One of the celebrated benefits available to military service members is health care coverage that is almost unseen from other employers.
Service members and their families are able to receive health care at no cost to them. But changes are coming to the military health care system, known as TRICARE.
What are these changes and how do they impact our military?
Current TRICARE coverage. There are currently two main options that military members and their families can choose from when deciding on their health care plan. TRICARE Prime is a health maintenance organization-type model in which members are assigned a primary care manager and access specialized care through referrals. In the military system, this means going to a military treatment facility when possible. All care is covered, including specialized care when done with a referral.
The other option available is TRICARE Standard, which operates as a preferred provider organization-type model. Members are able to choose their own provider, to include specialized care, as long as they are within the network of TRICARE Standard. This allows for greater flexibility and “shopping around” for a provider. The option comes with some costs to the service member.
Regional coverage changes. As of January 1, TRICARE Standard and TRICARE Extra will become TRICARE Select. The basic coverage model will remain the same. Those enrolled in TRICARE Prime will remain in Prime. Those enrolled in TRICARE Standard and TRICARE Extra will automatically be switched to TRICARE Select.
Geographic regions of coverage are also changing. There are currently three regions of TRICARE coverage in the United States: TRICARE North, South and West. When moving between regions, service members and their families are automatically transferred from one region to another. This is largely transparent to the service member but does create additional processing requirements for TRICARE as a whole. In the new system, these three regions will become just two: TRICARE East and West. According to TRICARE, this “will allow better coordination between the military hospitals and clinics and the civilian health care providers in each region.”
These regions will be administered by the contractors Humana Military and Health Net Federal Services.
Enrollment changes. National Guard and Reserve members will also be able to receive health care coverage through the TRICARE system during their time of service. This opens the covered health care services to thousands of new beneficiaries.
With this new change, service members and their families will be affected by an enrollment freeze as the systems are changed over to the new plan. Changes are still able to be processed via phone or mail but the online system will be unavailable to make enrollment changes until December 31.
The enrollment process to change from Prime to Select will also change. Currently, service members and their families can choose to change from one plan to the other at any time. Beginning in 2019, changing between plans will only be possible during designated enrollment periods. These periods will be available during significant life events, such as marriage, birth, or adoption of a child, or when executing a military move, known as a Permanent Change of Station.
A period of open enrollment will be available during 2018 to allow for a transition to the new model. An open enrollment period will also “begin on the Monday of the second full week in November and run through the Monday of the second full week in December of each calendar year.”
It’s important to make any changes to your TRICARE plan before Nov. 20, 2017. This will allow your new regional contractor to process your info during the enrollment freeze.
Costs going down. Enrollment fees and costs will depend on the date of enlistment or commission of the service member, as well as the plan that they choose to select.
Those who enlist or commission before Jan. 1, 2018, will be in Group A. Those who enlist or commission after Jan. 1, 2018, will be in Group B. Family members will be in the same group as the service member who acts as their sponsor.
TRICARE also offers benefits to Reserve members, retirees, and young adult dependents up to the age of 26. These beneficiaries will fall in Group B, regardless of when their sponsor joined the military.
TRICARE Prime will remain completely free of costs for service members and dependents enrolled in this plan.
Annual deductibles for TRICARE Select are based on rank and range from $50 to $150 annually for individuals and $100 to $300 annually for families.
The changes to the TRICARE system are significant and reflect a desire to keep coverage for service members and their families — while responding to the need to expand what’s covered and how the system operates.
There is also an annual catastrophic cap for all plans, which will remain at $100 for active-duty beneficiaries and $3,000 to $3,500 for retiree beneficiaries. Various services, including primary care, specialty care, emergency room visits, urgent care, and ambulance services will range from $15 to $116 based on care, group, status of sponsor, and provider.
Detailed cost information for both active duty and retirees can be found on the TRICARE website.
Impact to our military. The most noteworthy changes service members will need to respond to include the new enrollment periods and freezes. Service members will need to anticipate these requirements and make any desired enrollment changes during designated open enrollment periods.
While costs are not changing significantly, it is important for service members to understand the difference between TRICARE Prime and TRICARE Select, as well as the costs associated with each.
All military providers will remain part of the TRICARE system, while civilian health care providers’ participation will depend on their individual acceptance of Humana Military and Health Net Federal Services.
The changes will also provide more appointments at both military treatment facilities, civilian clinics, and urgent care clinics. TRICARE also promises increased timely access to specialty care after receiving a referral.
The changes to the TRICARE system are significant and reflect a desire to keep coverage for service members and their families — while responding to the need to expand what is covered and how the system operates.
Katie Begley is an OpsLens contributor, a U.S. Naval Academy graduate and a former Surface Warfare Officer. In addition to being a military spouse, she is a freelance writer specializing in travel, education, and parenting subjects. This piece originally appeared in OpsLens.
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