The military is known for its comprehensive healthcare for service members and their families. But did you know there are actually a few different plans to choose from? You may be hearing more about these options in the next few weeks—this marks the much-anticipated open enrollment period where beneficiaries can change their plan to different coverage.
The open enrollment period runs from November 12 to December 10, with changes going into effect on January 1 of next year. A similar enrollment period is also running for vision and dental plans.
TRICARE Prime
TRICARE Prime is the basic, no-cost plan that many military families use to receive good healthcare coverage at a great price—free! With this plan, members and their families are assigned a primary care manager at a military treatment facility in their area. Should they need specialized care, they can get referrals through the primary care manager (PCM).
TRICARE Select
Those who choose TRICARE Select have the added benefit of choosing a civilian care provider and seeing specialists with no referrals. They pay a small co-pay for care. Many opt for this plan when they want more control over who they see. It’s also beneficial for those who have complex medical issues.
Why Change?
For those satisfied with their coverage and plan, no action is needed. But those who want to change plans need to make the switch before December 10.
Under the new TRICARE guidance, beneficiaries are locked into a plan once they make their choice. They are only able to change between TRICARE Prime and TRICARE Select during a “qualifying life event.” These events include permanent change of station (PCS) moves, marriage or divorce, and the birth or adoption of a child. Military families move frequently, so the most common event triggering a change of plan is a relocation.
The annual open enrollment period provides another opportunity for beneficiaries to change their plan. Each person and family can evaluate what type of plan works for their overall health goals and budget.
Industry Standard
Prior to the TRICARE overhaul in 2018, beneficiaries were able to freely switch back and forth between Prime and Standard (now called Select). The only restriction was a 12-month requirement to be on Standard before switching back to Prime. This was only relevant if the member opted into TRICARE Standard.
With the changes in 2018, many military members and their families became concerned about the limitations placed on changing plans. If a beneficiary is unhappy with the care that they received or has to wait for long periods of time for referrals, they are unable to opt into a different plan. Also, pregnancy was not considered a qualifying life event. Those who wanted to choose their obstetrician were unable to do so if they were on the Prime plan.
The new system of designated open enrollment periods, with the option to change during qualifying life events, is more in line with what other healthcare models follow.
Patrick Grady, Chief of the TRICARE Health Plan, said the new system “syncs us with the way industry has done this. We’re adopting the practice most folks experience in the commercial sector.”
This year’s open enrollment period is the first of its kind in the TRICARE health system. Military members and their families are being advised to look closely at the healthcare coverage they currently receive. If it’s not the coverage they need, they have until December 10 to make any desired changes.
“If you want to make a change in your health care coverage, take command of your health and participate in open season,” says the TRICARE website.
