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Take Command: TRICARE Changes

Take Command: Changes Coming to TRICARE


On Jan. 1, 2018, historic reform will roll out in the Military Health System (MHS). The implementation of many of the 2017 National Defense Authorization Act (NDAA) provisions and a new era in TRICARE support contracts will improve health care delivery and enhance medical readiness. The NDAA is a federal law that specifies the Pentagon’s budget and major programs. Implementation of the 2017 NDAA (i.e., Section 701) will impact the TRICARE benefit for more than 9.4 million beneficiaries worldwide. As a result of the 2017 NDAA and TRICARE 2017 (T2017) move from three to two regions, beneficiaries will see many changes.

The changes will expand beneficiary choice, improve access to network providers, simplify beneficiary copayments, and enhance administrative efficiency. 

Below are answers to questions that TRICARE beneficiaries and other audiences may ask at events such as town hall meetings.

Q1:  Are there any new TRICARE health plans?
A:  TRICARE Select will replace TRICARE Standard and TRICARE Extra on January 1, 2018. TRICARE Select brings together the features of TRICARE Standard and TRICARE Extra in a single plan. Select enrollees may obtain care from any TRICARE authorized provider without a referral or authorization. Enrollees who obtain services from TRICARE network providers will pay lower cost sharing amounts for network care.

Please visit TRICARE.mil/changes for the latest information regarding the changes coming to TRICARE.

Q2: What are the TRICARE plans that will be available in January 2018?
A:  Following are the TRICARE plans that will be available.
  • TRICARE Prime. A health maintenance organization-style managed plan in which enrollees receive care from an established network of doctors and other health care providers. Care is coordinated through a primary care manager (PCM) who also provides referrals for specialty care.

  • TRICARE Select. A preferred provider plan in which enrollees can seek care from any authorized provider, but pay lower out-of-pocket costs when they receive care from the TRICARE network. This plan replaces TRICARE Standard and TRICARE Extra.

  • Premium-based plans. Health care coverage is available for purchase by certain populations who, by law, are no longer eligible for TRICARE Prime or Select due to age or inactive military status, or who are no longer eligible for military health care.
     
    • Continued Health Care Benefits Program (CHCBP). This plan offers health coverage for 18 to 36 months (or longer for qualified former spouses) after TRICARE eligibility or premium-based plan coverage ends.  CHCBP offers TRICARE Select benefits.

    • TRICARE For Life (TFL). TFL provides wrap-around medical coverage to beneficiaries eligible for Medicare and TRICARE who generally must pay for Medicare Part B.

    • TRICARE Retired Reserve (TRR). Retired Reserve members may purchase TRR for themselves and eligible family members. TRR offers TRICARE Select benefits.

    • TRICARE Reserve Select (TRS). Qualified Selected Reserve members may purchase TRS for themselves and eligible family members. TRS offers TRICARE Select benefits.

    • TRICARE Young Adult (TYA). TYA extends TRICARE to certain former dependent children under the age of 26 who lose TRICARE eligibility due to age (typically at age 21, but up to age 23). TYA offers TRICARE Prime or TRICARE Select benefits.

Please visit TRICARE.mil/changes for the latest information regarding the changes coming to TRICARE.

Q3:  Do I need to do anything to be sure I still have TRICARE coverage on January 1, 2018?

A:  All current TRICARE beneficiaries will be automatically enrolled in their respective plan on January 1, 2018. TRICARE Prime enrollees will remain in TRICARE Prime. TRICARE Standard and Extra beneficiaries will be enrolled in TRICARE Select. No action is required by beneficiaries.

Beginning January 1, 2018, eligible beneficiaries who are not already enrolled in a TRICARE health plan must enroll in a plan to be covered for civilian care. Lack of enrollment means beneficiaries can only receive care at a military clinic or hospital on a space available basis. Failure to enroll or maintain enrollment results in the termination of civilian purchased health care benefits.

Make sure your information is current in DEERS and sign up for updates so we can send you more information as it becomes available. www.tricare.mil/DEERS

Please visit TRICARE.mil/changes for the latest information regarding the changes coming to TRICARE.
 
Q4:  What do I need to do if I want to change from one TRICARE health plan to another?

A:  Beneficiaries wishing to change their TRICARE plan must proactively change their enrollment during enrollment eligibility periods.

Q5:  What are the enrollment eligibility periods?

A:  Beneficiaries wishing to change their plans may do so during an open enrollment season (November 12 - December 10, 2018) or in the 90 calendar days following a qualifying life event (QLE). 

Q6:  When is the open enrollment season?

A:  For all beneficiaries eligible to enroll in TRICARE Prime or TRICARE Select, the annual open enrollment season runs from Monday of the second full week in November to Monday of the second full week in December.

In 2018, this timeframe is November 12 - December 10, 2018.

