With the benefit set to undergo some of the biggest improvements in more than two decades, beneficiaries will be able to take command of their health care through expanded choices. These improvements include wider access to network providers, updated enrollment to reduce disruptions in care and simplified co-payments.
The Defense Health Agency recently met a key requirement for implementing these changes, with the publication of a formal document — called an Interim Final Rule — that establishes the legal “rules of the road” for putting in place changes mandated by Congress. The Interim Final Rule is now available for public review and comment.
“We are working hard to use the opportunity Congress gave us to continue building a health plan that does even better for our beneficiaries, the warfighter, and the taxpayers who support us,” said Vice Adm. Raquel Bono, Defense Health Agency director.
The goal of this change is to keep beneficiaries healthy by providing better health care options. This includes allowing doctors to make the decisions on whether beneficiaries need a referral or specialty care instead of the regional contractors. Urgent care will be available without a referral through either the military hospital or clinic or at a civilian urgent care center in areas the military health facility is not an option.
TRICARE is changing. Here is what beneficiaries need to know: Some of the key changes that will become effective on Jan. 1, 2018, will affect region consolidation, TRICARE plans, enrollment and costs. There are currently three TRICARE regions in the United States, including TRICARE North, South, and West. Starting in 2018, these regions will become TRICARE East and West. They will be administered by Humana Military and Health Net Federal Services. This change will allow for better coordination between the military hospitals and clinics and the civilian health care providers in each region.
Several changes will also occur in coverage plans at the start of the new year. TRICARE Select will replace TRICARE Standard and TRICARE Extra. In the U.S., TRICARE Select will be a self-managed, preferred provider network option. Beneficiaries will not be required to have a primary care manager and can visit any TRICARE-authorized provider for covered services without a referral. Overseas, TRICARE Overseas Select will provide access to both network and non-network TRICARE authorized providers for medically necessary covered services. TRICARE Select, both stateside and overseas, includes additional preventive care services previously only offered to TRICARE Prime beneficiaries. Beneficiaries can review all available plans at www.tricare.mil/changes under the plan finder.
Starting Jan. 1, 2018, all current beneficiaries will also be automatically transitioned into their respective plan as long as they are eligible. TRICARE Prime enrollees will remain in this plan. TRICARE Standard and Extra beneficiaries will be converted to TRICARE Select. Beneficiaries will be able to choose to enroll in or change coverage plans throughout the year-long grace period in 2018.
Beginning in fall 2018, enrollment will move to a calendar year open enrollment season like federal employee plans. During this time, active enrollment will be required to change plans for the following year. Those who are retiring will have to choose their plan and enroll to retain coverage. The open enrollment season begins on the Monday of the second full week in November and run through the Monday of the second full week in December of each calendar year starting in 2018. All beneficiaries should make sure their information is current in DEERS now so they are converted to the correct plan in January. Learn more about enrollment changes.
Beneficiaries will shift to a copayment structure from the current cost-share structure also starting Jan. 1, 2018. With fixed costs for specific services, beneficiaries will be able to better predict their health care costs. Updated out-of-pocket costs for 2018 will be available at www.tricare.mil/changes.
While the upcoming changes are significant, the goal of the Military Health System is to continuously improve health care for all its beneficiaries. Beneficiaries can prepare for the upcoming changes by visiting the TRICARE Changes page, where they can sign up for email alerts, complete a beneficiary checklist, and see available plans and updated costs for 2018.
“This marks a major milestone in our effort,” said Bono. “It highlights the opportunity for our beneficiaries to take command of their health plan, and our responsibility to ensure that these historic changes to TRICARE are a success for beneficiaries and the department.”