Did you know that Tricare is changing? Just when you thought you had a grasp on how Tricare works, it’s going to change.
Here are the things you need to know about the changes that are coming, when they will begin, how they will impact your military family and what actions you need to take.
Upcoming Changes Are Coming to Tricare
Regions stateside will be consolidated from the current North, South and West to simply Tricare East and Tricare West as North and South merge. There are 2 contractors that will cover Tricare East, Humana Military and Health Net Federal Services.
While Tricare Prime will not change, Tricare Standard and Tricare Extra will combine into one program, Tricare Select. This will happen on Jan. 1, 2018.
Tricare Select will be a self-managed program with a preferred provider network option available. You will not need to have a primary care manager (PCM). This will allow beneficiaries to go to any Tricare provider without a referral.
While change is usually unsettling, some things will improve. Access for beneficiaries to network providers under Tricare Select will be expanded to include more non-cost preventive services from network providers. The treatment for obesity, high-value care and telehealth will be expanded under Tricare Select.
Automatic enrollment for current Tricare beneficiaries will take place on Jan. 1, 2018. This means Tricare Standard and Tricare Extra beneficiaries will switch to Tricare Select instantly.
Throughout 2018, beneficiaries will be able to enroll in or change plans. In the fall however, Tricare will begin an annual open enrollment time.
At this point, beneficiaries will have to decide if they want to keep or change their Tricare plan for the next year. The open enrollment time will begin each year from now on the Monday of the second full week in November until the Monday of the second full week in December.
Under the previous Tricare rules, a beneficiary could change from Tricare Prime to Standard and vice versa at any time. Under the new Tricare policy, beneficiaries will not be able to. All changes must occur during open enrollment only.
The rules for qualifying life events (QLE) will also change. When a QLE occurs, the beneficiary has 90 days after the event to change the Tricare program they are enrolled to different one. Any member of that person’s family can also change their coverage during that time.
2018 will be a transition year meaning you can still change your Tricare program anytime however.
Prime beneficiaries will be able to get appointments quicker by not needing a referral for some things. Going to Urgent Care without a referral by the primary physician will be included in this.
Select beneficiaries will see a change to finances. Currently there is a cost share that requires the beneficiary to pay a percent of the total care. Under the new Tricare program, Tricare Select will pay a fixed dollar amount.
Tricare for Life beneficiaries will see their benefits preserved but the authority is there to restructure and updated them.
How will these Tricare changes impact military families?
As Tricare changes from a fiscal year to a calendar year period, military families might see a shift in money. If catastrophic caps or deductibles have been reached, now that the timeline has shifted, there will be no increase in out-of-pocket expenses during that time.
Tricare beneficiaries will be divided into 2 groups. All sponsors that joined the military prior to Jan. 1, 2018 will be in group A, which will be grandfathered in. Those who join the military on that date or later will be put into group B, known as the non-grandfathered group. There will be distinct enrollment fees as well as out-of-pocket costs associated with each group.
What actions should you take?
Beneficiaries must enroll in one of these programs or coverage will be terminated. If this happens, they will only be able to get care at a military clinic on a space available basis.
If you are currently enrolled in Tricare, you don’t need to do anything if you want to stay in the same plan.
If you want to change plans, you should do so. Before Jan. 1, 2018, dependents should make sure they are registered in DEERS. Updating your information in DEERS is a good idea.
“This sounds like a good idea,” wrote Edward J. Hermann. “Under certain circumstances I could certainly see using such a facility like a sick call operation.”
Currently, many service members, veterans, retirees and their families are experiencing long wait times to be seen at a military treatment facility. Sometimes they are visiting the local ER for more serious concerns or when they need a same-day diagnosis and treatment plan. This ties up ER personnel.
“It could cut down the use of the ER, especially on weekends, for those runny noses, colds, sinus, aches, etc., that many times plague the waiting rooms,” Bauman further commented. “The ER personnel could concentrate on true emergencies.”
Others commented on the expanded training capabilities and broadening of experiences for medical personnel.
“As a former Army medical member the idea of a clinic in the commissary sounds great,” Joseph Moorhouse wrote. “The medical personal would receive experience in a broad area of patients and an outpatient clinic in the store would be very convenient.”
Readers Question Food Safety
While many on the positive side cited increased convenience and access to timely medical care, others questioned the wisdom of having these clinics where we buy our food.
“Honestly, I don’t think that would be an appropriate place to see sick people. Why in heaven’s name would one allow germs around the foods that we have to eat?” wrote Dee. “I can’t see anything good coming of that idea.”
Many others echoed her thoughts. Some voiced support for the clinics as a place for vaccines.
“As a place to get a shot, I would have no problem with that,” commented Ken Myrick. “I really do not want to have to be around people who have infectious diseases around my food sources.”
Duane Schneider would completely avoid the commissary if walk-in medical care was added there.
“I would not go to the commissary for medical,” he wrote. “In fact, I would quit going to the commissary because it is crowded enough now without the traffic (of) sick people.”
Alternative Suggestions and More Questions
Some readers offered solutions to the concern about food safety. Several readers suggested opening a storefront in the commissary or exchange complex.
“I do think that the exchange venue would be a better alternative,” wrote Janet J. Bamford. “If the idea really ‘took off,’ it would be another step in the right direction. They are found within the military communities, and usually have longer operating hours. Furthermore, it could be an easier program to implement, if you began with a few shoppettes around the country. It’s unlikely that the corpsmen would be deluged with patients, especially if more than one shoppette in the community is staffed.”
Readers also raised concerns about who would be allowed to access these clinics.
“That sounds like a nice idea,” commented Catherine B. “Would they also treat veterans with commissary and exchange privileges?”
This pilot program is still in the planning stages and the Jacksonville, Fl., test clinic has not yet been opened.
It’s not too late to express your opinion on the Navy’s medical clinic pilot program! Share your thoughts in the comment section.