Thousands Of Rural Pharmacies To Depart TRICARE Network

TRICARE pharmacy

In October of 2022, some 400 thousand TRICARE beneficiaries could be forced to search for a new retail pharmacy as thousands of rural pharmacies depart the network. In 2021, Walmart left the TRICARE pharmacy network. It was a move widely reported at the time as being associated with a dispute with the TRICARE pharmacy management company, Express Scripts, over how much of a military discount to offer.

According to some sources, Walmart was unwilling to offer “more competitive” prices to veterans. At the same time this move was announced, a separate announcement welcomed retail giant CVS to the TRICARE pharmacy network.

These moves leave the impression among some that pharmacy options coming and going from the network is fairly common. At least up to now.

The Exodus Begins October 24, 2022

Between 14 thousand and 15 thousand rural pharmacies are departing the TRICARE retail pharmacy network by the last week in October. This change affects some four percent of the TRICARE population, which may not sound like much until you read the actual number of people that may be burdened by the move.

Approximately 400 thousand people in the TRICARE system could be required to find a new TRICARE network retail pharmacy to use. TRICARE has a “pharmacy standard” that requires one TRICARE pharmacy within a 15-minute drive for 90% of all TRICARE users. But if you fall into the 10% that does have a longer commute to a network option, it may be wise to consider switching to the home delivery option.

TRICARE retail pharmacy partners can be found in more than 40 thousand retail outlets.

What To Expect From TRICARE

If you are affected by this change, you will receive an official communication from Express Scripts notifying you of the change and your options under TRICARE in your area. Both CVS and Walgreens are still in-network TRICARE pharmacy options, and when the time comes you may transfer prescriptions to a participating pharmacy.

How do you do this?

It may be as easy in some cases as taking your prescription bottles to the new participating pharmacy and having your new pharmacist do the transfer. You can also request that your doctor send prescription information to the new provider, or contact Express Scripts to switch your prescriptions to home delivery.

Switching To TRICARE Home Prescription Delivery

There are multiple options for changing to TRICARE home prescription delivery service. You will need to create an account with Express Scripts if you do not have one already. Once your account is active you can opt into home delivery as well as choose to order refills online and track prescription shipments.

You may also have an option to have your physician submit electronic prescriptions using the Express Scripts “e-Prescribe” feature. In such cases the doctor submits the order, Express Scripts processes it, and mails you the medications.

If you are required to make a co-pay the invoice is included in the shipment. Your doctor can send prescriptions directly to Express Scripts, no third party is needed.

Those who need to transfer their prescriptions using a mobile device can do so using the Express Scripts Mobile App. Search for it by name in Google Play or the Apple App Store. Another option is to call Express Scripts at (877)363-1303. Have your prescription bottle ready as the representative will need that information to make a transfer.

You can also apply by mail via the Home Delivery Order Form. Complete and mail this form to the address listed on it, along with your prescription.

Why Set Up Home Delivery Through Express Scripts?

Convenience and the lack of a commute to get to a participating pharmacy aside, the biggest benefit for some is that you can receive up to 90 days of your prescription by mail via Express Scripts. You can also set up an auto-refill option to eliminate the need for reminders as the refill date gets close.

Those two things are a major advantage for some and it’s likely one of the biggest reasons some choose the home delivery option. Add to that free standard shipping, and this could be one of the more cost-effective and time-saving pharmacy options open to you.

 

TRICARE: A Comprehensive Guide

When you join the United States military, you become eligible for healthcare coverage under the military’s health insurance program, TRICARE. For those who serve this is not optional, but for dependents and spouses, there are ways to use TRICARE as their main coverage or as a supplement to health insurance they get elsewhere through an employer or by other means.

The TRICARE official site describes itself as the health care program for members of the uniformed services and qualifying family members for all of the above. TRICARE works by offering health care options through a network of on and off-base providers.

All active duty service members are automatically covered by TRICARE when they begin their military career by going to basic training. Enrollment is required, and each branch of military service determines your eligibility for TRICARE.

Who Qualifies for TRICARE?

There is an extensive list of people who qualify for healthcare coverage through TRICARE, and they are not necessarily all active duty, Guard or Reserve members. Some foreign troops may qualify, some former spouses and even some in-laws may qualify.

TRICARE basically subdivides its members into two basic groups. Military members are referred to as “Sponsors” with DEERS-registered spouses and children being “Family Members”. But among these groups, there are those who qualify for TRICARE based on their status as any of the below:

  • Active duty service members
  • Active duty immediate family members
  • National Guard/Reserve members and families
  • Retired service members and families
  • Beneficiaries eligible for both TRICARE and Medicare
  • Survivors
  • Children
  • Certain qualifying former spouses
  • Medal of Honor recipients and families
  • Dependent parents
  • Parents-in-law
  • Foreign Force members and families

To qualify for TRICARE coverage you and your spouse/dependents must be registered in the DEERS system. Those who ship out to basic training aren’t technically enrolled in TRICARE yet, but they are covered by it. A formal enrollment process is required in spite of the initial coverage, which is effective for up to 180 days until you are placed on active duty. Family members may also be covered.

Read More: TRICARE Basics

TRICARE Coverage Plans

The plans listed below are offered based on where you will perform your military duty. For example, for those who are active duty and stationed stateside, TRICARE Prime or TRICARE Prime Remote is typical, depending on location. The TRICARE plan active duty service members use when assigned to an overseas base is typically either TRICARE Prime Overseas or TRICARE Remote Overseas.

  • TRICARE Plus
  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Select
  • TRICARE Select Overseas
  • TRICARE For Life
  • TRICARE Reserve Select
  • TRICARE Retired Reserve
  • TRICARE Young Adult
  • US Family Health Plan

Of the options listed above, active duty troops are automatically enrolled in TRICARE Prime when shipping out to basic training. Spouses and dependents may have other options to consider when the time is right–knowing what those options are is crucial to making the most informed decisions about your health insurance.

Read More: TRICARE Prime vs. Select: How to Decide

TRICARE Costs

Costs vary depending on your plan. For example, an active duty service member who is enrolled today in TRICARE Prime will pay zero dollars in premiums and there is no deductible. Compare that to TRICARE Reserve Select, which features the following costs from 2022:

  • Service Member only: $46.70/month
  • Service Member and Family: $229.99/month

Much depends on whether you are getting a premium-based plan or not. Some TRICARE plans such as Prime Overseas costs may depend on whether you have selected a “point of service” plan or not. In many cases when serving overseas you will get your primary care on-base or on-post, with referrals to off-base providers in the network possible depending on the need and other factors. Active duty service members don’t have the point-of-service option but their family members may.

Getting Medical Care Under TRICARE

You will typically use a care provider within your network, which may be an on-base clinic or hospital but may also include off-base non-military options. You may also qualify for TRICARE coverage with authorized non-network providers, depending on the circumstances.

Options vary between plans, you will need to review the specific policies of the TRICARE plan you qualify for to learn what is possible under that plan.

An authorized TRICARE provider is described on the official site as, “any individual, institution/organization, or supplier that is licensed by a state, accredited by a national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE.”

Read More: What TRICARE Covers

Carrying Other Health Insurance Besides TRICARE

The TRICARE official site notes that active duty service members cannot carry other health insurance besides TRICARE. That rule does not apply to dependents and spouses. Under federal law, TRICARE pays after all other health insurance, except for:

  • Medicaid
  • TRICARE supplements
  • State Victims of Crime Compensation Programs
  • Other Federal Government Programs

Spouses and dependents who carry other health insurance such as that through an employer will have that insurance pay first. Once that payment is made your care provider can submit a claim for any qualifying remainder via TRICARE.

Spouses and dependents with other health insurance are advised to follow the rules of your main insurer for care and claims, and if your main insurance denies a claim because you did not follow their rules TRICARE may likewise deny the claim. It’s best not to treat TRICARE as a “second chance” option if you fail to meet the requirements of your primary insurer.

Read More: Using Other Health Insurance Besides TRICARE

Getting Other Medical Treatment and Care

Military spouses, dependents, veterans, and military retirees may have additional health care treatment options from the Department of Veterans Affairs. Most currently serving military members know they may qualify for VA medical care depending on their circumstances, but did you know that certain qualifying spouses and dependents may also be eligible for VA care? When exploring your TRICARE options, it’s important to also use any other medical benefits offered to you as a dependent or spouse.

Read More: VA Health Benefits For Military Spouses And Dependents

Enrolling In TRICARE

Knowing the type of TRICARE plan you need is key, but timing also counts. Your prior health coverage may have had similar features to plans offered by TRICARE in that you can enroll in or change during an open season period, or after a Qualifying Life Event (QLE). If you are selecting a premium-based plan such as the Continued Health Care Benefit Program you can enroll at any time.

A QLE can be a marriage, the birth of a child, or retirement from active duty. QLEs offer you a three-month (90 days) opportunity to change your TRICARE enrollment. If you aren’t sure about your options or your eligibility for a specific TRICARE plan, review your eligibility online or call 1-800-538-9552 to get assistance.

Depending on the QLE you may gain or lose certain health care coverage options. If you have a QLE you may be able to change your current TRICARE plan or enroll in a new one.

Read More: TRICARE Qualifying Life Events And Your Health Insurance

TRICARE Coverage Exclusions

There is a list of “covered services” on the TRICARE official site, which is too extensive to publish here, but includes services deemed medically or psychologically necessary. There is also a list of specific issues that are NOT covered by TRICARE under any circumstances. Those include, but are not limited to:

  • Alternative Treatments
  • Assisted Living Facility Care
  • Augmentation Mammoplasty
  • Aversion Therapy
  • Blood Pressure Monitoring Devices
  • Elective Psychotherapy and Mind Expansion Psychotherapy
  • Elective Services or Supplies
  • Exercise Programs
  • Experimental Procedures
  • Fluoride Preparations
  • Gym Membership
  • Hospitalization for Medical or Surgical Error
  • LASIK Surgery
  • Massage
  • Medical Care from a Family Member
  • Therapeutic Absences from Inpatient Facility
  • Uncovered Services and Supplies
  • Unnecessary Diagnostic Tests or unnecessary Inpatient Stays
  • Unproven Procedures
  • Vestibular Rehabilitation
  • Vision Therapy

There is no value judgment inferred from inclusion in the list above. As you can see, it’s a mixed bag of legitimate services that simply aren’t covered by TRICARE and services which may yet be unproven or not considered medically necessary. Such lists are subject to change, it’s best to speak with a TRICARE rep before you assume certain types of care may or may not qualify for coverage.

Use the TRICARE Covered Services tool at the TRICARE official site to see what may be currently approved under TRICARE. You can search via the link above using relevant keywords or categories.

Read More: TRICARE and Non-Covered Services

Is TRICARE Available Worldwide?

The United States has two TRICARE regions.

  • TRICARE East
  • TRICARE West

Overseas, TRICARE features a single region divided into three separate areas:

  • TRICARE Eurasia-Africa
  • TRICARE Latin America and Canada
  • TRICARE Pacific

What to Know About TRICARE Coverage

No two TRICARE options are exactly the same. Here’s what you need to know about some of the basic differences between these plans.

TRICARE for Active Duty

Active duty service members are covered in TRICARE from the moment they begin their military service, but they must enroll in the program when the opportunity is available. Initial coverage lasts six months before going on active duty after initial training and technical training.

There are a variety of active duty TRICARE options including:

  • TRICARE Prime
  • TRICARE Select
  • TRICARE Prime Overseas
  • TRICARE Select Overseas

Active duty troops, as mentioned above, cannot use any other health insurance program other than TRICARE. The same is NOT true for spouses and dependents as we will examine below.

Read More: TRICARE for Active Duty Service Members 

TRICARE for Spouses and Dependents

Spouses and dependents of active duty service members have options under TRICARE including but not necessarily limited to:

  • TRICARE Select: a preferred provider organization plan (PPO) offered to those in the United States.
  • US Family Health Plan: this is a TRICARE Prime option available through networks of community-based health care systems. This plan is not offered to all and is not nationwide. It is available only in “designated US Family Health Plan” areas.
  • TRICARE Select Overseas: This plan provides comprehensive coverage for family members living at overseas duty locations.

Read More: TRICARE for Spouses and Dependents

TRICARE For Reserve And National Guard Members

TRICARE benefits will vary based on the service member’s status. One of the most important initial benefits is something called Line of Duty Care which applies to members of the Guard and Reserve who are injured or get sick in the line of duty up to and including weekend drills, ADT, IDT, or other official training. TRICARE coverage is provided for travel to and from official duty as well.

Line Of Duty coverage is designed to address issues that may require an emergency room visit during Guard/Reserve training that is not considered being ordered to active duty, federal service, etc.

Line Of Duty care is separate from other TRICARE coverage such as TRICARE Reserve Select, pre-activation benefits you may be entitled to when called to federal service, and benefits provided under military transition assistance programs.

Read More: TRICARE Benefits For Guard and Reserve Members.

TRICARE Options for Retirees

It should be noted that when we discuss “retirees” in this context we are referring specifically to military members who are eligible to draw military retirement pay. We are not referring generically to all who are retired from work in general, just those who retired from military service.

Retired military members may be eligible for a variety of TRICARE options including:

  • TRICARE Prime
  • TRICARE Select
  • US Family Health Plan
  • TRICARE For Life
  • TRICARE Select Overseas

These healthcare options are offered based on location (stateside or overseas) and in some cases by age (TRICARE For Life is one example). Co-pays and enrollment fees may apply depending on age, status (Guard/Reserve versus active duty), and eligibility for Medicare Part A and B.

TRICARE Prime is the stateside option for those who have retired from the military and have not reached the age for Medicare eligibility. Once you have reached the age of eligibility for Medicare, you are no longer approved for TRICARE Prime as a retiree and must choose one of the other options open to those who can also use Medicare.

TRICARE requirements for members of the National Guard and the Reserve are different from those who retired from active duty service, and you may need to contact a TRICARE rep to discuss your specific circumstances if you have both active service and Guard/Reserve service in your military career history.

Read More: TRICARE For Active Duty Retirees

 

 

TRICARE Qualifying Life Events and Your Health Insurance

When you enroll in TRICARE, your status as a single or married service member determines the type of coverage you’ll enroll in.

So does your status as an active duty service member. When these things change, they may be considered Qualifying Life Events, which provides an opportunity to modify your TRICARE coverage within a 90-day window of the event. You may (depending on circumstances) be able to enroll in a new TRICARE plan or change the nature of your health care coverage in other ways.

Qualifying Life Events (QLE)

If you get married, have a child, experience a death in the family, or separate from military service, you have experienced a TRICARE QLE.

Basically, any change in your status that may require additional health care coverage may be considered a QLE from what’s already been mentioned above to other situations like dependent children becoming adults or moving away to college, accepting military retirement pay, or other factors.

These are not the only ones that may open a 90-day window for you to change your coverage, but no matter how you experience a QLE it is important to review your current policy and talk to a TRICARE rep to learn how you may be able to change your health care to suit your current needs.

In order to modify an existing plan or enroll in a new one, you must update DEERS with information related to your Qualifying Life Event, make enrollment changes within 90 days, and pay any required fees or premiums needed for the new coverage.

A List of TRICARE Qualifying Life Events

This list may not be comprehensive. QLE requirements are subject to change through legislation, TRICARE program changes, or other variables. The following list is current at press time:

  • Retiring or separating from active duty
  • Activating or deactivating for federal service
  • Getting married or divorced
  • Getting an annulment
  • Birth or adoption of a child
  • Having a child placed in the home by a court
  • Children becoming adults
  • Death in the family
  • Children moving away to college
  • Relocation to a new zip code
  • Gaining or losing a Primary Care Manager
  • Dependents gaining or losing command sponsorship at a military assignment
  • Turning 60
  • Becoming eligible for Medicare
  • Gaining or losing other health insurance

What to Know About Qualifying Life Events

Some QLEs aren’t good. Losing a Primary Care Manager (PCM), for example, requires you to find a new one and begin a new relationship with your replacement PCM. Other situations are just as unpleasant, but more punitive. A good example would be a dependent losing command sponsorship at an overseas assignment due to misconduct–not uncommon depending on the location and other variables.