During this period, eligible beneficiaries can enroll in or change their TRICARE Prime or TRICARE Select coverage, or choose to do nothing and remain enrolled in their current TRICARE Prime or Select coverage for the next calendar year. 

Prior to each annual open enrollment season, the Defense Health Agency (DHA) will share known changes coming to the plans for the next calendar year and dates these changes will take effect.

(Note: Beneficiaries may enroll or disenroll in TRICARE health plans at will during an enrollment grace period between January 1, 2018, and December 31, 2018). 

Q7:  What is a Qualifying Life Event?

A:  Qualifying life events (QLE) are defined events that trigger a 90-day window for eligible beneficiaries to enroll in or change TRICARE purchased care coverage for the rest of the calendar year. They can enroll in a plan if they weren’t enrolled before the QLE or transfer their enrollment to a different plan. If one member of the family has a QLE, other members of the family can also elect to enroll or change their current enrolled TRICARE coverage during the 90-day window. 

Most QLEs require an update in the Defense Enrollment Eligibility Reporting System (DEERS). The 90-day window begins from the date of the QLE.

QLEs are likely to include the following:

  • Marriage, divorce, or annulment
  • Birth or adoption of a child
  • Placement of a child by a court in a member’s home
  • Change in sponsor status (e.g., active duty to retiree)
  • Loss of eligibility (e.g., due to age, Medicare, etc.)
  • Move to a new ZIP code
  • Loss/gain of other health insurance 
  • Death of a sponsor, spouse, or child
  • Change in eligibility status (e.g., a dependent child marries an active duty service member)
The effective coverage date for TRICARE coverage initiated as a result of a QLE is always the date of the QLE. 

Please visit TRICARE.mil/changes for the latest information regarding the changes coming to TRICARE.



Q8: Are there any changes to cost and billing?

A:     Yes. The TRICARE benefit will change from a Fiscal Year (October - September) period to a Calendar Year (January - December) period to align with the annual enrollment period.

There will be a transition period from October 1, 2017, to December 31, 2017, to protect beneficiaries from incurring additional costs. During this time enrollment fees will be pro-rated for the three-month period and billed accordingly for enrollees who pay on a monthly or quarterly basis. Individuals who pay enrollment fees on an annual basis will have their payments credited appropriately. 

Payments that would normally count toward catastrophic caps and deductibles until October 1, 2017, will continue to count until January 1, 2018. This means that enrollees who reach their fiscal year 2017 catastrophic caps will not have additional out-of-pocket costs for authorized TRICARE covered services for the last three months of calendar year 2017. On January 1, 2018, new rules for deductibles and catastrophic caps will apply to some costs. (See Appendix A.)

Also, starting January 1, 2018, enrollees will fall into one of two categories based on when their sponsor first joined the military. These categories were established in law, and are not affected by other actions taken by the beneficiary (i.e., switching plans or failure to pay).
 
  • Enrollees whose military sponsor’s initial enlistment or appointment occurs before January 1, 2018 (i.e., all current eligible beneficiaries,) are in Group A, also known as “grandfathered.”

  • Enrollees whose military sponsor’s initial enlistment or appointment occurs on or after January 1, 2018, are in Group B, also known as “non-grandfathered.”
Group A and Group B enrollees will have distinct enrollment fees and out-of-pocket cost in accordance with current law. (See Appendix A.)

Please visit TRICARE.mil/changes for the latest information regarding the changes coming to TRICARE.

Q9:  What else do I need to do to prepare for the upcoming changes to TRICARE?

A:  Take command of your health! This is your benefit. There are steps you can take to ensure that you and your family have all the information you need to make decisions about your TRICARE benefit and that you have the coverage you desire on January 1, 2018 and beyond. 

Make sure your information is current in DEERS and sign up for updates so we can send you more information as it becomes available.

[Refer to beneficiary checklist. Highlights are below.]
 
  • Do you have a username and password for DS Logon? If not get a DS Logon! Go to https://go.usa.gov/xRpAB
     
  • Is your information--address, email, and phone number—current in DEERS? Check to be sure! www.tricare.mil/DEERS

  • Have you signed up for TRICARE benefits updates? Sign up today so you don’t miss any important information! www.tricare.mil/About

  • Did you have a baby or adopt a child? Did you get married or divorced? Did you move, retire, activate, or have any other significant life event? Learn about what you need to do. www.tricare.mil/lifeevents

  • Not sure what plans are offered where you live? Use the plan finder to find out what you may be eligible for. www.tricare.mil/planfinder

  • Do you make monthly TRICARE payments electronically? Be on the lookout. Your regional contractor will contact you to update your payment information.

  • Do you or someone in your family have special needs? Check our web page for details about how to contact your new regional contractor. www.tricare.mil/casemanagement.

Please visit TRICARE.mil/changes for the latest information regarding the changes coming to TRICARE.