TRICARE Is Changing. Here’s How It Affects You

By Katie Lange
Defense Media Activity

Graphic: TRICARE logoHopefully you’ve heard by now that the Military Health System is rolling out TRICARE benefit reforms in January to improve health care delivery and enhance medical readiness.

More than 9.4 million beneficiaries worldwide will be affected by the changes that take effect Jan. 1. To take command of your health, here’s what you need to know and do to make sure you’re covered.

First Thing’s First:

What plans are changing?

TRICARE Select will replace TRICARE Standard and TRICARE Extra on Jan. 1.

Otherwise, all other TRICARE plans (TRICARE Prime or premium-based plans) will be rolled over, unless you change your coverage.

Do I have to do anything to make sure I get coverage in 2018?

If you’re currently enrolled for TRICARE coverage, you should transition to your respective plan, no problem.

If you want to enroll in a plan or change your coverage after Jan. 1, you will need to take action now to get into the plan of your choice.

I’m a new active-duty service member. How does this work for me?

You’re automatically enrolled in TRICARE Prime. If you live in remote areas of the U.S., you’ll be enrolled in TRICARE Prime Remote.

Your eligible family members:
If they live stateside, they’ll automatically be enrolled in TRICARE Prime if they live in a Prime Service Area. If they live outside of a PSA, they’ll be enrolled in TRICARE Select. Family members have up to 90 days to change their plans if they want to.
If your family is in the TRICARE Overseas Program, they’ll be enrolled in TRICARE Select. They also have 90 days to change their plans, if they’re command sponsored.

There’s currently an enrollment freeze:

Under TRICARE now, there are three regions: north, south and west. Those are being consolidated into two. The west will remain mostly as-is and will be managed by Health Net Federal Services LLC, while the north and south regions will become the east and will be managed by Humana Military.

What this means for you:

The enrollment process will be put on hold for a few weeks so beneficiary files can be transferred to those regional contractors. This enrollment freeze starts Dec. 1 and will last until the data transfer is complete.

Will I still have access to care during the freeze?

Yes. If your enrollment is pending during the freeze, be sure to save all pharmacy and health care receipts just in case you need to submit them to get reimbursed for any TRICARE-covered expenses once your enrollment gets processed.
If you have a problem accessing care while your enrollment is pending, contact your regional contractor. If you have a problem getting your medications during that time, contact Express Scripts.

What if I haven’t enrolled yet?

As of Nov. 20, the Beneficiary Web Enrollment website is unavailable through the duration of the enrollment freeze, so online applications are no longer an option; however, you can still enroll by phone and by mail through your regional contractor. BWE will be available again around Jan. 1.

For detailed instructions on how to submit your enrollment applications while BWE is down, visit TRICARE.mil/changes/enroll. In the right column toward the bottom under “Related Downloads,” click on “Take Command Enrollment Freeze.”
Your application will be processed once the enrollment freeze is complete.

Enrollment fees are changing, too:

The costs for TRICARE benefits will shift from a fiscal year period to a calendar year in 2018, making it more consistent with civilian health plans. This will affect you if you’re in a plan that has an enrollment fee that’s billed by the fiscal year, including retirees and their family members in TRICARE Prime, Retired Reserve, Reserve Select, Young Adults and the US Family Health plans.

What this means for you:

The fees have begun the transition from Oct. 1 to Dec. 31, but there won’t be additional costs this year, even if you reach your catastrophic cap or deductible before Dec. 31. However, new deductible and catastrophic caps rules will apply to some costs in 2018.

If you make automatic payments: You’ll continue to pay your fees automatically past Jan. 1, unless you cancel your allotment.
If you use debit, credit or e-checks: If you’re in an area where your regional contractor has changed, you’ll need to update your payment method with them in December.

Read more about the new cost changes here

How to have a smooth transition:

Prepare for the changes:

Any other changes I should know about?

Explanation of Benefits will now be paperless. You will only be able to access them online unless you specifically request to get them by snail mail.

As we get closer to the New Year, more details about the changes will be released. So keep checking DoDLive.mil and DoD’s Facebook and Twitter pages to stay informed!

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TRICARE Is Changing. Here’s How It Affects You