What do you need to know about TRICARE in such cases? If you don’t report these changes in status for TRICARE beneficiaries, when it comes time to get care for these beneficiaries you may be denied payment under TRICARE and be liable for the full cost of the care. Failing to report QLEs in cases where coverage eligibility is in question may result in a loss of coverage.

This is also true in cases where the enrollee is about to age into Medicare or start drawing military retirement pay. If you do not choose to modify your TRICARE coverage in these cases you may lose it when you age out or officially become a military retiree.

What to Do After a Qualifying Life Event

After any QLE you will need to update your DEERS records to reflect your new status after the event. Once your DEERS records are updated you can make any TRICARE changes  you’re authorized to make online, by mail, or by phone.

You May Not Have to Change Your Coverage

If you experience a TRICARE Qualifying Life Event, you are not required to modify your coverage in certain cases. In others you are definitely required to act.

In cases where you remain eligible for the current health plan following the QLE, you do not need to do anything. If you are not in a health plan and fail to enroll, your only healthcare options may be military hospitals and/or clinics. You are not guaranteed treatment under such conditions, it may be provided on a space available basis.

In cases where you are due to retire from active duty you must make a TRICARE “enrollment decision” within 90 days of your retirement date. Failure to do so may result in your losing health care coverage.

Making Enrollment Changes When You Haven’t Experienced a QLE

You do not have to wait until you experience a Qualifying Life Event to change your TRICARE coverage, but if there is no QLE you will have to wait until TRICARE open season begins. Open Season happens annually starting on the Monday of the second full week in November to the Monday of the second full week in December.

In 2022 open season was scheduled for November 14 through December 13, 2022. If you decide to make changes in your enrollment during open season, those changes may typically happen at the beginning of the new year.

Who Does Open Season Apply to?

The TRICARE official site says open season enrollment is for anyone in or eligible to enroll in TRICARE Prime options including TRICARE Select and the U.S. Family Health Plan. Those eligible for open season have three courses of action they can use:

  • Remain in your current TRICARE plan. You will not be required to re-enroll and you can stay in the plan as long as you are eligible to do so.
  • Enroll in a TRICARE plan if you are eligible but not currently enrolled in TRICARE plans such as Prime or TRICARE select.
  • Change TRICARE plans. Are you already enrolled in a TRICARE Prime option or TRICARE Select? The TRICARE official site says you are permitted to change plans and/or switch between individual and family TRICARE enrollment.

Enrolling In TRICARE Health Plans

Coverage by TRICARE is automatic when troops are sent to basic training. That does NOT mean you are automatically ENROLLED in a healthcare program. When it is time to enroll or to change your enrollment, you can do so online using the milConnect portal, or you can submit enrollment forms by mail or fax. There are different forms for TRICARE Prime, TRICARE Select, and the U.S. Family Health Plan. You can also enroll by phone. You will need to call a regional contractor or coordinator:

Starting or changing your healthcare coverage may require you to provide proof of identity, updated DEERS records, and other information. The safety of your private data including account numbers, Social Security Numbers, and other information is key–you will need to remember some best practices where safeguarding your personal data is concerned.

When you begin or change TRICARE coverage, keep in mind that you should never give out private information including bank account numbers or routing numbers to third parties who have called you unsolicited. It’s one thing for you to call the number or numbers listed above to make arrangements for coverage.

It’s another thing entirely to get a phone call you did not solicit from a number you don’t recognize and have that person claim to be your health insurance representative. Never give private data or payment data to someone who has called you unsolicited.

TRICARE warns about such scams. Always refuse to give information to people who have called you. It’s different when YOU have called THEM. If you suspect you have been contacted by a scammer claiming to represent TRICARE, contact a representative immediately. If you gave any personal data to the caller, be sure to let the representative know and be sure to ask what steps you need to take next to protect your accounts and your identity.

 

 

Using Other Health Insurance Besides TRICARE

TRICARE is a healthcare program for military members and their families. This health coverage is offered to qualifying military members on active duty, in the Guard and Reserve, veterans, and military retirees. TRICARE is also offered to surviving spouses and dependents, and even “certain former spouses” according to TRICARE.mil. TRICARE is offered stateside, overseas, and at remote assignments. Your basic healthcare plan may depend greatly on your geographic location.

When a new recruit ships out to basic training, they are automatically covered by TRICARE. Enrollment is required and happens later, but from the moment new troops begin serving they have health insurance coverage.

Some may already have health insurance coverage through their parents or a spouse. For active duty troops, one of the major questions about TRICARE is how it works with other plans, and when. As we will discover below, there are major differences between the options that service members have compared to their family members.

Who Qualifies For TRICARE?

Those offered TRICARE coverage include, but may not be limited to:

  • Active duty service members and families
  • National Guard/Reserve members and families
  • Retired service members and families
  • Retired Reserve members and families
  • Beneficiaries eligible for TRICARE and Medicare
  • Survivors
  • Medal of Honor recipients and families
  • Dependent parents and parents-in-law

TRICARE Coverage Rules For Active Duty Service Members

Those serving on active duty or ordered to active duty are given TRICARE as their health insurance, and no alternative is permitted. This is NOT true of family members, veterans, retirees, and others. Those on active duty will use TRICARE as their only health coverage.

TRICARE Rules For Those Who Are Not Active Duty

The rules we mention here apply to all non-active duty TRICARE enrollees. Guard and Reserve troops not on active duty, retirees, family members, and all others under the “non-active duty” umbrella should know about the information in this section.

TRICARE rules state that when you carry any other health insurance besides TRICARE, it’s known as “other health insurance” for the purposes of making claims. When you carry other health insurance, TRICARE is the final payer, not the first payer.

There are exceptions. They include:

  • Medicaid
  • TRICARE supplements
  • State Victims of Crime compensation programs
  • Other federal government programs

You will file your non-TRICARE health insurance claims first, then you or your care provider will file a claim with TRICARE.

TRICARE and Medicare

When using Medicare and TRICARE together, you should expect Medicare to pay first along with any other health insurance. TRICARE pays after these two have paid–you will need to check the Medicare official site to see whether your insurance or Medicare pays first for the treatment or services you receive.

What Happens If Your Other Health Insurance Ends

Some may start out with other health insurance through an employer or school, but what happens when those coverages end? When you graduate from school or quit a full-time job, health insurance is terminated at some stage, and in such cases TRICARE makes provisions to become the primary insurer.

This is not necessarily automatic. You will need to submit a form to TRICARE to inform them your other health insurance is being terminated. You should also inform your Primary Care Manager or another care provider to avoid delays in payment between the old insurance and TRICARE.

The TRICARE official site warns that changing your other health insurance coverage options without informing TRICARE and your Primary Care Manager could result in being denied a TRICARE claim.

Avoiding Coverage Lapses And Other Problems

One of the most important things you can do to avoid gaps in coverage, delayed payments, or other issues? Keep the system updated.

This involves letting your TRICARE contractors and care providers know when you gain or lose access to other health insurance. You will also need to keep your family information updated in DEERS, especially when there are changes in family status.

If you have a newborn, an adoption, marriage, divorce, death in the family, or other event that could alter the nature of your health insurance coverage, update your military DEERS records as soon as possible. In cases where you have had a baby overseas, the TRICARE official site advises that your baby is covered by Prime “for the first 120 days after birth, but you must take steps to enroll your child to continue Prime after the first 120 days”.

Permanent Change Of Station or PCS season is also an important concern. Are you and your family about to receive permanent change of station orders to an overseas base? If you are currently assigned stateside, your TRICARE coverage options will change.

You should contact a TRICARE representative as soon as you have orders to discuss how to switch your coverage from the stateside version of TRICARE Prime to the overseas version. Failure to update could result in serious lapses in coverage or care. Start working on your transition as early as possible.

The same is true when transitioning back to a stateside base from an overseas assignment. And those who are being reassigned without command sponsorship of dependents–going on a remote assignment while leaving the family behind at a stateside location until the remote duty is finished–require extra consideration in TRICARE.

You won’t want to be in a hurry to sort out those details, start working with your TRICARE rep as soon as you can to get your TRICARE needs sorted out in these circumstances.

What to Know About TRICARE and Using Other Health Insurance

There are some crucial things to know about using TRICARE and other health insurance together. One of those things is fully understanding the rules for the other insurance option. If you do not file according to the rules of the other insurer, your claim may be denied. This is an important factor–you will read this advice again, as this is a common error.

If you try to submit a claim to TRICARE after having been denied by your primary insurer, it may be rejected by TRICARE as well.

Submitting to TRICARE before your primary insurer will typically result in the claim being denied. Do not submit claims to TRICARE first. In the event that TRICARE accidentally pays when you have other insurance, the error will force TRICARE to reclaim the funds. Your claim will only be processed after the primary insurer does in such cases.

When Your Primary Insurance Doesn’t Cover All Costs

The TRICARE official site advises you to follow all rules for submitting claims to the letter. If you do so and you are still not fully covered for a procedure or other care, file a claim with TRICARE, but know that TRICARE, as mentioned above, typically denies claims that were also denied by your main insurer if your claim was rejected because it did not follow the rules. This is a very common mistake that can be easily avoided with a little extra effort.

Is TRICARE Always The Best Option?

In some cases the answer may be yes–if you are at an overseas location and do not know the local language or customs, TRICARE is likely the best option unless an employer’s plan has similar considerations for you as an outsider to the country or culture. You may find language support services

If you are stateside and you feel that other health insurance offers you an advantage as a spouse, dependent, or another non-active duty beneficiary, taking that other insurance may be the best move. It is important to compare plans and determine the best option–sometimes it’s TRICARE, sometimes it’s not.

TRICARE for Active Duty Military Retirees

Many who retire from active duty military service are a decade or more away from qualifying for Medicare or other age-based services. Your choices for healthcare will be affected by this, and your location (stateside or overseas) is another factor to consider when planning your health care coverage.

For the purposes of this article, the phrase “retirement” refers specifically to those who have served enough time to qualify for military retirement pay. We are not discussing the generic “retirement” age for drawing civilian pensions, Social Security, Medicare, and Medicaid, etc. For this article, “retired” means “retired from military service”.

Additionally, this article is specifically for those who have retired from active duty military service. We will cover TRICARE options for those who have retired from the National Guard or the Reserve in a separate article. The rules for those retiring from the Guard/Reserve are different from those who retire from active service, especially where qualifying ages are concerned. If you aren’t sure whether your military service qualifies you for a specific type of TRICARE health insurance, contact a TRICARE representative who can review your specific circumstances.

TRICARE for Active Duty Military Retirees

Retired military members may be eligible for a variety of TRICARE options including:

  • TRICARE Prime
  • TRICARE Select
  • US Family Health Plan
  • TRICARE For Life
  • TRICARE Select Overseas

TRICARE Prime for Retired Military and Family

For active duty troops and families, TRICARE Prime does not feature enrollment fees or network copays. For retired service members and their families, such payments are required. You are only eligible as a military retiree for TRICARE Prime as long as you have not become eligible for Medicare based on your age.

Once you have reached the age of eligibility for Medicare, you are no longer approved for TRICARE Prime as a retiree.

You are required to enroll in TRICARE Prime as a retiree. Once you are approved, you are assigned a primary care manager or PCM who may be at a military base or a facility within your network. You will get referrals to specialists for care you can’t get with a PCM. Prime is an option for those who are living in the United States.

TRICARE Select for Retired Military Members and Family

TRICARE Select is described on the official site as a “self-managed” preferred provider organization (PPO) plan for those in the United States.

This option is offered to military retirees and is typically used when you have other health insurance. Certain military retirees will have to pay enrollment fees when signing up for TRICARE Select, and you may be responsible for cost shares and an annual outpatient deductible.

When using TRICARE Select you will have the option to schedule an appointment with any TRICARE-authorized provider, either network or non-network. Unlike Prime, you will not need referrals for “most primary and specialty appointments” but you may need pre-authorization from your regional contractor depending on the nature of your care.

Military retirees and family members typically don’t receive a TRICARE card under TRICARE Select. Your military retiree ID may serve as your insurance card. When using TRICARE Select, expect to pay your costs up front and be later reimbursed by TRICARE.

TRICARE Select Overseas

Similar to TRICARE Select, but made available to retirees and family members in “all overseas areas”. Enrollment is required, and certain military retirees will have to pay enrollment fees when signing up for TRICARE Select.

You will pay upfront for care and be reimbursed by TRICARE after submitting a claim. You can use TRICARE Select to schedule an appointment with any approved overseas care provider, referrals are not necessary, but you may need pre-authorization for some care options.

TRICARE US Family Health Plan for Retirees

The TRICARE US Family Health Plan is described on the official site as, “an additional TRICARE Prime option available through networks of community-based, not-for-profit health care systems” located across six regions in the USA. Military retirees and their families can apply for this health coverage, but there are restrictions.

Prior to October 1, 2012, the US Family Health Plan was open to Medicare-eligible beneficiaries age 65 and older. On October 1, 2012, this rule was modified; now Medicare-eligible beneficiaries who are 65 and older “can no longer enroll in the US Family Health Plan” but should apply for TRICARE For Life (see below).

This plan is not available outside the United States and is offered within certain areas including:

  • Maine
  • New Hampshire
  • Vermont
  • Upstate and Western New York
  • Northern Tier of Pennsylvania
  • Maryland
  • Washington D.C.
  • Parts of Pennsylvania, Virginia, Delaware, New York City
  • Long Island
  • Southern Connecticut
  • New Jersey
  • Philadelphia and area suburbs
  • Southeast Texas
  • Southwest Louisiana
  • West Virginia
  • Massachusetts
  • Rhode Island
  • Northern Connecticut
  • Western Washington state
  • Parts of eastern Washington state
  • Northern Idaho
  • Western Oregon

TRICARE for Life

This option is specifically for military retirees who are TRICARE-eligible and have Medicare Part A and B. Enrollment for this program is NOT required–it is automatic if you meet the requirements. This plan is available worldwide and requires payment of Medicare Part B premiums.

Under TRICARE For Life, you are allowed to use any care provider who takes Medicare, which is the first payer. TRICARE For Life pays after Medicare handles its portion. Your Medicare card and retiree ID are what you need to use these services. This coverage requires no enrollment fees, but as mentioned above you will pay Part B fees.

Typically, for care covered by both TRICARE and Medicare, you pay nothing. If care is paid for by only one of the two, you may be responsible for the deductible and cost share for that insurer (TRICARE or Medicare), and in cases where neither insurance applies you may be liable for “billed charges”.

TRICARE for Medically-Retired Service Members

Some service members are placed on either a Temporary Disabled Retirement List or a Permanently Disabled Retirement List. The TRICARE official site says you and your family may qualify for TRICARE benefits offered for retired service members (see above). Furthermore, if you have a disability rating of less than 30% (the TRICARE official site specifies this is a rating separate from the VA disability rating system) and are separated from active service, you may qualify for certain “transitional health care benefits” under TRICARE:

  • Transitional Assistance Management Program, which offers 180 days of health care benefits after regular TRICARE benefits expire. There are no premiums.
  • Continued Health Care Benefit Program, a premium-based plan offering health coverage for 18-36 months when you lose eligibility for TRICARE. This plan offers the same coverage as TRICARE Select (see above).

What qualifies someone to go on the Temporary Disabled Retirement List? You typically must have a medical issue that makes you “unfit for military service” and you must have a 30% disability rating “separate from the one given by the Department of Veterans Affairs”. On the temporary list, you are re-evaluated approximately every 18 months for up to five years. If your condition has improved you may be removed from the list, if it has gotten worse you may be placed on the permanent list.

