A doctor listens to a newborn’s heartbeat with a stethoscope. Updates to the Tricare system are bringing enrollment changes. Getty Images
A series of sweeping Tricare changes could have a big impact on some of the military health care system’s users — including an extra three months of deductible-free coverage.
Are you one of them? Here’s what you need to know.
2017 has been a big year for Tricare. Congress passed a law in 2016 ordering the system to make changes to how it operates, including combining two of its programs, changing timing rules for those who want to switch plans or register a new child with the system, and temporarily adding a bonus three months without deductibles.
Meanwhile, a regular contract process has brought a shake-up to the system’s regional contractors. It scrapped the three-region system, instead dividing all stateside users between Tricare East and West, and forcing those who pay premiums to update their payment information or risk coverage loss while causing an enrollment blackout.
Tricare for Life users are the only group not affected by any of the changes.
Coverage Freebies for Some Users
Currently, Tricare operates on the October to September fiscal year for most coverages. But that changes in 2018.
Starting Jan. 1, Tricare will instead operate on a calendar year. That means annual enrollment fees for some users, such as retirees, will be due Jan. 1 instead of Oct. 1, and all catastrophic caps and annual deductibles will reset on Jan. 1 instead of Oct. 1.
That means those on Standard and Tricare Reserve and some retirees who have hit their annual deductibles or catastrophic caps will get three extra months of coverage this year before their next cap reset.
However, those freebie months do not extend to those who pay enrollment fees. Tricare instead will prorate the annual fee you would normally pay Oct. 1, and let you know how much you owe for the remainder of the 2017 calendar year.
Rather than dividing the U.S. into three regions covered by three contractors, Tricare will be split into two regions starting Jan. 1, 2018: Tricare East and West.
Tricare East will be managed by Humana Military. Tricare West will be managed by Health Net Federal Services.
The new East region will include the District of Columbia; Alabama; Arkansas; Connecticut; Delaware; Florida; Georgia; Illinois; Indiana; the Rock Island Arsenal area of Iowa; Kentucky; Louisiana; Maine; Maryland; Massachusetts; Michigan; Mississippi; the St. Louis, Missouri, area; New Hampshire; New Jersey; New York; North Carolina; Ohio; Oklahoma; Pennsylvania; Rhode Island; South Carolina; Tennessee; most of Texas; Vermont; Virginia; West Virginia and Wisconsin.
The new West region will include Alaska; Arizona; California; Colorado; Hawaii; Idaho; all of Iowa except the Rock Island Arsenal area; Kansas; Minnesota; all of Missouri except the St. Louis area; Montana; Nebraska; Nevada; New Mexico; North Dakota; Oregon; South Dakota; west Texas; Utah; Washington and Wyoming.
Enrollment and Plan Change Blackout
Were you planning to switch Tricare plans or enroll in the program during December or late November? Better think again.
To get ready for the contractor change, Tricare officials are putting in place an enrollment blackout starting Nov. 21 and running through the end of the year.
That means you need to finish any new enrollment or enrollment changes — including primary care provider updates — before Nov. 21.
If you are a National Guard or Reserve member who wants Tricare coverage starting in January 2018 but you do not become eligible to enroll in Tricare Reserve Select until December, you cannot enroll early, Tricare officials said.
They said they are in the process of developing a solution for that group.
Update Your Payment Information
If you pay an annual or monthly fee to use Tricare, you will likely need to change where that goes, thanks to the contractor change.
Tricare officials said the regional contractors will contact you to update payment information.
New Names for Plans
Tricare Standard and Extra have been combined into one newly named plan, Tricare Select.
The coverage available is the same — the only thing that has changed for users is the title.
The title change, however, is likely to cause chaos in some patient-doctor office interactions as office staff learn of the roll-over and all users get used to the new terminology.
Blocked from Flipping Plans
Many Tricare users like the freedom of switching between Tricare Prime and Standard based on their current life situations.
That flexibility, however, is going away with the new Tricare Select system.
Instead, users will be able to switch only during annual open enrollment or when they have a “qualifying life event.”
Tricare officials have yet to release a decision on what they consider a “qualifying life event.”
Watch for Auto-Enrollment
If you are stationed far away from a military treatment facility — what Tricare calls “outside a Prime treatment area” — and currently use Tricare Standard or Extra, you’ll be automatically moved to Tricare Select.
If you want to instead use Tricare Prime Remote, you have until the end of March, 90 days after the switch, to make that decision. Otherwise, you’ll have to wait for the annual open enrollment or until you have a “qualifying life event.”
Changes to Child Enrollment
After you have a new baby or adopt a child, you need to add him or her to the Defense Enrollment Eligibility Reporting System (DEERS).
In the past, you had 60 days of Tricare Prime or Prime Remote coverage for the child without enrolling before they were automatically placed in Standard. Overseas users had 120 days.
Tricare Reserve Select and Retired Reserve users had to enroll the child before he or she was covered outside the hospital. After those dates, the child was automatically put in Standard until the one-year mark, after which he or she was not covered without enrollment.
The new system, however, brings two enrollment changes for children.
First, all active-duty children newly enrolled in DEERS will be automatically put on Tricare Prime if they live near a military treatment facility or Tricare Select if they are overseas or outside the “Prime service area.”
If parents want a different plan, they must call Tricare within 90 days of birth or adoption, or wait until the next annual open enrollment period or “qualifying life event” to change plans.
If parents fail to enroll their child in DEERS before the 90-day mark, the child will be able to be seen only at on-base clinics on a space-available basis until the next open enrollment period or “qualifying life event.”
That means if you are stationed outside the Prime coverage area and do not enroll your child, you could be saddled with all of his or her medical bills until enrollment becomes available again.
— Amy Bushatz can be reached at [email protected].
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