As it’s the middle of open season, those eligible have until Dec. 12 to enroll or make changes to their plans under TRICARE – the Defense Department’s healthcare system – for 2024.
The two main plans eligible for enrollment are TRICARE Prime, which includes the U.S. Family Health Plan, and TRICARE Select. TRICARE Open Season does not apply to its premium plans – TRICARE Young Adult, TRICARE Reserve Select and TRICARE Retired Reserve. TRICARE Open Season also does not apply to those who are eligible for Medicare or those using TRICARE For Life. It also does not apply to active duty service members. These groups do not have to do anything during Open Season.
“Open Season is an opportunity for you to evaluate the health care coverage that your family has and to see if you need to change plans or if you want to stay in the current plan that you’re in,” Zelle Zim, who’s on TRICARE’s policy and programs team, said at a TRICARE event on Wednesday. “You also have the opportunity to enroll in a new plan during TRICARE Open Season.”
For TRICARE Prime, it focuses on using military hospitals and clinics. There will be a primary care manager, who will give referrals and authorizations for other care. Participants must live within a Prime Service Area, which is generally a 40-mile radius from a military hospital or clinic.
Meanwhile, with TRICARE Select, participants can choose their own providers and there is no primary care manager. Participants will get the most affordable care if they stick within the TRICARE authorized network.
There is an enrollment fee for some TRICARE beneficiaries, depending on which group they are in.
Specifically, for TRICARE Prime, there is no fee for active duty service members, active duty family members and transitional survivors. However, TRICARE Prime retirees and their family members have an annual enrollment fee. Those in Group A – members whose sponsor’s initial enlistment or appointment was before Jan. 1, 2018 – the fee is $363 per individual or $726 per family. For Group B – whose sponsor’s initial enlistment or appointment was on or after Jan. 1, 2018 – the cost is $438.96 for an individual or $879 for a family. Generally, in comparison to 2023, some prices have stayed the same, while others have slightly increased.
Meanwhile, for retirees in TRICARE Select, the annual cost for Group A is $177.96 for an individual or $355.92 for a family. For Group B this is $564.96 for an individual or $1,131 for a family.
Both of these plans – TRICARE Prime or Select – have out-of-pocket costs for some participants. TRICARE Prime has no annual deductible. For this plan, active duty service members and their families have no out-of-pocket costs for covered services from a network provider or with a referral or pre-authorization. However, retirees, their family members and all others have co-payments or cost-shares for covered health services from network providers. Under TRICARE Select, after the deductible is met, participants have fixed co-pays for in-network care and cost-shares for out-of-network care.
Family information should be put in the Defense Enrollment Eligibility Reporting System (DEERS) to ensure proper eligibility.
“One thing that’s very important when we talk about our TRICARE eligibility is your sponsor’s status and that sponsor status and your relationship to that sponsor is captured in DEERS,” Zim said. “DEERS is where all of that family information is captured and it’s maintained by your personnel records office. All the information that is in DEERS is what feeds our eligibility information for TRICARE. So, it’s important that you have that information up to date in DEERS. If you have changes in your family, you always want to make sure that’s in DEERS. That way, we can make sure that everyone in your family is eligible for the correct plans.”
Additionally, participants can mix and match plans amongst their family members.
Participants may also be eligible for Federal Benefits Open Season for dental and vision coverage. That Open Season runs through Dec. 11 and coverage would begin on Jan. 1. However, for most of these dental and vision plans, someone would also need to be enrolled in a TRICARE plan.
Kirsten Errick covers the Defense Department for Federal News Network. She previously reported on federal technology for Nextgov on topics ranging from space to the federal tech workforce. She has a Master’s in Journalism from Georgetown University and a B.A. in Communication from Villanova University.