Things to Think About When Considering Your TRICARE Options

If you are getting ready to retire from military service, there are three basic questions you should ask about your plans that could affect your healthcare choices. How close to being Medicare-eligible are you? Are you planning to retire stateside or do you plan to live overseas? And finally, how close to a military base will you be? This is important because you may need a TRICARE plan that does not require you to travel long distances to get care. The distance issue isn’t a factor in all cases, but those requiring more specialized care should take travel into consideration.

And finally, the TRICARE official site issues a reminder; If you become eligible for Medicare under age 65 (for any reason) you are required to use Medicare Part B to keep TRICARE.

 

 

TRICARE for National Guard and Reserve Members

TRICARE Benefits for Reserve and National Guard Members

Members of the National Guard, Reservists, and their families may be eligible for coverage under TRICARE. Eligibility depends on the service member’s military status, which may change many times over a career in the Guard or Reserve. Your care options may vary depending on whether your current status is:

  • Inactive
  • Activated
  • Deactivated
  • Retired

You and your family can verify basic eligibility for TRICARE via the Defense Manpower Data Center or by logging into Beneficiary Web Enrollment (BWE) on the MilConnect official site. Family members are eligible if they are listed in DEERS and the service member qualifies for TRICARE.

To log in to these portals to check TRICARE eligibility, you need one of the following:

  • Common Access Card (CAC),
  • DFAS (MyPay) Account, or
  • DoD Self-Service Logon (DS Logon) Premium (Level 2) account

What TRICARE Benefits Are Provided for Reserve and National Guard Members?

The TRICARE benefits and health plan options below depending on the service member’s status.

  • Line of Duty Care
  • TRICARE for Inactive Guard/Reserve (on duty 30 days or less)
  • TRICARE When Activated (on duty for more than 30 days)
  • TRICARE When Deactivated
  • TRICARE When Retired

TRICARE Line Of Duty Care

Line Of Duty care applies to members of the Guard and Reserve who, “…incur or aggravate an injury, illness, or disease while in the line of duty” which can include drill weekend, ADT, IDT, or other training as specified on orders. Coverage is provided for travel to and from official duty as well.

You will not show up in DEERS as being eligible for TRICARE under these circumstances, However, Line Of Duty coverage is meant to anticipate circumstances that may result in an emergency room visit during military training in a Guard/Reserve capacity. Line Of Duty care is completely separate from other TRICARE coverage such as TRICARE Reserve Select, pre-activation benefits you may be entitled to when called to federal service, and benefits provided under military transition assistance programs.

Due to the nature of this coverage, TRICARE Line of Duty coverage is NOT considered minimum essential coverage for the purposes of meeting the requirements of laws like the Affordable Care Act.

TRICARE for Inactive Guard/Reserve on Duty for 30 Days or Less

TRICARE Reserve Select is offered to those who are not on active duty orders, not covered under other Transition Assistance programs such as TAMP, and to those who are not eligible for the Federal Employee Health Benefits program. TRICARE Reserve Select is a premium-based health insurance plan offered to qualifying members of the Guard/Reserve and their families worldwide.

The TRICARE official site notes that those in the Individual Ready Reserve do not qualify for this healthcare option.

If you have TRICARE Reserve Select, you may get care from an authorized provider in your network or out-of-network.

TRICARE for Activated Guard and Reserve Members

Those who are activated and placed on active duty status are enrolled in one of the following plans depending on the location of duty; stateside, overseas, stateside remote duty, or overseas remote duty. Plans include:

  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas

You will be covered by one of these plans as applicable but you are required to formally enroll, typically when you arrive at the duty station. Family members may be added to your plan at enrollment time. TRICARE is the only health benefit option you have when activated for federal active duty service. TRICARE coverage allows you to claim zero out-of-pocket expenses when claiming “covered services” and when you do have to pay, TRICARE reimburses you 100%.

TRICARE Coverage When You Are Deactivated

There are two options for coverage when you are deactivated. One is TRICARE Reserve Select (see above) which is offered first. This is for those who are not on active duty orders, not covered under other options such as TAMP, and to those who are not eligible for the Federal Employee Health Benefits program.

When you are deactivated, you have another option to claim benefits under a program called  TAMP; the Transitional Assistance Management Program. This adds 180 days of health care benefits which begin after regular TRICARE benefits end. There are no premiums to be paid for under TAMP.

Who is eligible for TAMP?

Sponsors and eligible family members who meet one of the following conditions:

    • You are involuntarily separating from active duty under honorable conditions
    • You received a voluntary separation incentive (VSI)
    • You received voluntary separation pay (VSP) and can’t receive retired or retainer pay upon separation.
    • You are a Guard or Reserve member separating from a period of more than 30 consecutive days of active duty for a pre planned mission, or working to support a contingency mission or COVID-19 response
    • Separating following involuntary retention (AKA “stop loss”) in support of a contingency operation
    • Separating after agreeing to remain on active duty for less than one year in support of a contingency operation
    • Receiving a sole survivorship discharge
    • Separating from regular active duty service and agreeing to become a member of the Selected Reserve of a Reserve Component.

You can view your eligibility for TAMP in DEERS or via MilConnect.

TAMP Coverage Periods

During TAMP coverage periods, you and your family members may qualify to enroll for or use one of the following:

    • Military care facilities
    • TRICARE Prime
    • TRICARE Select
    • US Family Health Plan
    • TRICARE Prime Overseas
    • TRICARE Select Overseas

As mentioned earlier in this article, TRICARE coverage options like Prime and Select are based on duty location.

TRICARE When Retired

If you retire from military service, having served the full duration of a military career 20 creditable years or more in the Guard or Reserve, you may qualify for TRICARE benefits as a military retiree. It’s important to note that you must draw a military pension or be eligible to draw one to qualify. Being retired in a non-military sense has no bearing on this coverage or its availability.

Retired Reserve members and their families have TRICARE options which are based on the age of the military member. For those under 60 years old, you may qualify to buy into TRICARE Retired Reserve; turning down this option means you will not qualify for other TRICARE retiree coverage until you turn 60.

For those who opt-in to TRICARE Retired Reserve who have children who are about to age out of TRICARE, an option called TRICARE Young Adult may help.

For those ages 60 or older,  the TRICARE official site says, “you and your family become eligible for the same TRICARE health benefits as all other retired service members” and such options depend on where you live. Stateside the following options apply:

  • TRICARE Prime
  • TRICARE Select
  • TRICARE For Life (with Medicare Part A & Part B)
  • US Family Health Plan

Outside the United States, the following options may be offered to you:

  • TRICARE Select Overseas
  • TRICARE For Life (with Medicare Part A & Part B)

Things to Know About TRICARE Options for Family Members of National Guard or Reserve Members

Your TRICARE coverage is provided when the service member is eligible for the coverage. These scenarios can include circumstances where one of the following applies:

  • On military duty for less than 30 days
  • Activated
  • Called to active duty service for more than 30 consecutive days
  • Deactivated-after leaving active duty for more than 30 consecutive days

Did you know you can purchase TRICARE Dental Program coverage? This is an option completely separate from the other TRICARE coverages, and you must enroll for dental coverage. As mentioned above, all dependents to be covered under TRICARE must be registered in DEERS.

Those who are eligible for TRICARE and Medicare Part A should know that you are typically required to carry Medicare Part B in order to continue using TRICARE.

 

 

TRICARE for Spouses and Dependents

TRICARE is the military health insurance plan for service members and their families. TRICARE automatically covers new troops when they ship out to basic training, but they must enroll themselves and their family members later. Servicemembers are automatically covered by TRICARE Prime during basic training and technical training and are required to enroll in Prime or other options depending on where their first duty station might be (stateside or in the United States).

Family members are typically enrolled in Prime or Prime Overseas but have other options–including those not offered to active duty service members.

TRICARE Options for Spouses and Dependents

Spouses and dependents of active duty service members have the following options under TRICARE:

  • TRICARE Select: a preferred provider organization plan, also known as a PPO, which offered to those in the United States
  • TRICARE Select Overseas: This plan provides comprehensive coverage for family members living at overseas duty locations.
  • US Family Health Plan: the TRICARE official site as “an additional TRICARE Prime option available through networks of community-based, not-for-profit health care systems”. This plan is not offered nationwide, but only in “designated US Family Health Plan” areas.
  • TRICARE For Life: The TRICARE official site describes this as Medicare-wraparound coverage for TRICARE-eligible beneficiaries. To qualify you must have Medicare Part A and B.

Who Is TRICARE Select for?

TRICARE Select is offered to the immediate families (spouses, children) of active duty service members, military retirees and family, spouses and children of qualifying Guard/Reserve members, survivors, and several others. You must enroll in this program and you must be registered in DEERS before doing so.

Using TRICARE Select

When you use TRICARE Select, you may make medical appointments with any TRICARE-authorized care provider. You have options to use in-network and out-of-network providers and referrals are not required for “most primary and specialty appointments.”

The TRICARE official site advises that you may need “pre-authorization from your regional contractor for some services”. TRICARE Select does not require you to carry a TRICARE insurance card. You use your military-issued ID as proof of your insurance coverage.

Paying For TRICARE Select

This health insurance features costs that may vary depending on the status of the service member. In general, you’ll pay an annual outpatient deductible, plus cost sharing for any TRICARE-covered services. There are enrollment fees for TRICARE Group A retirees, a practice that started in 2021.

Who Is TRICARE Select Good For?

TRICARE Select is not available to service members on active duty. That includes members of the National Guard and the Reserve. Spouses and family members may choose Select in cases where they live somewhere TRICARE Prime is not offered or available, or if you have other health insurance coverage. Select is also good when using a healthcare provider that is not in the TRICARE network and you do not want to change your provider.

What Is TRICARE Select Overseas?

TRICARE Select Overseas is a plan offered to spouses and dependents. Select Overseas offers “comprehensive coverage in all overseas areas” according to the TRICARE official site. You must enroll in TRICARE Select Overseas, and you are required to be registered in DEERS (and your record must show you as eligible to enroll in TRICARE) before you do so.

Who Is TRICARE Select Overseas for?

After active duty family members, other groups may be eligible for TRICARE Select Overseas. These include, but may not be limited to:

    • Retired service members and their families
    • Family members of those ordered to active duty service for more than 30 days in a row.
    • Guard/Reserve members
    • Qualifying non-activated Guard/Reserve members and their families under the Transitional Assistance Management Program
    • Retired Guard/Reserve members (who are 60 or older) and their families*
    • Survivors

Using TRICARE Select Overseas

You don’t need a referral to an overseas provider, and you can schedule an appointment with “any” overseas care provider as long as they are listed in the authorized directory. Pre-authorization may be required for some care or services. You do not need a TRICARE card, your military-issued ID card acts as your proof of insurance.

Paying for TRICARE Select Overseas

Overall costs may depend on the status of the service member, but in general expect to pay an annual outpatient deductible, cost sharing for services, plus any required enrollment fees. With TRICARE Select Overseas, you should expect to pay for your care upfront and out of pocket. You will file a claim to be reimbursed for your health care.

Who Is Right for TRICARE Select Overseas?

You are not required to use TRICARE Select Overseas; you can be enrolled in the service members’ TRICARE Prime Overseas instead. If you don’t want either option you may need to purchase other health insurance.

What Is the TRICARE US Family Health Plan?

This option is offered as “an additional TRICARE Prime option” offered via community-based, not-for-profit health care systems. There are six care centers in the United States offering care under this option. Those care centers are:

  • Johns Hopkins Medicine
  • Martin’s Point Health Care
  • Brighton Marine Health Center
  • St. Vincent Catholic Medical Centers
  • CHRISTUS Health
  • Pacific Medical Centers

Not all regions have US Family Health Plan options. You may be eligible for the TRICARE US Family Health Plan if you live in one of the following areas:

  • Maine
  • New Hampshire
  • Vermont
  • Upstate and Western New York
  • Northern Tier of Pennsylvania
  • Maryland
  • Washington D.C.
  • Parts of Pennsylvania, Virginia, Delaware, New York City
  • Long Island
  • Southern Connecticut
  • New Jersey
  • Philadelphia and area suburbs
  • Southeast Texas
  • Southwest Louisiana
  • West Virginia
  • Massachusetts
  • Rhode Island
  • Northern Connecticut
  • Western Washington state
  • Parts of eastern Washington state
  • Northern Idaho
  • Western Oregon

Who Qualifies for the TRICARE US Family Health Plan?

This TRICARE option is offered to active duty family members, military retirees, and their families, family members of Guard/Reserve members who are called to active duty for more than 30 days, plus the following:

    • Qualifying non-activated National Guard/Reserve members and their families under the Transitional Assistance Management Program
    • Retired National Guard/Reserve members (age 60 or older) and their families
    • Survivors
    • Medal of Honor recipients and their families
    • Qualified former spouses

Using the TRICARE US Family Health Plan

All care under this plan is provided by an approved provider you pick from a list of private doctors affiliated with an approved not-for-profit health care option. If you need specialized care, the primary care provider is expected to help you get appointments for these services. No care at military hospitals or TRICARE providers in the area is possible with the TRICARE US Family Health Plan.

Paying for the US Family Health Plan

There are no enrollment fees for active duty family members. There are no out-of-pocket costs for care IF you are getting that care from your approved provider. All other care requires annual enrollment fees and copays.

Who Is Right for the TRICARE US Family Health Plan?

Those who live in one of the designated areas for this program should consider the option, even if they choose not to enroll. Making a fully informed choice about your healthcare–even TRICARE options–is crucial if you want to get the most out of your coverage.

What Is TRICARE For Life?

TRICARE For Life is offered to those who are eligible for TRICARE and who also carry Medicare Part A and B. Enrollment is NOT required, this coverage is automatic if you have Part A and B. You must pay Medicare Part B premiums, and in the United States, TRICARE is NOT the primary payer. TRICARE pays AFTER Medicare in the USA and U.S. territories. In overseas areas, TRICARE is the first payer.

Who Is Eligible for TRICARE For Life?

The eligibility requirements for this option are likely the most simple of all those listed here. To qualify you must simply be TRICARE-eligible AND carry Medicare Part A and Part B.

How TRICARE For Life Works

TRICARE For Life is available to use with any care provider who accepts Medicare. You WILL need a Medicare card, but you won’t need a TRICARE insurance card since your military-issued ID card serves as your proof of insurance. Treatment MAY be available at military hospitals or other facilities but this is provided on a space-available basis only.

Paying for TRICARE For Life

There are no enrollment fees for this TRICARE option but you are required to pay premiums for Medicare Part B. Those fees are established based on the applicant’s income. If you need to know which options are covered under this TRICARE program you can use a search tool provided on the official site to look up specific types.

Using TRICARE For Life

This program is offered worldwide; the TRICARE official site says you may use “any provider you want” but warns that higher costs may be possible when you “get care from Veteran’s Administration providers or providers who opt-out of Medicare because they’re not allowed to bill Medicare”.

 

 

TRICARE Basics

The Basics of TRICARE: An Overview

TRICARE is a health care program offered to military members, veterans, and their families.  TRICARE offers a blend of coverage and treatment opportunities shared between civilian providers and the military healthcare system. TRICARE is offered worldwide, and there are specific coverage options for remote assignments, those who are military retirees, and military family members.

The TRICARE official site reminds applicants that each branch of service determines who in its ranks is eligible for TRICARE. At press time that includes but may not be limited to:

To see if you are eligible for TRICARE, check your records in DEERS to make sure your information there is fully up to date. Then review your eligibility for TRICARE by logging into MilConnect.

Where You Get Healthcare Under TRICARE

Depending on your location, you may have the option to get on-base care at a military clinic or hospital, you may be able to choose a civilian provider in your network, or you may need to select an authorized-but-non-network option.

If you choose care on-post, know that you will be given priority based on your TRICARE healthcare plan. TRICARE Prime and TRICARE Plus patients have priority on base, so if your plan is on a lower priority you may wish to select a different option. But how do you know which plan you are on?

