On January 1, 2018, many changes were made to the TRICARE program. Importantly, TRICARE continues to offer several different health plans, and plan availability still depends on who you are and where you live. Two of the key changes concern TRICARE plan options and new enrollment requirements.
As a result of action by Congress, beginning this past January, TRICARE’s Extra and Standard plans were rolled into one system known as TRICARE Select, which is a fee-for-service, self-managed care option similar to a preferred provider organization (PPO). TRICARE Prime, which is TRICARE’s HMO-like plan, remains the same except for some changes to the contract regions. The old the three-region system has been replaced with two regions — TRICARE East and West. The US Family Health Plan, also a TRICARE Prime program, continues and remains the same. Under TRICARE Prime, beneficiaries are assigned a primary care manager who coordinates their care using network providers.
TRICARE Prime is available in certain geographic regions of the country. The program is available to active duty service members and their families, retired service members and their families, members of the National Guard and Reserve who have been activated plus their families, retired members of the National Guard and Reserve and their family members, recipients of the Medal of Honor and family members of recipients, and certain survivors and ex-spouses (if they qualify).
The recent changes to TRICARE Prime and TRICARE Select have been accompanied by a change in the way beneficiaries enroll in these programs. TRICARE has shifted to a calendar-based open enrollment period each year, similar to that which exists for many private sector health plans. The open enrollment season is an annual period when you can enroll in a TRICARE health plan for the next year. With TRICARE, the annual open season will occur each fall, beginning on the Monday of the second full week in November to the Monday of the second full week in December. For 2018, the open enrollment period begins November 12 and ends December 10.
During the open enrollment season, you can:
- Enroll in a new TRICARE Prime or TRICARE Select plan
- Change your enrollment (e.g., switch from individual to family enrollment)
- Enroll in a FEDVIP vision or dental plan (for certain categories of beneficiaries)
If you are already enrolled in a TRICARE plan, you do not need to do anything to remain in your current plan other than pay the annual fee during or after the open enrollment period.
Beginning in 2019, all Tricare users will be blocked from switching between plans at will. Instead, they will have to wait for a “qualifying life event,” such as the birth of a baby or a PCS move, or change during an annual open enrollment period each Fall.
Starting in 2018, TRICARE has switched to a calendar year system for the payment of annual enrollment fees. For retiree sponsors entering the service before January 1, 2018, the annual enrollment fees are $289.08 for an individual and $578.16 for a family. The fee amounts will be adjusted annually in future years based on a cost-of-living calculation.
These enrollment fees apply to beneficiaries enrolled in TRICARE Prime, including the US Family Health Plan program, and TRICARE Prime Remote. Although TRICARE Prime does not have an annual deductible, the enrollment fee counts toward the annual $3,000 “catastrophic cap” — the most any retiree family will pay out of pocket per year. There is no yearly enrollment fee for active duty service members, active duty family members, and transitional survivors (surviving spouses during the first three years and surviving dependent children worldwide).
For questions concerning enrollment in the US Family Health Plan, visit the “Enroll Today” page on the US Family Health Plan website.