Many people often ask – when is Tricare enrollment? Normally, service members and their families can choose the Tricare insurance program that best suits their military’s health care program’s needs between November 9 and December 14. Those enrolled in a Tricare plan and happy with their benefits are not required to do anything. Anyone who does not actively switch will remain in the same plan for 2021.
Service members with Tricare Select health insurance and are enlisted in the military before 2018 must start remitting an annual enrollment fee to remain insured the next year. Moreover, members must make their payment before Tricare’s open enrollment period ends December 14.
Those who might want to make changes on their plan can explore the differences between the two basic plans introduced in 2018. Tricare Prime and Tricare Select divide beneficiaries into two groups.
These are Group A – if your enlistment started before 2018 and Group B if your enlistment started on or after January 1, 2018. The provided questionnaire can help you understand better the options you have and decide on the plan that is better for you. Whichever group you belong to, service members should first review their information in the Defense Enrollment Eligibility Reporting System (DEERS). DEERS is the eligibility source that ensures that all information is correct, including the beneficiaries’ addresses and details.
The HMO option
Tricare Prime is a managed care option and is often referred to as a health maintenance organization (HMO). It has a primary care manager responsible for an individual’s medical care. Although this plan is mandatory for active service members, their families can choose either the Prime or Select option.
Members of Prime can be attended by any Tricare-authorized provider who will charge a copayment based on its service. The care manager can make referrals when necessary and assist in getting the proper authorization.
Tricare Prime is available in two regions including Humana Military manages the East Region, and Health Net Federal Services manages the West Region. Copays for in-network providers are between from $20 for a primary care visit to $30 for a specialist.
A point-of-service option lets family members visit a specialist without a referral for an additional cost. Tricare Prime may have less out-of-pocket costs but provider choices are limited.
The PPO Option
Tricare Select, a preferred provider organization (PPO), is available everywhere throughout the United States and offers more flexibility for family members. Beneficiaries can be attended by a provider of their choice, both for primary and specialist care.
Notably, Copays range between $26 and $45. That depends on whether the service member is in Group A or Group B and whether the provider is in or out of network. It is worth noting that maximum out-of-pocket expenses are similar for both plans – about $1,000 for active-duty family members in Group A and about $1,044 for Group B. For all the others, the cap starts at $3,500 for Group A and Group B.
Once the open enrollment period ends, those who have enrolled in Tricare can switch their plans only if they have what’s called a “qualifying life event” (QLE) like having a baby, getting married or moving. In cases like these, you will have 90 days from the date of the event to make a change.
Feel free to visit the Tricare website for more information on enrollment fees for these plans and further details. Enrollment can be completed online, by mailing the enrollment form to the regional coordinator or by telephone to the regional coordinator.
Dental and Vision Plans
Notably, retired service members do not qualify for dental insurance via the Tricare Retiree Dental Program.
During open enrollment season, these retired service members must enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP) for dental insurance. If they have a Tricare plan, retirees also can choose for vision insurance.
Family members of active duty men and women will still receive dental care through the Tricare dental plan and also will be eligible for FEDVIP vision coverage. Typically, FEDVIP gives a choice between 10 dental carriers and four vision carriers. For more information, contact health insurance today!