TRICARE Coverage Plans

There are many options, but what you qualify for from the list below depends on where you are stationed if you are still serving, whether you are a retiree or not, and whether you are on active duty or not. Your TRICARE options include:

  • TRICARE Plus
  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Select
  • TRICARE Select Overseas
  • TRICARE For Life
  • TRICARE Reserve Select
  • TRICARE Retired Reserve
  • TRICARE Young Adult
  • US Family Health Plan

Of the options listed above, active duty troops are automatically enrolled in TRICARE Prime. All others have the choice to use Prime or TRICARE Select which is a preferred provider organization plan also known as a PPO.

TRICARE Prime and TRICARE Select are offered as stateside options and overseas options. When you are assigned to a base overseas after having served stateside, you will enroll in the Overseas version of Prime or Select. That enrollment is not necessarily automatic–expect to file paperwork and update your insurance coverage.

RELATED: TRICARE Prime vs Select: How To Decide

Enrolling In TRICARE Prime When Entering Active Duty

When you ship out to your basic training, the TRICARE official site says you are “automatically covered” by TRICARE Prime but enrollment is still required. New troops typically sign up for TRICARE at their first duty assignment.

You’ll enroll any qualifying immediate family members at that time, but those family members must be registered in DEERS.

Those wondering about dental coverage should know that in most cases active duty members get dental care at an on-base clinic but there are civilian options available via the Active Duty Dental program operated by United Concordia.

Active duty troops should know that TRICARE is the only health benefit you may use. There are no out-of-pocket expenses under TRICARE Prime; those who must pay for coverage are reimbursed by TRICARE.

TRICARE For National Guard/Reserve Members and Families

Members of the Guard/Reserve and their family members may be eligible for TRICARE. You’ll need to log into the Defense Manpower Data Center or MilConnect to verify eligibility for Line of Duty Care, Active and Inactive care, and options for those who are retiring. In general, the TRICARE official site says members of the Individual Ready Reserve (IRR) may have the option to purchase dental coverage but typically do not qualify for other TRICARE benefits unless on active duty orders OR recently deactivated.

TRICARE Enrollment Seasons

Like many insurance programs, once enrolled in Prime or Select you may only make changes to your enrollment during the Open Season or after a Qualifying Life event such as a marriage, leaving active duty, or the birth of a child. Changes must typically be applied for within 90 days of the event. For some TRICARE plans (premium-based plans) you can enroll at any time.

What If I Have Other Health Insurance?

The TRICARE official site states that those with other coverage in addition to TRICARE (think Medicare or coverage offered by an employer, TRICARE supplements do not qualify as “other health insurance” and the Prime option may not be the best choice in such cases.

How Much Does TRICARE cost?

Each TRICARE plan has its own unique features, and your costs may vary depending on the nature of your plan, how many (if any) dependents you want to list in your plan, where you are assigned (stateside or overseas), and other variables. The TRICARE Compare Cost tool can help you get an idea of what to expect from your own coverage.

TRICARE Coverage for Survivors

Surviving family members may still be covered by TRICARE after the service member dies. This will depend on the military status of the service member at the time of death and the relationship of the survivor to the servicemember (a spouse or child).

In the event of the service member’s death, the survivor is not required to update DEERS but the death must be reported to the TRICARE pharmacy contractor in order to update those specific records.

However, some information may be slow to update in certain military records systems; the TRICARE officials site advises that it may be helpful to inform the Defense Manpower Data Center by:

  • Visiting a local ID card office with a copy of the death certificate;
  • Faxing a copy of the death certificate to 1-800-336-4416 or;
  • Mailing a copy of the death certificate to:

Defense Manpower Data Center Support Office
400 Gigling Road
Seaside, CA 93955-6771

TRICARE When Separating from Military Service

Some want to know if they are still eligible for TRICARE coverage when separating (not retiring) from active duty. TRICARE literature states, “You and your family may qualify for temporary health care coverage when you separate from the service”.

In order to know what you may qualify for, you will need to schedule a physical exam and a “separation history” between 90 and 180 days before your official date of separation. This process is designed to help review your “complete medical history”.

Your family members, age 18 and older, may be able to access their medical information on MilConnect up to six months after you separate, but a DS Logon is required.

There are two programs for temporary TRICARE coverage while you are separating. You may qualify for one of the following:

  • Transitional Assistance Management Program
  • Continued Health Care Benefit Program

The Transitional Assistance Management Program provides up to 180 days of premium-free health care benefits after regular TRICARE benefits end. These benefits help with your transition to civilian life.

The Continued Health Care Benefit Program (CHCBP) is a premium-based plan offering up to 36 months of temporary healthcare coverage when you lose your current eligibility. It is intended as a “bridge” between TRICARE and a replacement health care plan.

 

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TRICARE and Non-Covered Services

What to know about TRICARE and non-covered services.

TRICARE most likely covers most of what you need to stay healthy, both physically and mentally, to help you get well after an illness, or to help you heal after an injury. However, there are services they don’t cover. This can complicate things, especially if the service is something you think you need to have. Here is a little bit about what you need to know about TRICARE and non-covered services. 

What are the TRICARE exclusions?

TRICARE usually excludes services and supplies that they do not think are medically or psychologically necessary to treat or diagnose a covered illness, injury, pregnancy, or well-child care. Keep in mind that all services and supplies that are related to a non-covered condition or treatment, or provided by an unauthorized provider are excluded. According to TRICARE, these are their current exclusions:

  • Acupuncture
  • Alterations to Living Space
  • Alternative Treatments
  • Assisted Living Facility Care
  • Augmentation Mammoplasty
  • Autopsy Services
  • Aversion Therapy
  • Blood Pressure Monitoring Devices
  • Camps
  • Charges for Missed Appointments
  • Computerized Dynamic Posturography (CDP)
  • Cosmetic Drugs
  • Domiciliary Care
  • Dry Needling
  • Dynamic Posturography
  • Dyslexia Treatment
  • Elective Psychotherapy and Mind Expansion Psychotherapy
  • Elective Services or Supplies
  • Elevators or Chair Lifts
  • Exercise Equipment
  • Exercise Programs
  • Experimental Procedures
  • Fluoride Preparations
  • Gym Membership
  • Homeopathic and Herbal Drugs
  • Hospitalization for Medical or Surgical Error
  • LASIK Surgery
  • Learning Disorders
  • Long Term Care
  • Massage
  • Medical Care from a Family Member
  • Mental Health Exclusions
  • Multivitamins and Megavitamins
  • Mycotoxin Testing or Toxic Mold Testing
  • Naturopathic Care
  • Neurofeedback
  • Nursing Homes
  • Orthoptics
  • Paternity Test
  • Personal Items
  • Postpartum Stay without a Medical Reason
  • Private Hospital Rooms
  • Psychiatric Treatment for Sexual Dysfunction
  • Psychogenic Surgery
  • Retirement Homes
  • Safety Medical Supplies
  • Sensory Integration Therapy
  • Sexual Dysfunction or Inadequacy Treatment
  • Transcutaneous Electrical Nerve Stimulation (TENS)
  • Therapeutic Absences from Inpatient Facility
  • Uncovered Services and Supplies
  • Unnecessary Diagnostic Tests
  • Unnecessary Inpatient Stays
  • Unproven Procedures
  • Vestibular Rehabilitation
  • Vision Therapy
  • Vitamin D Screening

Can you still use non-covered services?

Technically you can, but you would have to pay out of pocket for them. Depending on what the service is, that might not be an option.

Can you get a waiver for non-covered services?

Yes, you can. The waiver is a written agreement between you, your provider, and your TRICARE contractor, Humana Military. You will need to request the waiver before you get the treatment. You can download a TRICARE Covered Services Waiver. If you give the waiver to your provider to fill out and they do not complete the waiver and file it before performing the service, then you are not responsible for the costs of the non-covered service.

The only time your network provider should bill you for excluded or excludable services is if you fail to inform your provider that you are a TRICARE beneficiary, or if your provider informs you that the service isn’t covered and you agree in advance and in writing to pay for the services.

A network or non-network provider that isn’t following the rules could be committing fraud, so make sure you understand what is covered and what isn’t. The good thing to remember is that things can change in the future, and it is possible that something that isn’t covered right now could be covered by TRICARE in the future. 

 

Telemedicine Options Through TRICARE For Your Mental Health

Does TRICARE Cover Telemedicine Options? Here Is What You Need to Know

Why Use Telehealth?

Telehealth can be easier on your schedule since you can use the service from anywhere. You can use your smartphone, tablet, or computer. Telehealth can also be less stressful than going to an in-person appointment.

You won’t have to worry about driving there, or finding a place to park. You might not have to worry about having to leave work or finding childcare. Telehealth can be a good way for some people to get the care that they need without having to be in an in-person environment.

How Can I Use Telehealth Services?

As a TRICARE recipient, you can use Doctor On Demand or Telemynd. Both of these services connect you with licensed therapists, psychologists, and psychiatrists.

Doctor on Demand

Doctor on Demand offers urgent care and behavioral health options. The average wait time is five minutes or less with an urgent care provider. The wait time for behavioral health is just a few days. They are open beyond regular business hours and they also have an app. You can find these behavioral health services through Doctor on Demand:

  • Anxiety and depression
  • Stress
  • Trauma and loss
  • PTSD
  • Bipolar disorder
  • Relationship issues
  • Mental health screenings
  • Grief

Keep in mind that Doctor on Demand isn’t currently available to active duty service members. There is however a pilot program in TX for active duty service members to receive urgent care through Doctor on Demand.

Telemynd

Telemynd is a nationally recognized partner of TRICARE and provides behavioral health services, psychology, and psychiatry services. They match you with a provider who is uniquely qualified to treat you. There will be zero copays or cost shares, no predetermined maximum sessions per calendar, no authorization required for telebehavioral health for TRICARE Prime active duty family members and retirees, and 100% secure sessions conducted over video.

Telemynd also offers the MyCare Intensive Support Program. This program is remote intensive mental health care for clients with passive suicidality. It provides targeted ongoing support over 8-12 weeks, includes psychiatric care, psychotherapy and care coordination, and provides a transition plan to ongoing care after the program ends.

They have also stated on the site that “MyCare Intensive Support Program is not a crisis resource. If this is an emergent crisis or you are experiencing thoughts of harm to yourself or others, please call 911 immediately. For a list of crisis resources, click here.”

What Is the Copay?

Your copay will be the same as it normally is. However, during COVID-19 there are zero copayments or cost-shares for telemedicine. This could change at any time.

Active duty service members will need a referral before getting care under the telemedicine benefit. Active duty family members and retirees shouldn’t but there are some exceptions.

Telemedicine can be a good option for some TRICARE recipients. To learn more, visit the TRICARE page on telemedicine or the Humana page on telemedicine.

 

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The Near Patient Program is Helping Military Families Overseas

The Near Patient Program is Helping Military Families Overseas

Last September, the Near Patient Program was started to give TRICARE Families overseas extra support. The program will allow families to find the access they need to medical and non-medical professionals in their overseas locations. Oftentimes when you are stationed overseas, you might have some trouble figuring out where to go for your medical needs. The Near Patient Program can help with that. 

Michael Griffin, program analyst with the TRICARE Overseas Program Office at the Defense Health Agency, stated, “The Near Patient Program helps beneficiaries based in certain overseas locations with their health care needs. Service members and their families can often experience cultural and language barriers in a foreign country. This program makes navigating the overseas health care system easier, so families have a more positive patient experience.”

The Near Patient Program team is made up of both clinical and non-clinical staff who will assist families in navigating the overseas health care system. The teams work with overseas civilian providers, MTFs, the TRICARE area office (TAO), and Combatant Commands (COCOMS) to address the patient’s medical or cultural questions.

What Services Does the Near Patient Program Provide

Listed on the Tricare Overseas website is this list of what they provide:

  • Explain the in-country health care system based on local expertise
  • Break down local medical practices and help bridge cultural gaps and nuances 
  • Answer medical questions and help to improve patients’ understanding of care
  • Provide comprehensive assistance from beginning to end of the patient journey 
  • Oversee inpatient admissions and collaborate with others, as appropriate
  • Work with local providers to ensure medical records collection and resolution of non-clinical issues

As you can see, this can be very helpful to those overseas who find the medical process confusing or just need reassurance that they are getting the best care possible. 

Who qualifies for the Near Patient Program? Those who are enrolled in TRICARE Prime Overseas or TRICARE Prime Remote Overseas. Service members and their families also need to be in one of the following countries:

  • Germany
  • Italy
  • Benelux (Belgium, Netherlands, Luxembourg)
  • Spain
  • Greece
  • Poland
  • Bahrain
  • South Korea
  • Japan

Beyond having TRICARE Overseas and being stationed in one of those locations, you will need to make sure that you or a family member has opened a case with the TRICARE Overseas Program in the past two years.

If you are stationed overseas and not near a program, you can find support through the TOP Regional Call Center

How do you contact your local Near Patient Program team? You would do so through the MyCare Overseas beneficiary app. You can use the portal live chat feature. You can find this app in the Apple Store or on Google Play. They also have a web-based portal to pull up on your laptop or computer. 

Make sure to take advantage of this program if you are overseas or will be in the future. This will help you during your time overseas and allow you to continue to get the medical care you and your family need.

 

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The 10 Best Medical Benefits for the Military and Their Families

Ranking the Best Medical Benefits for Members of the Military and Their Families

TRICARE is a big part of being a service member. TRICARE is the health care program of the United States Department of Defense Military Health System. Within TRICARE and the military as a whole there are many different medical benefits. Here are 10 of the best of those.

1) Breast Pumps and Supplies

TRICARE offers breast pumps, breast pump supplies, and breastfeeding counseling at no cost to new military moms. This includes service member moms as well as military spouses, and every branch qualifies, including the National Guard and Reserves. This benefit allows for one breast pump for every one birth event, either birth or adoption.

2) United Concordia

United Concordia administers the TRICARE Dental benefit. This is separate from the rest of TRICARE. You would use your Department of Defense Self-Service login to create your account. The monthly premiums are based on the sponsor’s military status and type of enrollment.

3) Pharmacy Benefit

When it comes to using a pharmacy, you can use the military pharmacy at no cost or go to a local pharmacy. The big ones are Kroger, Publix, Walgreens, Rite Aid, and CVS. You can also use TRICARE Pharmacy Home Delivery, pretty much anywhere you might be stationed.

4) TRICARE for National Guard and Reserves

If you serve in the National Guard or the Reserves, you can still use TRICARE. You will have to pay a monthly premium to get what is called TRICARE Reserve Select. As of 2022, the cost is $229.99/month for the service member and family and $46.70/month for individuals.

5) Military Crisis Line

The Military Crisis Line is a phone number, online chat, and text-message service that is free to service members including the National Guard and Reserves, and veterans. You don’t have to be registered with the U.S. Department of Veterans Affairs (VA) or enrolled in a VA health care to use the line.

6) WIC Overseas

WIC or the Women, Infants, and Children Overseas Program provide families with nutritious food, tips on how to prepare balanced meals, nutrition and health screenings, and other resources that help you and your family lead healthier lives. WIC Overseas is available to civilian employees, DoD contractors, family members, and members of the uniformed services.

7) ECHO

ECHO stands for Extended Care Health Option and provides financial assistance to beneficiaries with special needs to an integrated set of services and supplies. You must be enrolled in EFMP (Exceptional Family Member Program) through the sponsor’s branch of service. Eligible beneficiaries are those who are diagnosed with moderate or severe intellectual disabilities, a serious physical disability, or an extraordinary physical or psychological condition.

8) TRICARE Young Adult

TRICARE Young Adult is for qualified adult children. It can be purchased after eligibility for regular TRICARE coverage ends at age 21(or 23 if in college). They must be unmarried and an adult child of an eligible sponsor. They must also be 21, but not yet 26 years old, and not eligible for enrollment in an employer-sponsored health plan based on their own employment. They also can’t be otherwise eligible for TRICARE. You can choose between Select and Prime and there will be monthly premiums and the plan and sponsor’s status determine what you pay for covered services.

