up for this new benefit during the federal benefits open season.
For Tricare beneficiaries, the open season — from Nov. 13 through Dec. 12 — applies to those enrolled in or eligible for Tricare Prime, including the U.S. Family Health Plan option, or Tricare Select. During this period, enrolled beneficiaries can make changes to their health coverage — such as switching from Tricare Prime to Tricare Select, or moving from individual to family enrollment. If you’re eligible for a Tricare plan but are not enrolled, now is the time to do it.
If you’re already enrolled in a Tricare plan and don’t want to make any changes, you don’t have to take any action; you’ll continue to stay enrolled in that plan. Even if you don’t want to change plans, you should still check to see if there are changes in Tricare costs that could affect you.
The only time you can enroll in or change your Tricare plan is during open season, or a qualifying life event such as moving, birth or adoption of a child, marriage, divorce, retirement from active duty, or a death in the family. Another example is losing or gaining other health insurance.
If you aren’t in a Tricare plan and don’t enroll during open season, the only care in the Military Health System for which you’d be eligible is at a military hospital or clinic — and only if space is available.
Open season doesn’t apply to active duty service members, who have full health coverage, or to those in Tricare for Life, which is automatic for those who have Medicare Part A and Part B. It also doesn’t apply to Tricare premium-based plans — Tricare Reserve Select, Tricare Retired Reserve and Tricare Young Adult — which can be purchased at any time during the year. But those in Tricare Young Adult with either the Prime or Select options can only change plans during open enrollment or a qualifying life event.
Tricare Prime is a health maintenance organization-style plan in which you get most of your care from a primary care manager, with referrals required for specialty care. There is no deductible. Active duty service members, their family members and transitional survivors don’t pay enrollment fees or out-of-pocket costs for covered services. Retirees, their families and all others pay enrollment fees and out-of-pocket costs for covered services except for preventive care.
Tricare Select is a preferred provider organization-style plan in which you choose your Tricare-authorized provider and don’t have to get referrals for most services. There are deductibles, co-payments and cost-shares.
Information on Prime and Select cost changes for 2024 were not yet available at publication time. For more information, visit the Tricare open season page.
Increased costs in premium-based Tricare plans
Military families who are enrolled in the Tricare premium plans for young adults, reservists and retired reservists, and separating service members will once again see hikes in their premiums, starting Jan. 1.
The Tricare Young Adult Prime and Select plans are available for purchase by qualified former dependent children up to age 26. The Tricare Young Adult programs must be at no cost to the government, under the rules set by Congress when it was implemented in 2013. So, the full cost of the program’s premiums is reflected in the fees charged to families. Defense officials look at the health care expenditures for the program for the previous year and calculate the costs.
|Tricare Premium Plan
|Young Adult Prime
|Young Adult Select
|Reserve Select (Individual)
|Reserve Select (Family)
|Retired Reserve (Individual)
|Retired Reserve (Family)
Pharmacy costs increase
Tricare beneficiaries who get their prescriptions filled at a retail pharmacy or through the mail-order program will pay more for their prescription drugs in 2024, as increases set by a 2018 law go into effect.
There aren’t co-payments for prescriptions filled at military pharmacies.
♦$16 for a 30-day supply of a generic at a retail pharmacy, up from $14 in 2023.
♦$43 for a 30-day supply of a covered name-brand drug at a retail pharmacy, up from $38 in 2023.
♦$13 for a 90-day supply of a generic through the mail-order pharmacy, up from $12 in 2023.
♦$38 for a 90-day supply of a covered name-brand drug through mail-order, up from $34 in 2023.
♦$76 for a 90-day supply of a non-formulary prescription drug — not on the list of drugs that are covered by Tricare — up from $68 in 2023.
Pending the outcome of a contract protest, a new generation of Tricare managed-care contracts will probably start in 2025. It takes about a year to transition to the new contracts, so for now, beneficiaries continue with the current contractors under the current system.
When the new contracts do kick in, about 1 million beneficiaries in six states will move from the East Region to the West Region. Those states are Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin. This is to more equally distribute the number of beneficiaries between the regions.
One thing the new contracts will do is require the contractors to do more rigorous checking of their provider network directories, to ensure those doctors and other providers are still accepting Tricare patients. But DoD health officials are working with current contractors to address that issue now, to improve access to health care for military families.
Some changes already implemented in 2023 include Tricare coverage for preconception and prenatal carrier screening tests for cystic fibrosis, spinal muscular atrophy, fragile X syndrome, Tay-Sachs disease, hemoglobinopathies, and conditions linked with Ashkenazi Jewish descent. Tricare also eliminated cost-sharing for female tubal sterilization as a preventive service, when performed by Tricare-authorized providers.
Families of active duty, National Guard and reserve service members — as well as guardsmen and reservists who aren’t on active duty — are eligible for the Tricare Dental Program, which requires separate enrollment.
Most retirees and their family members are eligible for dental and vision coverage under the Federal Employees Dental and Vision Insurance Program, or FEDVIP, which is administered by the Office of Personnel Management and also requires separate enrollment.
The open season for FEDVIP is Nov. 13 through Dec. 11, which is one day shorter than the Tricare open season.
The rates for FEDVIP will go up an average of 1.4% for dental in 2024, according to OPM
Twelve dental carriers provide 23 dental plan options available across FEDVIP. Seven of those dental carriers offer a combined 14 nationwide dental plan options. The remaining five carriers offer regional coverage.
If you’re already enrolled in a FEDVIP dental and/or vision plan and don’t want to make a change, your enrollment will automatically continue.
Those in the military community must be enrolled in a Tricare health plan to be eligible for FEDVIP vision coverage. Those eligible include active duty family members, retirees and their eligible family members, and Selected Reserve members and their families.
The 2024 average premium for vision plans will increase by 1.1% over the 2023 rates, according to the Office of Personnel Managment.
Five national providers offer 10 vision insurance plans available to all eligible for FEDVIP.
Visit www.benefeds.com to enroll in FEDVIP and to get more information.
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.