Issue: The Military Health System (MHS), which includes the TRICARE program, is undergoing unprecedented change. While these changes do not affect all categories of beneficiaries, all beneficiaries should be aware of these changes.
Background: The National Defense Authorization Act of 2017 directed major changes in the military’s health care system to modernize the benefit and improve access and care delivery. These include changes to the TRICARE benefit and the way providers access beneficiaries’ health information through a new electronic health record (EHR) called Genesis.
TRICARE Select to replace TRICARE Standard and Extra.
On January 1, 2018 TRICARE Select will replace TRICARE Standard and Extra and act as a preferred provider organization (PPO) style plan. PPO’s are designed to offer beneficiaries the freedom to choose their own providers but there will be an established network, which will offer lower co-payments than providers outside of the network. Beneficiaries who are currently utilizing TRICARE Standard or Extra will be automatically enrolled in TRICARE Select. The deductibles and cost shares will not change.
Beneficiaries who do not want to be in Select may opt out during an “open enrollment” period during the November/December time frame of 2017. DoD has yet to finalize the dates.
The DoD will automatically enroll active duty family members in TRICARE Prime if they live near an active duty military installation or TRICARE Select if they do not.
Requests to change TRICARE Prime or Select coverage can be made during the annual open enrollment period in November/December 2017. Additionally, beneficiaries may do it at other times if they experience a qualifying life event (QLE) such as a marriage, divorce, birth, adoption, re-location etc. An enrollment change must occur within 90 days of the QLE.
TRICARE enrollment fees, deductibles and catastrophic caps will be calculated on a calendar year basis (instead of the current fiscal year basis) and based on the sponsor’s original enlistment or appointment date before or after January 1, 2018.
TRICARE Prime changes.
TRICARE Prime plan and benefits is not changing. If a new entrant enlists or is appointed as an officer on or after January 1, 2018, the TRICARE benefits will not change but there will be different cost shares and copayment amounts. New family members using Prime will see changes in cost shares also.
TRICARE Retired Reserve, TRICARE Reserve Select and TRICARE Young Adult changes.
Enrollment in these premium based plans will essentially remain unchanged. TRICARE will mail letters informing these beneficiaries of changes in their cost shares.
TRICARE for Life (TFL).
There are no changes in the TRICARE for Life benefit in 2018.