9) TRICARE Autism Care Demonstration (ACD)

The TRICARE Autism Care Demonstration covers the applied behavior analysis (ABA) series. This began on July 25, 2014, and was authorized to run through December 31, 2023. You must be enrolled in a TRICARE health plan and diagnosed with ASD by an approved provider. The changes that were made in 2021 worked to develop a more comprehensive ACD program that addresses the needs of all beneficiaries with ACD and integrates all potential services for the best possible outcomes. You can read more about it here.

10) TRICARE for Life

TRICARE for Life is a Medicare wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Part A and B. Coverage is automatic if you do have Medicare Part A and B, and you must pay Medicare Part B premiums. There are no enrollment fees and premiums are based on income. Coverage is available worldwide.

 

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TRICARE Covers Doulas, Lactation Consultants, and Lactation Counselors

What You Need to Know About TRICARE Covering Labor Doulas and Lactation Consultants and Counselors

If you have ever given birth, you may already know how valuable a labor doula, lactation consultant, or lactation counselor can be. As a part of its 5-year Childbirth and Breastfeeding Support Demonstration, TRICARE began covering labor doulas, lactation consultants, and lactation counselors on January 1, 2022, as long as certain conditions are met. 

  • The care must be from labor doulas, lactation consultants, and lactation counselors who meet TRICARE certification requirements for their services to be covered. 
  • They won’t be offered at military hospitals and clinics. 
  • Beneficiaries will need to double-check to make sure if the provider they want to use is in-network or not.
  • You should be able to nominate certain providers if yours is not in-network.
  • You will not need to have a referral for services under this demonstration. 

The Childbirth and Breastfeeding Support Demonstration’s purpose is to study the impact of adding these providers and services when it comes to the cost, quality of care, and maternal and fetal outcomes for the TRICARE population. This is required by the National Defense Authorization Act for Fiscal Year 2021. 

Labor Doulas

Only labor doulas, often called birth doulas or even birth assistants qualify. Labor doulas are not medical personnel and can not provide medical assistance. They provide support and guidance to the pregnant woman and her family, preparing for labor, during the birth, and immediately after the baby is born. 

In 2019, the American College of Obstetricians and Gynecologists (ACOG) stated, “Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.” In addition, the benefits of using a doula include possible shorter labor times, a decreased need for pain medication, fewer c-sections, and fewer reports of dissatisfaction with the experience of labor. 

TRICARE will accept doulas who have been certified by: 

  • BirthWorks International
  • Doulas of North America (DONA) International
  • Childbirth and Postpartum Professional Association (CAPPA)
  • International Childbirth Education Association (ICEA)
  • toLabor

Breastfeeding Support, Lactation Consultants, and Lactation Counselors

According to TRICARE, “Lactation counselors have received specialized training to aid in breastfeeding and infant nutrition from breast milk, and generally provide breastfeeding counseling to support normal lactation and breastfeeding parents of healthy, full-term infants and Lactation consultants have the highest level of breastfeeding training and may be necessary when complex problems surrounding breastfeeding arise.”

The U.S. Preventive Services Task Force (USPSTF) recommends breastfeeding counseling as a preventive service for pregnant women, new mothers, and their children. They recommend interventions both during pregnancy and after birth to support breastfeeding. Breastfeeding is good for babies, and also can impact maternal health. 

Because of the 2015 NDAA, beneficiaries have had access to up to six breastfeeding/lactation counseling sessions per birth event. Military moms are also allowed one no-cost breast pump to help with breastfeeding per birth event. 

You can find the full “Establishing a TRICARE Childbirth and Breastfeeding Support Demonstration” by the Defense Department here that was posted back in October.  

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Military Benefit Changes for 2022

Military Benefit Changes for 2022

These are the changes that have been announced so far. Please keep checking back, as we will continue updating new changes to your military benefits for 2022.

TRICARE Updates 2022

TRICARE Pharmacy Network

TRICARE Pharmacy Network will have updates going into 2022. As of December 15th, 2021, Walmart and Sam’s Club will no longer take TRICARE. CVS will be added after being away from the network for the last five years.

 

>> Have questions about you or your spouse’s military benefits? We’ve partnered with the Veterans Education Project to help find the answers you need. Find the answers to your benefits questions today!

 

TRICARE Premiums

TRICARE premiums will change for reservists, retired reserves, and some military family members. 

Monthly premiums for TRICARE Reserve Select will be going down. For individuals, they will drop 1% from $47.20 to $46.70. For families, it will go down 3.8% from $238.99 to $229.99. 

Monthly premiums for Retired Reserve will be going up. For Individuals, they will be changing from $484.83 to $502.32. For families, they will be changing from $1,165 to $1,206.59. 

TRICARE Young Adult monthly premiums will also be going up. TRICARE Young Adult Select Premiums will increase from $257 to $265, and TRICARE Young Adult Prime Premiums will increase from $459 to $512. 

Continued Health Care Benefit Program quarterly premiums are also going up. For the member, the amount is changing from $1,599 to $1,654, and for member and family, it is changing from $3,605 to $4,079. 

You should also check on the TRICARE fees that may have changed for 2022 on their website.

COLA Increases

COLA will have an increase of 5.9% in 2022. This is a big jump from the 2021 increase of 1.3%. The last time COLA was close to this percentage was in 2008 with an increase of 5.8%. 

COLA increases are based on the increase in the CPI-W, from the 3rd quarter of 2020 through the third quarter of 2021. Increases can change year to year. The last few years have seen 0.3% in 2017, 2.0% in 2018, 2.8% in 2019, and 1.6% in 2020. Military retirees, those who receive disability payments, or other benefits from the Department of Veterans Affairs, federal retirees, as well as Social Security recipients, will all see a 5.9% increase in their monthly payments.

Retirement Pay

When it comes to retirement pay, it is important to keep in mind that since the increase for the year is calculated differently than active duty pay, the raises can seem a little different based on the year. Based on the 5.9% increase, in 2022 you would receive $59 for every $1,000 in government benefits you receive. If a veteran is receiving around $2,000 a month as retirement pay, they would see an increase of $118 a month.

A veteran who entered military service after July 31, 1986, has had the option of going with the “Career Status Bonus” or (CSB)/REDUX instead of the “High 3-year average” option with regards to retirement pay. This means that they would have received $30,000 during their 15th year of service and will see a reduced retirement rate until they are 62 years old. This also means that their COLA increase is reduced by 1%, which would change the amount of the increase they would see in 2022.

VA Disability

VA Disability payments would also increase in 2022. A veteran with a 60% rating would see about a $51 a month increase, while a veteran with a 100% rating would see about an $85 a month increase. The amount they would receive depends on their rating as well as their veteran-dependent status. The rate for 2022 would be 5.9% and is based on COLA rates.

Social Security Payments

According to the Social Security Administration, the average monthly Social Security benefit in June 2021 was $1,555 for the retired worker. Based on this, the average beneficiary would see an increase of $87 in 2022.

3.0% Military Pay Increase

A 2.7% pay raise has been proposed for 2022. This is a little less than last year which was 3.0%. For junior enlisted, this would be an increase of around $768 a year.

The main guideline for determining military pay raises comes from the quarterly report of the US Employment Cost Index (ECI) which is put out by the Bureau of Labor Statistics (BLS).

The fiscal 2022 NDAA will need to be passed and then the 2.7% raise will take effect as of Jan 1, 2022.

BAH 2022 Rates

BAH is the Basic Allowance for Housing. The 2022 BAH rates have not been posted yet and the DOD’s BAH calculator still needs to be updated. You can use this to find out how much you will be bringing home for BAH in 2022 once updated. Remember, if your rate goes down you are grandfathered into the old rate unless you move or change rank.

BAH is based on your rank, dependent status, and geographic location. BAH is intended to cover 95% of your housing costs. This % can change each year and was 99% just a few years ago. Your rates are based on your duty station zip code.

Your new BAH rate will go into effect on January 1st and you will see it in your January 15, 2022 paycheck.

The proposed BAH increase will need to be approved by Congress and the President. That being said, individual rates are based on the cost of living in your exact location. 2.7% is being proposed for 2022. In 2021, BAH was 2.9%.

BAS 2022 Rates

BAS (Basic Allowance for Subsistence) 2022 rates have not been updated yet but 2.3% is proposed. BAS had a 3.7% increase in 2021. Rates have not changed all that much in the last few years since they are based on the cost of food.

BAS is meant to be used to pay for food for enlisted and officers. It is only intended to help pay for food, not to cover all the costs. The rate also does not change based on dependents because the money is not meant to cover food for family members.

The increase will take place on January 1st and you will see it on your January 15th, 2022 paychecks.

We will update as more 2022 military benefits changes are announced!

 

>> Have questions about you or your spouse’s military benefits? We’ve partnered with the Veterans Education Project to help find the answers you need. Find the answers to your benefits questions today!

 

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TRICARE Pharmacy Network: Walmart & Sam’s Club Out

Walmart and Sam’s Club Are No Longer Part of the TRICARE Pharmacy Network

Where can you go instead?

As of December 15th, 2021, Walmart and Sam’s Club will no longer take TRICARE. This will be a big change and you may be wondering what to do if you normally get your prescriptions from these places. Try not to worry too much, there are still many options for getting your prescriptions.

Keep that December 15th deadline in mind and make sure to transfer your prescriptions over before then. If you keep them at Walmart or Sam’s Club past the date of the change, they will be considered a “non-network” pharmacy. You can still get the prescriptions, however, you would need to pay full price and then submit a claim for reimbursement. These reimbursements are also subject to deductibles or out-of-network cost shares and copays.

Your Best Bet is to go to a Military Pharmacy

When it comes to fulfilling your prescriptions, your best bet is to go to a military pharmacy. You can do so for free. Most are connected to military hospitals or clinics but some are free-standing.  Here is where you can find a military pharmacy near you.

TRICARE Pharmacy Home Delivery

You can also use TRICARE Pharmacy Home Delivery, which will ship to any address in the US or US territories to include APO/FPO addresses. Overseas, you must use your APO/FPO address or embassy address if you are assigned to one and don’t have an APO/FPO address. You can’t use your APO/FPO address for refrigerated drugs, and it is not available in Germany.

In the US or US territories, all beneficiaries besides active duty service members will need to get certain maintenance drugs through either TRICARE Pharmacy Home Delivery or at a military pharmacy.

Where Else Can You Go?

You can also use retail network pharmacies. There are more than 56,000 locations in the US and US territories. They are not available in American Samoa. You also can’t find network pharmacies in other overseas locations. In the Philippines, you must get your prescriptions at a certified pharmacy.

With the network pharmacies, you would have your provider send your prescription electronically or hand-carry a written prescription to the pharmacy.

Some big pharmacies that are network pharmacies are:

  • Kroger
  • Publix
  • Walgreens
  • Rite Aid
  • CVS (coming soon)

After leaving the TRICARE network for 5 years, CVS will be coming back.

In addition, local pharmacies can also be in-network. You can search for those in your local area to see exactly where to go on the TRICARE website.

 

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Tricare Dental Premiums to Increase Soon

Increases Slated for Tricare Dental Premiums

The Tricare Dental Plan (TDP) is a dental insurance opportunity offered to all branches of military. The dental benefit is regulated by United Concordia and is available to eligible active-duty family dependents, eligible National Guard and Reserves service members, and their family dependents. It is offered to both in the continental United States (CONUS) and overseas (OCONUS). However, beginning in May 2021, the premiums for Tricare Dental coverage will be increasing slightly. Service Members should start noticing the coverage increase during the May pay period. The increases will range from $0.05 to $0.47 depending on the Service member’s status and the number of dependents covered by the program.

Active-Duty Coverage

For dependents, whose Service Member is active duty, there are 2 levels of dental coverage.  The active-duty member is not included in the rates.

  • Single coverage is either for a spousal dependent or a single child
  • Family rates are for a spousal dependent and any number of children, or more than one child without a spouse

National Guard and Reserve in a Drilling status

For non-activated National Guard, selected reserve component (what most individuals visualize as “the reserves”), and mobilization Individual Ready Reserve (IRR) component, there are 4 levels of dental coverage.

  • The sponsor only provides coverage to the service member
  • Single coverage does not provide coverage to the service member but covers one family dependent: either a spouse or a child
  • Family coverage includes the spouse and all young dependents but does not cover the military member
  • Sponsor and family include the service member and their spouse and all children

Non-Mobilization IRR

For non-mobilization IRR, there are also 4 tiers of dental coverage.

  • The sponsor only provides coverage to the military member
  • Single coverage does not provide coverage to the service member but covers one family dependent: either a spouse or a child
  • Family coverage includes the spouse and all children but does not include the service member
  • Sponsor and family include both the military member and their spouse and all children

You may need to verify that your payment amounts are adjusted to the new rate

Individuals who receive Tricare Dental benefits and do not pay using the military payroll payment option need to verify that their payment amounts are adjusted to the new rate. If fees are not paid upon the due date, you could be disenrolled from the Tricare Dental program.

What happens if I’ve been disenrolled from the Tricare Dental program?

Once you have been disenrolled, you are ineligible to re-enroll for at least 12 months.

Who’s eligible?

To be eligible for enrollment into the TDP, your sponsor must have at least 12 months remaining on their military contract at the time of enrollment. Eligible family members include spouses and children until age 21 (or age 23 if full-time students). Therefore, you enroll for 12 months.

Cost-Sharing

In addition to monthly premiums, Tricare Dental Plan coverage offers cost-sharing for most of the service branches.  This ranges from from 0% to 50%.

Tricare Dental Maximum Payment Limits

There are also additional maximum payment limits of:

  • $1,300 per year per person for regular coverage
  • $1,200 per year per person for services related to accidents
  • $1,750 lifetime maximum limit per individual for orthodontic coverage benefits

Is Tricare Dental right for you?

For most families and situations, Tricare Dental Plan coverage is a great option. However, some individuals may find it more cost-effective to “self-insure” for dental expenses.  Individuals in the National Guard and reservists and retirees in particular may find “self-insuring” more cost-effective. The cost-benefit analysis for each situation needs to include:

  • family size
  • genetic dental disposition
  • personal dental habits
  • general dental health

There is obviously no one correct answer for every family.

How to Enroll

To enroll in the Tricare Dental Program, visit the Tricare enrollment page and register online. Unfortunately, if you are OCONUS, you cannot enroll online; see the instructions on the enrollment page for more information.

 

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TRICARE to Provide Free Physical Therapy for Low Back Pain

Free Physical Therapy for Low Back Pain to Be Provided by TRICARE

The Defense Department recently published a notice outlining a new demonstration that will begin January 1, 2021 and run until December 31, 2023. TRICARE beneficiaries in select states who have a documented diagnosis of low back pain will receive three free physical therapy visits. The goal of the demonstration is to determine whether waiving physical therapy cost-sharing will incentivize more beneficiaries to attend physical therapy, which may in turn reduce overall healthcare costs and improve patient outcomes.

Physical Therapy and Low Back Pain

Physical therapy is generally recommended as a first line of treatment for those with low back pain episodes lasting longer than a few weeks, and even for those who have a condition called spinal stenosis. Stenosis can be treated with surgery, but doctors usually recommend more conservative measures first to avoid potential complications, since physical therapy is much less invasive. Physical therapy could provide significant relief for patients with low back pain, therefore avoiding the need for surgery or other interventions and medications.

The DOD’s publication noted that physical therapy is considered a high-value treatment, in contrast to low-value treatments, which would include opioids as a first- or second-line treatment, bedrest, and surgery for non-specific back pain. These low-value treatments do not always have the best patient outcomes and can result in unnecessary healthcare costs and opioid dependence.

States Where the Program Is Available

Those who are over the age of 60 are more prone to lower back pain and problems. Unfortunately, physical therapy can be expensive, with co-pays as high as $41 for outpatient specialty visits for TRICARE Retired Reserve beneficiaries. These costs can add up for those on a limited income. For this reason, the program will include states with the highest TRICARE retiree population:

  • Arizona
  • California
  • Colorado,
  • Florida
  • Georgia,
  • Kentucky
  • North Carolina
  • Ohio
  • Tennessee
  • Virginia

The program is not limited to retirees, and anyone in these states can take advantage of the free therapy visits.

