TRICARE Changes Coming Your Way. Here’s Your To-Do List.
Each year as the Department of Defense appropriations process unfolds, I feel like I’m watching a sporting event — sitting on the edge of my seat, fingers crossed and hoping my team wins.
At stake in this annual game: How millions of military members, retirees and their families will be affected by the negotiations and ultimate outcome. Sometimes the process is a snoozer, but often it’s a high-stakes endeavor with the potential to shape pocketbooks and day-to-day routines. The implementation of the 2017 National Defense Authorization Act is resulting in substantial changes to the military’s health care program, including the TRICARE benefit.
Aimed to improve the patient experience – quality of care, access, options – and, of course, save money, here are some of the key changes along with action items for you to consider:
- Fiscal year becomes a thing of the past. Aligning with the civilian health care system, the TRICARE benefit will change from fiscal year (October-September) to calendar year (January-December). Enrollment fees for the final quarter of 2017 will be prorated, and deductibles and catastrophic caps will not re-set until Jan. 1, 2018.
What You Need To-Do: If you’ve already met your deductible or hit your catastrophic cap for 2017, it’s a good idea to schedule medical appointments that you’ve been putting off. That way, you won’t pay additional costs for authorized services received through the end of 2017.
- Some core program names have changed. The HMO-like option, called TRICARE Prime, will keep its name. But the PPO-type plans, formerly known as TRICARE Standard and TRICARE Extra, will be consolidated into a single plan called TRICARE Select. This isn’t a big deal since the main difference between Standard and Extra is whether your doctors are in or out of the TRICARE network and those who currently use Standard or Extra will be automatically converted to TRICARE Select. TRICARE Select enrollees will be able to visit any authorized provider without a referral. But going out of network will still cost more, as it did before.
What You Need To-Do: Read up on the plans to educate yourself about the option that’s best for you and take action if you want to change your plan. An easy way to get the latest information is by signing up for TRICARE e-mail updates at www.tricare.mil/subscriptions and exploring all the changes at www.tricare.mil/changes.
- A shift from three regions to two. The North and South Regions from the current system are being merged into a single East Region. Yes, you may have to change doctors. Network provider directories will be released in November 2017. To facilitate the transition, a system-wide enrollment freeze takes effect Dec. 1-Dec. 23, 2017. Beneficiaries can still call contractors to enroll and they will be processed in DEERS when transition is complete. Contact your regional TRICARE contractor if you have questions on how this could affect you or your care.
What You Need To-Do: Check to see if your current health care providers will still be in your network following the realignment. Out-of-network care can cost big bucks and typically doesn’t count toward deductible or catastrophic cap limits. Also, if you or a family member need to switch plans or enroll in a plan for the first time, aim to submit your enrollment form by Nov. 20, 2017. Any forms received from then until the last week of the year won’t be processed until January 2018.
- Enrollment will be required, but 2018 is a year of transition. Annual enrollment for health care benefits each fall has long been a part of the civilian benefits routine. Now it’s going to be a must for military members and their families as well as retirees. If you’re enrolled in TRICARE Prime on Dec. 31, 2017, you’ll automatically be enrolled in Prime next year. And if you’re enrolled in TRICARE Standard or TRICARE Extra, you’ll automatically be converted to TRICARE Select for 2018. So, there’s no action required in 2017 or any subsequent year unless you want to change plans or your eligibility changes.
Keep in mind the open enrollment period for 2019 will be Nov. 12-Dec. 10, 2018. You only need to take action if you want to change plans; otherwise you will remain in your current plan. In 2018, TRICARE beneficiaries will get two “breaks” designed to help ease the transition:
- You’ll be allowed to change plans at any time in 2018 if you choose. Beginning in 2019, however, you’ll only be able to change plans during the annual enrollment period or if you have a qualifying life event (marriage, loss of insurance, birth of a child, etc.).
- If you take action to disenroll from your TRICARE plan, without enrolling into another TRICRE plan, and opt to get medical care from a civilian provider, TRICARE will share the costs with you as if you used an out-of-network provider. After this happens once, however, you’ll have to enroll in TRICARE. If you don’t, future care will not be covered except through a military facility on a space-available basis.
What You Need To-Do: If you retire from the Military after January 1, 2018, you will need to take action to enroll in a TRICARE plan. Otherwise, mark the 2018 enrollment period on your calendar or put a reminder in your phone. As always, ensure your entire family is registered in the Defense Enrollment Eligibility Reporting System.
- Those who retire after January 2018 must enroll. In the past, all you needed was a military ID card to receive military health care. As of Jan. 1, 2018, that will no longer be the case. All retirees must enroll in TRICARE, regardless of the TRICARE option chosen.
What You Need To-Do: If you’re retiring next year before the annual enrollment period begins, sign up for TRICARE Select or Prime to make sure you have coverage in 2019. Remember, since 2018 is a transition year, you can enroll at any time.
- Retirees will see changes in out-of-pocket costs. Although TRICARE For Life will remain unchanged, retirees who joined the Military before January 1, 2018 who aren’t yet old enough to qualify for Medicare will have more predictable out-of-pocket costs for some services under TRICARE Select. These costs will be the same amount, on average, beneficiaries would have paid in 2017. For example, in 2018 a trip to the emergency room will cost $116, instead of 20% of the negotiated fee in 2017. And ambulance service will cost $106, instead of 20% of the negotiated fee in 2017. On a case-by-case basis this could mean you’ll pay more for certain services. In addition, retirees who opted for TRICARE Standard and TRICARE Extra were not required to pay an annual enrollment fee. That will change in 2021. Beginning that year, the PPO-type plan is scheduled to require an enrollment fee. For retirees who joined the military before 2018, the fee will be $150 per individual or $300 per family, and each year the enrollment cost will be adjusted for inflation. For retirees who enlisted or were commissioned after Jan. 1, 2018, the enrollment fee is significantly higher — $450 for an individual and $900 per family.
What You Need To-Do: You may need to build a bigger slice of “health care expenses” into your budget and bulk up your emergency fund so you’ll have enough cushion for potential increased cash outlays.
- Cost shares are replaced with copays. The current cost-sharing system applicable to TRICARE Standard and Extra beneficiaries will, in most cases, be replaced with a new and easier to understand copay system in which a set cost will be assigned to most types of use if you see a network provider. For example, if you visit an urgent care center, you’ll pay a flat $35 no matter which provider you see.
What You Need To-Do: The new system should make it easier to anticipate your expenses, so visit TRICARE.mil for all the copay details.
There are 60-plus pages of mandated changes and instructions related to TRICARE in the 2017 National Defense Authorization Act. This includes many programs and pilots to help chart the future path of this important program. Visit the TRICARE website for more details.
TRICARE policies and benefits are governed by public law and federal regulations. Changes to TRICARE programs are continually made as public law and/or federal regulations are amended. For the most recent information, contact your TRICARE regional contractor, TRICARE Service Center, or local military treatment facility.
For services payable by both Medicare and TRICARE For Life, Medicare pays first and the remaining liability may be paid by TRICARE For Life.
For services payable by TRICARE For Life, but not Medicare, such as overseas care, TRICARE For Life pays the same as for TRICARE Standard beneficiaries. Beneficiaries are responsible for the TRICARE Standard fiscal year deductible and cost shares.
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
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