As Tricare’s opening season approaches, it’s time to start thinking about the need for change.
The open season starts on November 14 and ends on December 13.
During this time, you can enroll in a health plan, switch health plans, or switch between individual and family enrollment. You can also stay in whatever plan you have, of course.
You are not required to make changes, but if you wish, the opening season is the only time you can do so, unless you have a qualifying life event such as a move, wedding , the birth of a child or retirement from active duty. If you have a qualifying life event, you have 90 days to make qualifying enrollment changes.
If you are not already in a plan and do not enroll during the opening season, you will only be eligible for care at a military hospital or clinic – if space is available. Defense Health officials advise that even if you don’t plan to change your Tricare coverage for next year, you should check for any cost changes that may affect you.
As of this writing, Defense Health Agency officials have not released the new Tricare Fee Schedule for 2023 Tricare Prime and Tricare Select.
By law, the DoD is required to increase certain portions of out-of-pocket expenses by recipients by an amount based on the annual cost-of-living adjustment for retirees, which is 8.7 percent for 2023. The increases costs also reflect changes in the cost of health care services. and drugs, and other factors, according to the Defense Health Agency.
There are also differences in some costs depending on when the sponsor entered the military, which is required by law. Those who registered before January 1, 2018 are in Group A, while those who registered on or after January 1, 2018 are in Group B.
Who can participate?
Anyone enrolled in or eligible for a Tricare Prime option (including the US Family Health Plan) or Tricare Select is eligible to participate in Open Season.
Open season does not apply to active duty members, who have full health coverage, and it does not apply to retirees who are in Tricare for Life. Coverage is automatic if you have Medicare Part A and Part B.
Tricare Prime is a health maintenance organization type plan where you get most of your care from a primary care manager, with referrals required for specialty care. There is no deductible. Active duty members, their family members and transitional survivors pay no enrollment fees or disbursements for covered services. Retirees, their families and all other persons pay registration fees and disbursements for covered services, except preventive care.
Tricare Select is a preferred provider organization type plan where you choose your Tricare authorized provider and do not need to obtain referrals for most services. There are deductibles, co-pays and cost shares.
Those with premium-based plans — Tricare Young Adult, Tricare Retired Reserve, and Tricare Reserve Select — can purchase those plans at any time. But those in Tricare Young Adult with the Prime and Select plan options can only switch plans during an open enrollment season or qualifying life event.
For more information, visit the Tricare Open Season page.
Note: Make sure your information is up-to-date in the Defense Enrollment Eligibility Reporting System. If the information is wrong, you may not be able to use your Tricare benefit and you may also miss the enrollment deadlines.
New Pricing for Premium Tricare Programs
Rates have increased for programs based on Tricare premiums – Tricare Young Adult, Tricare Reserve Select and Tricare Retired Reserve – as previously determined by the Defense Health Agency. These increases come into effect on January 1, 2023.
The new monthly premiums are:
♦ Tricare Young Adult: For TYA Prime, an 11% increase to $570 per month. For TYA Select, a 10% increase to $291 per month.
♦ Tricare Retired Reserve: A 9% increase to $549 per month for the member only; and $1,321 for member and family.,
♦ Tricare Reserve Select: a 4% increase to $48 per month for members only; and $240 for the member and his family.
Changes to the pharmacy retail network
Tricare beneficiaries have the option of obtaining their medications at military pharmacies, retail network pharmacies, and through the home delivery benefit. Active duty military members pay nothing for their prescription drugs when using these options. For others, pharmacy fees for all of these options will remain stable until December 31, 2023.
The military pharmacy is always the cheapest option for all military beneficiaries, as there is no cost for generic and brand name drugs covered at these pharmacies.
About 15,000 community and independent pharmacies left the Tricare retail pharmacy network on October 24. Among the more than 40,000 pharmacies that remain in the network are CVS and Walgreens, as well as numerous grocery pharmacies, wholesale warehouse stores and smaller chains, including some independent neighborhood pharmacies.
Defense Health Agency officials say nearly 95% of recipients will maintain access to at least two network pharmacies within 15 minutes of their home, and 99.8% will have access within 30 minutes.
You can search for a network pharmacy using Express Scripts’ Find a Pharmacy tool. If your pharmacy has left the network and you need to move your prescription, take your medicine bottles to another participating network pharmacy; this pharmacy will inform you of its process. You can also call your doctor’s office to request that your prescription be sent to the new network pharmacy or call your new network pharmacy to ask them to transfer your prescription.
Other changes coming with the new year will affect those who depend on specialist drugs for complex chronic conditions such as cancer, rheumatoid arthritis, multiple sclerosis and other illnesses. As of January 1, Accredo will be the main specialty pharmacy in the Tricare network, and beneficiaries must obtain their specialty medications from a pharmacy in the network.
Until this change, prescriptions for these specialty drugs were filled at a variety of locations, including a number of individual retail pharmacies, and through the Express Scripts mail-order pharmacy.
The Accredo service is already available for those who wish to change before January 1st.
Other Perk Changes
There are a number of benefit changes in the Tricare program each year. Among those of 2022:
♦ User fees or cost sharing are eliminated for long-acting reversible contraceptive methods. These include intrauterine devices, contraceptive injections, and subdural contraceptive sticks.
Anyone who was charged a co-payment for any of these services after July 28 can submit a claim to their regional contractor after November 1.
♦ Co-payments and cost sharing are back for telehealth services. A temporary waiver of these costs that came into effect at the start of the COVID pandemic has expired, so patients now pay these costs, which are like the costs of in-person care and depend on the category of beneficiary, the plan of health and the type of appointment of the patient.
Audio-only telehealth appointments became a permanent Tricare benefit in July 2022.
♦ Eligible Tricare Prime or Tricare Select recipients can enroll in the Tricare Childbirth and Breastfeeding Support Demonstration, which will run until December 31, 2026. It will expand overseas in 2025 This demonstration project covers certified non-medical labor doulas, lactation consultants, and lactation counselors.
Families of active duty, National Guard, and Reserve service members, as well as guardsmen and reservists not on active duty, are eligible for the Tricare dental program, which requires separate enrollment.
Most retirees and their family members are eligible for dental and vision coverage under the Federal Employees Dental and Vision Insurance Program, or FEDVIP, which is administered by the Office of Personnel Management and also requires a separate listing.
Rates will increase by an average of 0.21% for dental in 2023.
FEDVIP’s opening season this year is November 14 to December 12, one day less than Tricare’s opening season.
There are 23 dental plans offered by 12 carriers, seven of which offer national coverage. The other five offer regional coverage.
If you are already enrolled in a FEDVIP dental and/or vision plan and do not wish to make a change, your enrollment will continue automatically.
Members of the military community must be enrolled in a Tricare health plan to be eligible for FEDVIP vision coverage. Eligible persons include active duty family members, retirees and their eligible family members, and selected reserve members and their families. There are 10 vision insurance plans available from five national providers.
There is a silver lining in vision coverage: rates will decrease by an average of 0.41%.
Visit www.benefeds.com to register for FEDVIP and for more information.
Federal Times reporter Molly Weisner contributed to this report.
Karen has covered military families, quality of life and consumer issues for Military Times for over 30 years, and co-authored a chapter on media coverage of military families in the book “A Battle Plan for Supporting Military Families”. She previously worked for newspapers in Guam, Norfolk, Jacksonville, Florida and Athens, Ga.