Program Eligibility

Within the ten states that are eligible for the program, there are some additional requirements:

  • Only new physical therapy episodes will be eligible.
  • The physical therapy appointment(s) must take place in an eligible state.
  • Physical therapists and physical therapy assistants must be licensed.
  • Physical therapists must be in-network with TRICARE.

Fortunately, there will be no limitation on the length of time between when the low back pain episode happened, and when the physical therapy will take place, the only limitation being that the beneficiary has not already had physical therapy for the same episode of back pain.

In addition, moving from an eligible state to a non-eligible state will disqualify beneficiaries for the free therapy, but a beneficiary who moves from a non-eligible state to an eligible one will qualify for free therapy if they meet the above guidelines.

Will this Program Be Permanent?

There is a potential for the demonstration to become permanent if patient outcomes improve and healthcare costs decrease. The program would then be made available to the entire TRICARE population.

 

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More Provider Choices for Some TRICARE Recipients

TRICARE Recipients May Have More Provider Choices

There are a number of changes to the TRICARE program every year. The most recent proposed change will allow the option for some military families and retirees to choose a different health network apart from the current East and West regions available. Presently, Humana Military Healthcare Services holds the TRICARE East contract and Health Net Federal Services holds the TRICARE West contract.

RELATED: New TRICARE Select Fees for Retirees

T-5, The Fifth Generation of TRICARE Managed Care Support Contracts

In August of this year, the Pentagon delivered a report to Congress addressing the fifth generation of TRICARE managed care support contracts, known as T-5. A number of issues were raised by a congressional committee in regards to the current contract structure.

The Current Contract Structure:

  • Does not support innovation, beneficiary choice, or market-based management strategies
  • Stifles competition
    • Incumbents have significant advantage
    • Few private sector health care delivery companies have financial resources or relevant past performance to compete for such large scale contracts
  • Limits the Defense Health Agency (DHA) and does not conform with the reforms previously directed by the committee to:
    • Provide the DHA with options to swiftly address contractor performance issues or shortfalls
    • Incentivize contractors to comport with the most high quality, innovative, and cost-effective industry best practices to improve quality of care for TRICARE beneficiaries
    • Maximize returns on DHA investment

The reforms mentioned by the committee are in reference to the 2017 National Defense Authorization Act, which required the Department of Defense (DOD) to make significant changes to TRICARE, regularly report on the structure of its managed care contracts, and explain how it will comply with legislation that patients will be afforded more health care choices – something the DOD said it will carry out in phases and with wide-spread education of changes to beneficiaries.

“Multiple Provider Network” Concept

The proposed T-5 changes would involve partnerships between winning TRICARE contractors and local health plans/networks in the regions, creating a “multiple provider network” concept. The congressional committee hopes that by shifting the next iteration of TRICARE contracts to this construct, it will allow private sector support plans to better serve beneficiaries. Better service would come by more closely matching local beneficiary needs with innovative service and care capabilities, improving integration with military treatment facility leadership, and facilitating a more agile, cost-effective approach for the DOD.

In a second August report, sent from the DHA to the Senate Armed Services Committee, the implementation of a pilot program with these proposed changes was set out, testing the concept only in certain areas. Contracts will be issued directly to provider networks, enabling them to accept TRICARE beneficiaries – an approach which will allow local/regional “plans and providers to focus solely on delivering health care services rather than these back office activities [and hopefully] lead to more plans and providers competing for TRICARE business.”

This pilot program is already underway in Atlanta, where the TRICARE East Region contractor Humana Military has partnered with Kaiser Permanente in an agreement through 2023 to offer TRICARE Prime to local residents. Kaiser Permanente is one of the nation’s largest not-for-profit health plans, serving 12.4 million members and continuously developing and refining medical practices to help ensure that care is delivered in the most efficient and effective manner possible. According to Humana Military, this pilot program will test whether such a partnership actually can improve the quality of care while also reducing costs for TRICARE beneficiaries.

The Pentagon-released draft request for proposal for the T-5 contracts could be worth upwards of $58 billion. Responses to the draft from interested contract bidders are due September 18.

 

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Watchdog Reports Troops May Not Be Receiving Adequate Health Care

Watchdog Reports: Troops and Families May Not Be Receiving Adequate Mental Health Care

Even before the COVID-19 pandemic, military families were having trouble getting the mental health care they needed, according to new data from an online survey conducted in late 2019. Whether they are active-duty families, military retiree families or veteran families, about half reported they were satisfied with their ability to get mental health appointments, according to the Military Family Advisory Network’s family support programming survey. The survey was open online from Oct. 7 to Nov. 11, and 7,785 people participated. About 42 percent of those were active-duty members and spouses. Most respondents — 83 percent — said they had not used mental health crisis resources; those who had used such resources were more likely to be spouses of veterans or retirees. Of the 7,785 people who participated, about 4,000 answered health questions when they were directed based on earlier answers, and even fewer answer the mental health questions.

According to an article by Militarytimes.com, thousands of troops and their family members may not be getting the mental health care they need because of a variety of issues with the Defense Department health care system, according to a new report from DoD auditors. Auditors with the DoD Inspector General found that DoD is not consistently meeting the requirements under law and by DoD policy, for access to outpatient mental health care, causing patients to experience delays. Generally, the wait time for an urgent care visit must not exceed 24 hours; a routine visit must not exceed one week, and a specialty care referral must not exceed four weeks.  Auditors also found that — pre-COVID-19 — 53 percent of all active duty service members and their families who got referrals to TRICARE because they needed mental health care did not receive the care. It is not known why, because health officials do not track the reasons. That represented an average of 4,415 out of 8,328 per month at those 13 MTFs who did not receive that care.

At one military treatment facility, a psychiatrist specializing in child and adolescent care gave auditors three examples of how delayed treatment may have contributed to patient safety issues, including second suicide attempts, and hospitalization. Another mental health provider said it could take up to seven weeks for a follow-up visit and the clinic is not tracking how well they can treat a patient once the patient is in the clinic. Nine of the 13 MTFs reported they were not able to meet evidence-based treatment guidelines or monitor treatment dosage for patients.

Auditors found that seven of those 13 military treatment facilities or their supporting TRICARE networks did not meet the access standards for special mental health care each month.

“Our survey, which was fielded before COVID-19, found that military families experienced difficulty scheduling mental health care appointments,” said MFAN’s Executive Director Shannon Razsadin. “That’s something we never want to hear, and we are concerned about the additional barriers caused by COVID-19.”

Top obstacles for getting mental health care for currently serving families were lack of available appointments, time to attend appointments and concerns about negative career implications, according to the survey. The report, which adds statistics to back up what military families have long known, recommends exploring telehealth as an option for providing more access to mental health care. Another reason for problems with access to care was inadequate staffing. In interviews during site visits to the 13 MTFs, staff members at 11 of the MTFs said they would need more staff to meet standards for access to mental health care, or to care for both active duty members and their families. The Military Health System does not have a system-wide model to identify the appropriate levels of staffing needed in MTFs and in Tricare, auditors found. The auditors recommended that health officials develop a single system-wide staffing approach for the behavioral health system of care, that estimates the number of appointments and number of personnel needed.

As recommended by IG auditors, DHA will establish a standard process for mental health assessments, but the elements of that assessment will be tailored to each patient’s needs, officials stated in their response. Some MTF providers told auditors they were concerned with the adequacy of the Tricare network in their area, in terms of enough mental health care providers, which has long been a concern of Tricare beneficiaries.

During the pandemic, telehealth through Tricare has indeed increased. Tricare has covered telehealth for several years for certain medically necessary services. Most of the families who participated in the survey had never used telehealth, but the good news, Razsadin said, is that more than one-third of the active-duty families said they would be likely or very likely to use it. Tricare officials have already taken steps to make it easier to use telehealth, such as temporarily waiving cost-shares and co-payments for all covered, in-network telehealth services during the pandemic. They have temporarily relaxed some licensing requirements across state lines to allow providers to treat patients who live in a different state. There has long been a shortage of mental health providers across the country. Tricare officials have temporarily expanded some types of care eligible through telehealth and allow coverage for telehealth consultations by telephone. Officials have said they will evaluate whether to make some of the expansions permanent.

That may be an example of a silver lining in the COVID-19 pandemic, said Razsadin. “It’s given us an opportunity to get more flexible in how we provide different types of support. I think this is an eye-opening experience… This is an opportunity to also look at what works and what could work longer term as we support military families.

 

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TRICARE Doula Coverage Bill Proposed

A bill calling for the Secretary of Defense to provide additional resources, including the services of doulas, for pregnant beneficiaries in the Tricare program, was introduced in Congress this May. The sponsors for this bill, Senators Kiersten Gillibrand (New York) and Richard Blumenthal (Connecticut) propose that the additional support would actually help to cut heath care costs by improving maternal health.

What Is a Doula?

Doulas are professionally trained in childbirth to provide physical, educational, and emotional support to mothers in pregnancy, during labor, and postpartum. Their specific services vary greatly, however, because they are shaped according to the individual needs of the mother or couple they work with.There are different types of doulas, but their primary purpose is the same—doing whatever you need, within reason, to help you be the parent you want to be.

Common Doula Services at Different Stages of Pregnancy

Birth Doulas

  • Meet with the expectant mother, and her partner if applicable, spending time to get to know them and their birth preferences, what they hope for and expect.
  • Are available to answer questions or concerns as they come up leading up to the birth.
  • Go on call to be available 24/7 near to the due date to promptly arrive where the birth will take place, either at home or in hospital.
  • Offer help in breathing practices and relaxation techniques.
  • Encourage the partner, when applicable, to participate in the birth, guiding them on how to do so.

Postnatal Doulas

  • Provide emotional support for mothers and couples as they adjust to the new addition to the family and all the changes that brings.
  • Answer questions and concerns about anything that impacts the infant and its place in the family, like when should the parent(s) return to work, breastfeeding difficulties, sleep issues, etc.

Why Should Military Moms Have Access to Doulas Covered?

  • While all families need extra emotional support through pregnancy and childbirth, military spouses and enlisted mothers are at higher risk of stress and isolation during this exciting time.
  • Frequent moves means continuously building communities from scratch, so often times support in the form of family and friends in a daily capacity is low or non-existent.
  • Deployments and other mission requirements which cause spousal separation during pregnancy may take away the expectant mother’s only support.
  • Expectant mothers/families may PCS during a pregnancy, disrupting their consistency of care.
  • If delivering on base, the medical staff in the hospital may PCS or deploy themselves over the course of a patient’s pregnancy.

These possible, even probable, inconsistencies of support and care could be eased by having access to a doula.

Operation Special Delivery

Operation Special Delivery is a national non-profit organization founded after 9/11 initially to support expecting mothers whose spouses were deployed, injured, or who had died in the line of duty. They have built a network of professional doulas who offer their services to qualifying military families for a set fee of $500.

Qualifications:

  • Military personnel ranked E-7 and below, including Active Duty, Reserve, and Veterans
  • ALL deployed military personnel, regardless of rank

You can find a participating doula in your area by submitting your information on the Operation Special Delivery website.

 

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New TRICARE Select Fees for Retirees

New TRICARE Select Fees For Retirees Begin January 1, 2021

On June 22nd, TRICARE announced in a press release that TRICARE Select Group A retired beneficiaries must pay for enrollment fees “in order to maintain their health coverage.” The new fees are set to take effect on January 1st, 2021, and this is the first time that TRICARE beneficiaries will be required to pay monthly enrollment fees.

What’s Going On?

Dr. Danita Hunter, director of the TRICARE Health Plan at the Defense Health Agency, stated that this change is mandated by Congress and that they “are communicating this well before the change is implemented so beneficiaries can be informed about the change, as well as their TRICARE plan and cost options.”

The change taking effect on New Year’s Day, 2021, was set in motion back in 2017 when the change was mandated by Congress in the National Defense Authorization Act for Fiscal Year 2017. The Defense Health Agency was granted permission by Congress to delay the implementation until the 2021 calendar year.

Who is Impacted?

The changes only affect the Group A retirees and their family members enrolled in TRICARE Select. You are considered Group A if your initial enlistment began before January 1st, 2018. Active duty family members enrolled in TRICARE Select will experience NO change, and will not pay enrollment fees.

What Do I Do if This Affects Me?

If you are enrolled in TRICARE Select and fall into Group A, then you must set up a monthly allotment through your Department of Defense (DoD) pay center for your monthly payments to start on January 1st, 2021. If you are a sponsor and you do not receive funds through a DoD pay center, you can set up payments via electronic funds transfer (EFT), credit card, or debit card. Please note that the EFT must be from a U.S. bank.

TRICARE’s website does indicate that your Regional Contractor will contact you soon to assist you with setting up payments. Expect this contact from TRICARE later in the summer.

What are the Enrollment Fees for TRICARE Select Group A retirees?

The enrollment fees that are set to begin on January 1st, 2020 are:

  • Individual Plan: $12.50 per month
  • Family plan: $25 per month

These fees will be collected via monthly installments from the sponsor’s military pay system where retirement pay is disbursed.

Are There Exemptions?

If you have TRICARE Select, you must pay enrollment fees, unless you are:

  • An active duty family member
  • A transitional survivor
  • A medically retired retiree or family member

Other Changes starting January 1st, 2021

In addition to the fees listed above for those retirees in TRICARE Select Group A, the catastrophic cap, which is the max amount you will pay out-of-pocket per year, will increase from the current $3,000 to $3,500 beginning next year. On a positive note, your TRICARE Select enrollment fees will apply towards your catastrophic cap.

What if I Take No Action?

If you are TRICARE Select Group A, and you do not take action to set up your monthly payments, then you will be disenrolled from TRICARE Select for failure to pay enrollment fees on January 1st, 2021. You will have 90 days from your last paid through date to request reinstatement, and you must contact your regional contractor to request reinstatement.

Also, if you do not take action, you will only be able to get care from a military hospital or clinic if space is available.

Final Thoughts on New TRICARE Select Fees

From the time of its announcement until the time of its implementation is six months. These new enrollment fees will affect many of us, and the timing may not be the greatest. Granted, the legislation was passed back in 2017 before COVID-19 was a thing. However, we are months into a 15-day quarantine that was intended to flatten the curve to prevent the spread of the coronavirus; which means that we don’t know what to expect in January 2021.

The idea that veterans and their families may lose health coverage for inaction, to a bill that was passed before the world started battling a pandemic, is troublesome. TRICARE is just following orders as they are an appropriation of legislation and cannot create policies like this on their own. If this legislation bothers you, I encourage you to write to your congressional leaders. I know I have.

(Image courtesy of Vitaliy Vodolazskyy via 123rf.com)

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Free TRICARE to Cover Dependents Until Age 26?

TRICARE Extension Possible for Dependents

On January 25th, Congresswoman Elaine Luria (D-VA) reintroduced the Health Care for Military Families Act, (H.R. 475), which would allow young adults to stay on their parents’ TRICARE plan until the age of 26, and without an increase in premiums.

This could save some military families over $400 per month.

Similar, Equal Access as Civilians Under ACA

The legislation, which was also introduced in June of 2020, has been brought to the table again by Representative Luria and her co-sponsor, Representative Michael Waltz (R-FL). 

“The Affordable Care Act allows young adults to stay on their parents’ health plans until 26, however, the ACA did not give military families this same benefit,” announced Congresswoman Luria in a press statement. “During this public health emergency, it is more important than ever to provide our service members and their families with affordable and accessible health care.”

“Our service members have risked everything to protect our nation and preserve our freedoms, they should not have to worry about the health and welfare of their families while serving our country.”

– Congressman Waltz

“Our service members have risked everything to protect our nation and preserve our freedoms,” added Congressman Waltz. “They should not have to worry about the health and welfare of their families while serving our country. That’s why I’m proud to support this legislation to support our military families, provide an additional retention-incentive for our service members, and ensure the children of our troops have the same, equal access to health care as their civilian counterparts.”

Coverage Currently Covers Up to 23 in Some Cases

Currently, unmarried biological, step-children and adopted children are eligible for TRICARE until the age of 21, or 23 if in college, according to TRICARE’s website. In order to extend it out to age 23, the child must be enrolled in a full course of study at an approved institute of higher learning, and the sponsor must still provide more than half of their financial support. When the child’s eligibility to remain on their parent’s TRICARE plan runs out, they have the option to purchase their own TRICARE Young Adult health care plan. However, these plans only provide coverage until the young adult turns 26 years old.

Congresswoman Luria’s legislation attempts, again, to take the TRICARE health care coverage, a huge benefit earned through military service, and conform it to those private health care plans regulated by the Affordable Care Act. Under the ACA, children up to 26 can remain on their parents’ health care plans at no additional out of pocket costs to the dependent.

Same Bill Was Introduced in June of 2020

On the same day it was introduced, H.R. 475 was referred to the House Committee on Armed Services for evaluation. To be fair, the predecessor to this legislation (H.R. 7176) was referred to the same committee on June 11, 2020, and it did not move forward. As it stands now, the legislation is not on the committee’s calendar.

The greatest pushback to this legislation, and probably what stopped the forward movement of the other, is the estimated cost. While no estimate has yet been provided by the Congressional Budget Office (CBO), it will likely cause some debate. Or it could get rolled up as a provision into an omnibus bill. 

We will watch the movement of H.R. 475 through the process and post updates as they happen. 

(Image courtesy of kenishirotie via 123rf.com)

 

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TRICARE: Guide to TRICARE

TRICARE: All About the TRICARE Program

Answering the call for our nation’s military, provides numerous benefits to the individuals who serve within its branches. In addition to serving the nation with selfless and honorable service, also comes valuable training, pay, retirement and healthcare benefits. However, a lot of military benefits can be overwhelming and sometimes overlooked, which leads to a service member not knowing exactly what benefits are available. One of the many benefits that is often misunderstood is the insurance the military provides to its members and their families, known as TRICARE.

What Is TRICARE?

TRICARE is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for U.S Armed Forces military personnel, military retirees, and their dependents, including some Members of the Reserve Component. TRICARE is the civilian care component of the Military Health System, although historically it also included health care delivered in military medical treatment facilities. However, like most insurance policies, there can be some difficulty in navigating using the TRICARE system. Below are 3 key areas that Service Members, both current and retired, need to understand to effectively use the healthcare benefit.

Who is Eligible?

TRICARE is a health program for:

  • Uniformed Service Members and their families
  • National Guard/Reserve Members and their families
  • Survivors
  • Former spouses
  • Medal of Honor recipients and their families
  • Others registered in the Defense Enrollment Eligibility Reporting System (DEERS). This is critical, considering most of the issues with enrollment come from Service Members not having the proper documentation on their dependents loaded into DEERS.

What Options are Available

TRICARE offers numerous health plans. The availability of those plans depends on who you are and where you live. Although there are 11 healthcare plans that cover everything from overseas locations to retirees, the three major plans that effect Service Members are TRICARE Prime, TRICARE Prime Remote and TRICARE Select.

TRICARE Prime

TRICARE Prime is a health maintenance organization (HMO) style plan available to Active Duty personnel, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family Members. Most TRICARE Prime enrollees must exclusively use the MTF (Military Treatment Facility) to receive their care, if the MTF has the resources available. If the MTF does not have the resources to support the patient, then the MTF notifies the region’s contractor and the contractor’s provider network is used to supplement the MTF’s capacity.

TRICARE Prime Remote

(TPR) is a managed care option available in remote areas in the United States. By law, you can only use TPR if both your sponsor’s home and work addresses are more than 50 miles (or one hour’s drive time) from a military hospital or clinic. TPR is only available to Active Duty Service Members (including activated Guard/Reserve Members) and their families who live and work in designated remote locations.

TRICARE Select

is a premium-based health plan that active status qualified National Guard and Reserve Members may purchase. It requires a monthly premium and offers coverage comparable to TRICARE Prime and TRICARE Prime Remote for the military Member and eligible family Members. It has a partial premium cost sharing arrangement with Department of Defense (DoD) like civilian private or public sector employer plans, although typically at a lower cost than civilian plans. Note: If a Service Member is on Active Duty (including Activated Guard/Reserve Members), they cannot use TRICARE Select.

TRICARE covers Dental

TRICARE offers three different dental plans, Active Duty Dental Program, TRICARE Dental Program and FEDVIP Dental. Each plan has its own dental contractor.

Active Duty Dental Care

Service Members will receive most of their dental care at Military Dental Clinics, usually located in conjunction with Military Treatment Facilities. If a Service Member needs care outside of a military dental clinic, how they receive the care depends on the Service Member’s location.

TRICARE Dental Program

The TRICARE Dental Program is a voluntary dental plan. Sponsors can enroll through the Beneficiary Web Enrollment website. An individual can enroll if they are a Family Member of an Active Duty Service Member, Family Member of a National Guard/Reserve Member or National Guard/Reserve Member who is not on Active Duty or covered by the Transitional Assistance Management Program (TAMP). Note: Service Members will receive Active Duty dental benefits if they are on Active Duty or covered by TAMP.

FEDVIP Dental

FEDVIP Dental is a Voluntary dental insurance plan that covers Retired Service Members, Family Members of retired Service Members, Retired Guard and Reserve Members, Family Members of retired Guard and Reserve Members, Medal of Honor recipients, Family Members of Medal of Honor recipients and Survivors.

As you can see in the links provided above, TRICARE is a tremendous resource provided by the military to its Members, both past and present. Is it perfect? No, however, what insurance is? Most of the negative experiences that come from using TRICARE stem from the overall lack of knowledge on the system and its coverage plans. In a world of constant change, proper knowledge of your healthcare coverage options will turn uncertainty into confidence.

 

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TRICARE to Cover 3D Breast Cancer Screenings in 2020

Breast Cancer Screenings Will Use New Technology

There is good news with regards to TRICARE and breast cancer screenings as the Department of Defense Department has added new technology for breast cancer screenings to its coverage. This was decided after female veterans in Congress pushed the Pentagon to make it available to active-duty service members, retirees, and their families.

Although TRICARE does cover regular 2-D breast screenings, adding this new technology will be a good thing for woman’s health. Digital breast tomosynthesis, which is a 3D mammogram, is said to better detect breast cancer.

When Will This Be Available?

This will go into effect on January 1st, 2020, although it has only been approved as a provisional coverage at this time. It should be able to be extended up to five years and the hope is that during that time the United States Preventative Services Task Force will recommend DBT for breast cancer screenings. The reason that this will only be provisional at this time is that it could not be added as a permanent service because the US Preventative Services Task Force doesn’t currently recommend the technology for breast cancer screenings. Hopefully, this will change.

This decision came after Rep. Chrissy Houlahan, D-PA and Sen. Martha McSally, R-AZ, urged Thomas McCaffery, the assistant secretary of defense for health affairs, to expand TRICARE coverage to include DBT screenings.

McSally said in a statement, “I’m glad to see the Department of Defense step up and provide needed coverage for DBT screenings to our active-duty service members and others. This common sense change will benefit the many women who utilize Tricare.”

They introduced the legislation in the House and Senate in November. This legislation would require TRICARE to offer this new technology as a primary and preventive health care service. TRICARE does already offer DBT in some instances for diagnosing patients, however not for routine screenings.

DBT builds a three-dimensional image of a breast to better detect and diagnose breast cancer. This is especially true for women with dense breast tissue. It is already available for those who use Medicare, or the Department of Veterans Affairs health care. Right now, TRICARE only covers the two-dimensional images.

The most common type of cancer in women is breast cancer and DBT has been found to help radiologists detect breast cancer and reduce the need for biopsies. According to the American Cancer Society, one in eight women will develop cancer in their lifetime so why shouldn’t TRICARE cover a better way to screen for it?

After this goes into effect on January 1st, 2020, the Defense Health Agency will be working to fully implement DBT for breast cancer screenings by early 2020. McSally’s office plans to work with the department to ensure it becomes a permanent service with TRICARE.

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TRICARE & FEDVIP Open Enrollment Begins [updated]

2022 Open Enrollment Season to Begin for TRICARE and FEDVIP

TRICARE and FEDVIP open enrollment season is almost here. When it opens on November 8, 2021, you can change your TRICARE plan, get or swap dental plans, and obtain vision coverage, depending on your military status.

Based on the most current numbers from Health.mil, there are over 9 million TRICARE beneficiaries just between the TRICARE Prime, TRICARE Select, and TRICARE for Life plans alone. Many of you reading this fall under one of those plans.

TRICARE Open Enrollment Dates & Options

For this reason, it is imperative for you to know that the 2022 TRICARE Open Season runs from November 8, 2021 through midnight (ET) December 13, 2021.

TRICARE Open Enrollment Period is Nov 8 through Dec 14, 2021.

During this period of open enrollment, if you are enrolled in TRICARE Prime, TRICARE Prime retiree, or TRICARE select, you have a few options to consider:

  1. Do Nothing. If you wish to remain with your current TRICARE plan then you do not need to re-enroll. The coverage from your current plan will continue as long as you remain eligible.
    1. As a caveat, if you are a Group A retired beneficiary, you and your family must pay a new monthly TRICARE Select enrollment fee to maintain your TRICARE Select coverage. Please sign up during Open Season. The fees associated with this plan go into effect January 1, 2021. Read more about TRICARE Select Enrollment Fees
  2. Enroll in a Plan. If you are eligible for a TRICARE Prime option or TRICARE Select but you’re not enrolled, you can enroll in a plan during open enrollment.
  3. Change plans. If you are already enrolled in a TRICARE Prime option, or TRICARE Select, you are able to switch plans, and switch between coverages, i.e. from individual to family enrollments and vice versa. 

Please be advised, if you are not already in a plan and do not enroll in a plan during the open enrollment period (9 November – 14 December), then you will only be eligible for care at a military hospital or clinic, if space is available.

Enrollment Changes Outside of Open Season (Qualifying Life Events)

During the open season is the only time you can make these changes unless you have a qualifying life event. In order to make enrollment changes outside of the open enrollment period, you must do so only after a Qualifying Life Event (QLE). 

A QLE is a specific change in your life situation that directly affects your health care coverage.

Most Common Qualifying Life Events

Here are some of the most common:

  • Change in sponsor status (retiring/separating from the service)
  • Change in family composition (marriage, divorce, child birth/adoption, death)
  • Moving (child moving to college, relocation outside of current ZIP code)
  • Losing or gaining other health insurance (OHI)

TRICARE Qualifying Life Events List

These events are:

  • Activating or deactivating for Reserve & Guard service
  • Deploying or mobilizing
  • Being injured on active duty
  • Moving/PCSing
  • Getting married
  • Divorcing
  • Having a baby or adopting a child
  • Children going to college
  • Children becoming adults
  • Death in family
  • Getting other insurance
  • Becoming eligible for Medicare
  • Separating from the military
  • Retiring

A TRICARE QLE opens a 90-day period in which you can make eligible enrollment changes. A QLE for one family member means all family members are permitted to make enrollment changes.

With TRICARE, you can enroll in a plan or change your plan. Each one is a bit different. TRICARE Prime doesn’t really have any out-of-pocket expenses for active duty families. However, there are fees associated with going outside your prime network without a referral or filling prescriptions at a retail pharmacy or through the mail.

For the longer, official list, go here for the TRICARE list of QLEs.

What About Retirees?

For retirees, TRICARE Prime does require an annual enrollment fee as well as co-payments for appointments and procedures not done at a (MTF) military treatment facility. TRICARE Select will having you paying more out of pocket, but also allow you more freedom to select providers without a referral. If you are currently enrolled in TRICARE Prime or TRICARE Select you are eligible to change your plan during the open season.

RELATED: TRICARE Prime vs Select: How To Decide

 

FEDVIP Open Enrollment Dates and Options

The Federal Employees Dental and Vision Insurance Program (FEDVIP) is a voluntary, enrollee-pay-all dental and vision program available to Federal employees and annuitants, certain retired uniformed service members, and active duty service members. 

The Federal Benefits Open Season mirrors TRICARE and runs from Nov 9 to Dec 14, 2021.

This program is sponsored by the U.S. Office of Personnel Management (OPM) and offers eligible participants a choice between 10 dental and 4 vision carriers. These include:

Dental Plans

READ: TRICARE Dental Updates for 2022

Vision Plans

The 4 vision plans include:

READ: TRICARE Vision Updates for 2022

Available to you is also a FEDVIP Plan Comparison tool, which allows you to research plans and premiums based on where you live. You can compare up to three dental or vision plans side-by-side for ease of use.

BENEFEDS, who administers the enrollment, plan change, and payment processes for FEDVIP, is offering a Virtual Benefits Fair spanning the entirety of the open enrollment period (9 November – 14 December). During this event you will have the opportunity to chat with carriers and review 2021 plan details.

Webinars are also available that should be able to answer your questions regarding FEDVIP and the Virtual Benefits Fair.

FEDVIP Qualifying Life Events

FEDVIP also maintains a list of qualifying QLEs that allow you to enroll in the FEDVIP program, or to make changes to your existing FEDVIP plan outside of open season.

Since each Federal benefits program follows its own law and regulations, do not assume that the FEDVIP QLEs will be the same as the TRICARE ones. For example, retirement is not a QLE under the FEDVIP, whereas it is a primary reason under TRICARE’s list.

The timeframe for requesting a QLE change with FEDVIP is from 31 days before to 60 days after the event.

Now, For Your Plan of Action

So, that is a lot of information, but it is only the tip of the medical coverage iceberg. Here are the three takeaways you should focus on:

  1. Review your current plan and medical coverage to identify gaps in coverage or needed changes to your current coverage.
  2. Review the links provided here and (at the respective websites) to identify opportunities to close any gaps in coverage identified above.
  3. Research and compare plans that would best suit your coverage needs and be ready for the open enrollment.

Your medical coverage is a most prized benefit that you deserve for your service to our great nation. Even so, you must ensure that the coverage you have is right for you and your loved ones. Thank you for your service.

 

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Military Benefits Changes for 2020

2020 Military Benefit Updates Changes

For the latest military benefit changes for 2022, please go here.

Changes announced so far.  Please keep checking back, as we will continue updating new changes to your military benefits for 2020.

TRICARE Drug Costs To Increase By Over 40%

Every year on January 1st, TRICARE has its regular cost increases. In 2020, we will see updates on prescription drug costs. According to an article on Military.com, we could see an increase of as much as 42%. This could be quite a change for some people.

As of January 1st, 2020, prices of all generic drugs, as well as the brand-name and non-formulary drugs that you purchase either through mail-order or at in-network, or at out-of-network pharmacies will increase. If you continue to get your prescriptions filled at on-base or on-post pharmacies, the cost will remain free and you will not see the increase.

These changes should be kept in mind if you are used to getting your prescriptions away from the on-base or on-post pharmacies.

2020 Rates for Vision and Retiree Dental Insurance

The rates for vision and retiree dental insurance will be increasing in 2020. If you are enrolled in FEDVIP, which is vision insurance for military dependents, retirees, and their families and dental insurance for retirees and their families, you will need to decide if you will change plans or stick with what you have based on the new 2020 rates.

Dental premiums will increase by 5.6% on average over current rates, with vision premiums increasing by 1.5% on average, according to TRICARE. The Federal Benefits Open Season begins on November 11th and ends December 9th. If you want to change your plan, you must do so during open season or following a FEDVIP qualifying life event. You can use the FEDVIP plan comparison tool to see what these changes mean for you and if you should choose another plan. In 2020, FEDVIP will offer 10 dental and 4 vision carriers you can choose from.

COLA Increases

COLA will have an increase of 1.6% in 2020 which is lower than the 2019 increase of 2.8%. COLA increases are based on the increase in the CPI-W, from the 3rd quarter of 2018 through the third quarter of 2019. Increases can change year to year. The last few years have seen, 0.0% in 2016, .3% in 2017, 2.0% in 2018, and 2.8% in 2019. Military retirees, those who receive disability payments, or other benefits from the Department of Veterans Affairs, federal retirees, as well as Social Security recipients will all see the 1.6% increase in their monthly payments.

Retirement Pay

When it comes to retirement pay, it is important to keep in mind that since the increase for the year is calculated differently than active duty pay, the raises can seem a little different based on the year. Based on the 1.6% increase, in 2020 you would receive $16 for every $1,000 in government benefits you receive. If a veteran is receiving around $2,000 a month as retirement pay, they would see an increase of $32 a month.

A veteran who entered military service after July 31, 1986, has had the option of going with the “Career Status Bonus” or (CSB)/REDUX instead of the “High 3-year average” option with regards to retirement pay. This means that they would have received $30,000 during their 15th year of service and will see a reduced retirement rate until they are 62 years old. This also means that their COLA increase is reduced by 1%, which would change the amount of the increase they would see in 2020.

VA Disability

VA Disability payments would also increase in 2020. A veteran with a 60% rating would see about an $18 a month increase, while a veteran with a 100% rating would see a $49 a month increase. The amount they would receive depends on their rating as well as their veteran dependent status. The rate for 2020 would be 1.6% and is based on COLA rates. Rates are effective as of December 1st, 2019.

Social Security Payments

Beyond veteran payments are social security payments. According to the Social Security Administration, the average monthly Social Security benefit in June 2019 was $1,471 for the retired worker. Based on this, the average beneficiary would see an increase of $24 in 2020.

3.1% Military Pay Increase

In March of this year, the White House proposed a 3.1% pay increase for service members to take place on January 1, 2020. Both the House and Senate approved the 3.1% pay raise. For junior enlisted, this would be an increase of almost $1,000 a year and up from 2.6% in 2019, and 2.4% in 2018.

The main guideline for determining military pay raises comes from the quarterly report of the US Employment Cost Index (ECI) which is put out by the Bureau of Labor Statistics (BLS).

The fiscal 2020 NDAA passed and the 3.1% raise will take effect as of Jan 1, 2020.

RELATED: Military Pay Charts

BAH 2020 Rates

BAH is the Basic Allowance for Housing. The 2020 BAH rates have been posted and the DOD’s BAH calculator has been updated. You can use this to find out how much you will be bringing home for BAH in 2020. Remember, if your rate goes down you are grandfathered into the old rate unless you move or change rank.

BAH is based on your rank, dependent status, and geographic location. BAH is intended to cover 95% of your housing costs. This % can change each year and was 99% just a few years ago. They did not change this from last year. Your rates are based on your duty station zip code.

Your new BAH rate will go into effect on January 1st and you will see it in your January 15, 2020 paycheck.

The proposed BAH increase is 2.9% for this year and will need to be approved by Congress and the President. That being said, individual rates are based on the cost of living in your exact location. In 2018, the proposed rate was also 2.9% and 2.55% was approved. In 2018, it was .7%.

BAS 2020 Rates

BAS (Basic Allowance for Subsistence) has a proposed increase of 2.4% for 2020. This is a change from the 3.4% that is normally proposed. Rates have not changed all that much in the last few years since they are based on the cost of food.

The BAS Rates for 2020 should be:

Enlisted: $372.71 per month

Officers: $256.68 per month

BAS is meant to be used to pay for food for enlisted and officers. It is only intended to help pay for food, not to cover all the costs. The rate also does not change based on dependents because the money is not meant to cover food for family members.

The increase will take place on January 1st and you will see it on your January 15th, 2020 paychecks.

We will update as more 2020 military benefits changes are announced!

 

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Getting A Free Breast Pump With TRICARE

You may have heard that TRICARE will give you a free breast pump when you have a baby. But, you might also have some questions about how this all works, what you need to do to get your pump, and any other details about the benefit.  Here is what you need to know about getting a breast pump with your TRICARE benefit:

What Does TRICARE Cover With The Breast Pump Benefit?

TRICARE covers breast pumps and breast pump supplies.

Who Is Eligible For The Breast Pump?

Any female TRICARE beneficiaries that have a birth event. A birth event is a pregnancy or when someone legally adopts an infant and intends to breastfeed the infant. This benefit is for those who have TRICARE Prime, TRICARE Select, TRICARE Reserve Select or any other TRICARE plan. Your service member can be active duty, retired, or guard/reserve.

Where Can You Get The Breast Pump?

The awesome thing about this benefit is that you can get your breast pump from a lot of different places. You can get one from a network or durable medical equipment provider, the Commissary, the Post Exchange (PX,) Base Exchange (BX,) or Station Exchange run by The Army/Air Force Exchange Service (AAFES,) The Department of the Navy, The United States Marine Corps, or The United States Coast Guard. You can also get them from a civilian stateside or overseas retail store, or an online store where standard shipping and handling are also covered.

There is no specific list of approved providers, however, if you are going to get your breast pump from a retail store, going with a store that knows about the TRICARE benefit and what to do is a good idea.

The following can all be great retail stores to go with to receive your breast pump:

How Do You Get Your Breast Pump?

There are a few steps you need to take in order to receive your breast pump.

  • Step One – Get a prescription. This must be from a TRICARE-authorized doctor, nurse midwife, physician assistant, or nurse practitioner. Your prescription must show if you are getting a basic manual or standard electric pump. In order to qualify for a hospital grade pump, you would need to have a special referral and authorization. You will need a diagnosis code on the prescription if you plan to get your breast pump from a network provider or durable medical equipment supplier.
  • Step Two – Your next step is to find the pump that you want and the place you want to get the pump from. You can contact your regional contractor in order to find a network provider or supplier. You would then need to show them your prescription. Some retailers have a form for you to fill out so that you can easily get your pump after you submit your information and prescription. If you are going to go with a military clinic or hospital, you would need to follow their procedures to get your breast pump.
  • Step Three – If you would like to purchase your breast pump ahead of time and then receive a refund, you would need to submit a DD Form 2642, as well as a copy of your prescription and receipt. If you don’t have a receipt you will not be able to be reimbursed. In addition, if you were not eligible for the breast pump when you bought the breast pump, you can not get a refund. The date on your prescription can be after the date on your receipt. You would then mail all of your paperwork to your TRICARE claims processor and you will then receive a check from your regional contractor.

Can You Get Any Breast Pump You Want?

TRICARE will pay up to a certain amount for a breast pump and initial breast pump kit. As of March of 2019, the rates are $312.84 for stateside and $500.55 for overseas. The rates may change every year. This benefit is not limited to a specific manufacturer, brand, or model number.

What Breast Pump Supplies Are Covered?

According to TRICARE, these breast pump supplies are covered:

  • One breast pump kit per birth event. The kit may not be separately billed for and reimbursed.
  • Standard power adapters: 1 replacement per birth event, and not within 12 months of the breast pump purchase date.
  • Tubing and tubing adapters: 1 set per birth event.
  • Locking rings: 2 every 12 months
  • Bottles: 2 replacement bottles and caps/locking rings every 12 months following the birth event
  • Bottle caps: 2 every 12 months after the birth event
  • Storage bags: 90 bags every 30 days following the birth event
  • Valves/membranes: 12 for each 12 months following the birth event
  • Supplemental Nursing System (SNS): 1 per birth event when a physician prescribes
  • Nipple shields/splash protectors: 2 sets (2 shields/set) per birth event when a physician prescribes

You can also receive more of the amounts listed above when your provider prescribes them and when medically necessary. You would need new prescriptions when you need replacement supplies that exceed the limits.

Where Can You Get Your Breast Pump Supplies?

You can get your breast pump supplies at all the same places you could get your breast pump at. You would use the same process as you do for getting your breast pump.

What Happens If Your Breast Pump Breaks?

You can get the pump replaced under certain conditions. You would want to contact your regional contractor for more information.

Can You Get A Breast Pump For Each Baby?

Yes, TRICARE allows you to have one breast pump per birth event.

When Can You Get Your Breast Pump and Supplies?

You can get them starting at 27 weeks or up to three years after the birth event. The three year period starts on the child’s birth date or the date of legal adoption.

All of this information is based on the March 2019 update of this TRICARE benefit which you can read more about here.

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Baby Stores with Military Discounts for New Moms, Parents

With a new baby either on the way or already here, you are most likely looking for ways to save money right away. Here’s a list of baby stores with military discounts, as well as discounts on products and services to assist new and expectant mothers.

Baby Stores with Military Discounts for New Moms and Parents

Find discounts on baby products at online baby stores for military and veterans.

Baby Tula

Baby Tula sells baby carriers and other items such as backpacks and lunch boxes. They offer a 15% military discount to active duty, veterans, and retired military You would just need to verify your military status online. The discount is not available on sale or promotional items.

Enfamil

Enfamil is a formula company and they offer a 10% off military discount. You would need to verify your military status online and then you will be given a one-time use code. You can get a new code every time you need to order.

Happiest Baby SNOO Sleeper

The Happiest Baby SNOO Smart Sleeper is a bed for your baby that will keep them safe on their back and help them become a better sleeper. The military discount is for 20% off your SNOO purchase.  Verification is required.

For more info, please go here.

Hello Bello

Hello Bello sells baby personal care products, diapers, home care, and vitamins. They offer a 20% off military discount to active members of the military. You would just need to confirm your military status and unlock a unique code.

MyKinderPack

MyKinderPack by Kindercarry offers baby carriers They offer active duty, veterans, and retired military 10% off. The discount is not valid on already discounted items. You would need to be verified online.

Pottery Barn Kids

They do not appear to have a current military discount! 

Pottery Barn Kids offers high-end, stylish furniture, bedding, toys, and more. They offer a 15% off military discount on in-store purchases. Certain brands are excluded.

Pure Formulas

Pure Formulas sells vitamins, allergy relief, homeopathic remedies, and more. They offer a 10% off military discount to active duty, retirees, veterans, spouses, and dependents. You would need to verify with ID.me. All other promotions and discounts will be overwritten.

Tactical Baby Gear

Tactical Baby Gear sells baby carriers, diaper bags, emergency blow out kits, and more. They offer a 15% off military discount when you verify your military status online.

Water Lilies Baby Boutique

At Water Lilies Baby Boutique you can find different types of accessories, treats, babywearing products, and more. They offer a 10% off military discount. You would need to verify your military status online.

Military Discounts for New Moms and Pregnant Women

Destination Maternity

At Destination Maternity, now Motherhood, you can find maternity, nursing clothes, and pajamas. They offer a 10% off military discount. The discount is for active duty, military families, and can be used in-store and online with verification with ID.me. 

Specific locations honor the discount.  Check your local store locations for more info. For instance, for a list of San Diego locations with the discount, please go here.

For more info at ID.me, please go here.

JCPenny Portrait

JCPenny is a great place to get your baby’s photos done. They offer a military coupon which can have deals such as a free 8×10 standard print, or 50% off of your photography purchase. You would just need to show your military ID.

Operation Baby Shower

Operation Baby Shower was founded in 2007 by LeAnn Morrissey, who had the idea to send a baby shower in a box to four pregnant military moms whose partners were deployed. They host joyful baby showers for military families across the country. They work with sponsors, donors, and volunteers.

Operation Special Delivery

Operation Special Delivery was founded by a doula, Patricia Newton, after September 11th, 2001, to help support expecting mothers whose spouses were deployed, injured, or who sacrificed it all. This organization provides qualifying military families with a professional labor and birth doula for $500. Those with the rank of E1-E7, and all deployed service members qualify for this program.

TRICARE Breast Pumps

With TRICARE, you can receive a free breast pump for every birth event, including adoption. You just need a prescription from your doctor and many breast pump companies work with TRICARE to make the process pretty easy.

For more info, please see our article on Getting A Free Breast Pump With TRICARE.

Military Discounts on Child Care

AuPair in America

AuPair in America offers child care providers that live with their host families. Parents who serve in the US military can apply for free, and there is also a standing $500 program fee discount. You can combine this with a referral credit but not other discounts or promotions. You will need to show proof of eligibility.

Care.com

At Care.com, you can find babysitting, senior care, house and home help, and care for pets. They offer a military discount of 25% off of subscriptions of your choice. The discount is for service members of all five branches, the national guard and reserves, and veterans. You would just need to enter the code, “MILITARYFAMILY25.”

KinderCare Learning Centers

KinderCare Learning Centers offers child care and early childhood education. They have partnered with Child Care Aware of America to offer fee assistance for eligible active duty military families as a solution to address their child care needs when care at an on-base Child Development Center isn’t available.

They also offer a child care subsidy program administered through the USDA for eligible active duty members or active duty reservists of the US Coast Guard called to action for 180 days or longer, US National Park Services, US Customs and Border Protection, and US General Services Administration that don’t live or work near a CDC. Eligibility does vary by program.

 

>> Looking for more discounts? Check out MyMilitaryBenefits’ free discount newsletter for discounts for military families, discounted travel, and more!

 

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What TRICARE Covers

As a member of the military or a spouse of a member of the military, you are entitled to TRICARE, which is a benefit of serving. You might have TRICARE Prime, TRICARE Select or another TRICARE plan. One of the most common questions people have is what TRICARE is and what it actually covers. 

This is especially true when you are going through the changes that come with living your life. Here is a little bit about different life events and what you need to know about what TRICARE covers and what changes when you go through them.

What TRICARE Covers During Life Events

When You Get Married

When you get married after already being a service member and using TRICARE, you will have 90 days from the date of your marriage to make changes to your health plan. Your new spouse’s plan will depend on where you live and your military status. There is also a dental plan that your spouse can purchase that is seperate from the TRICARE Health plans.

Marriage

New Spouses

Getting Married? Know Your TRICARE Health Care Options

Dental

When You Get Divorced

You and your eligible children have 90 days after a divorce or annulment to change your TRICARE health plan. The eligibility for TRICARE will not change for the sponsor or any biological or adopted children. Your former spouse’s TRICARE benefits will end at 12:01 am the day of the divorce, unless they meet certain requirements.

Divorce

Former Spouses

When You Give Birth To or Adopt A Child

When you or your spouse gives birth to a child, you have 90 days from your child’s birth date or the date of the adoption to enroll in a health plan. You will need to register your child in DEERS to start. TRICARE offers coverage during your pregnancy, as well as newborn, and well-baby care. They also offer a free breast pump for every birth event.

New Baby

Adopting

Placement of Child in Sponsor’s Home

Breast Pumps

When Your Children Become Adults

You might be wondering what happens when your military children become adults. You will have 90 days after your child turns 21 to make changes to TRICARE. That means you do have until at least age 21 before things change, as opposed to having to do something right when they turn 18. From ages 21-26, they may qualify for TRICARE Young Adult if they remain unmarried, and are adult dependent children. If they do not qualify for TRICARE Young Adult, they can purchase the Continued Health Care Benefit Program.

TYA – TRICARE Young Adult

TRICARE For Children

CHCBP – Continued Health Care Benefit Program

When Your Child Goes To College

You can get TRICARE for your college student, until their 23rd birthday or graduation, whatever comes first. They will need to be enrolled full time at an approved college, and the sponsor must be provide at least 50% of their child’s financial support while in college. After your child turns 23 or graduates, they may qualify for TRICARE Young Adult or they can purchase the Continued Health Care Benefit Program.

TRICARE For College Student

CHCBP – Continued Health Care Benefit Program

TYA – TRICARE Young Adult

When You Have A Death In Your Family

When there is a death in your family, you will have 90 days afterwards to change your health plan. If the sponsor is the one who passed away while serving on active duty, TRICARE will continue to provide coverage for any surviving family members. The plans and the cost will depend on the sponsor’s military status when they died, and if they are a spouse or a child. Spouses can keep TRICARE unless they remarry. If another family member passes away, who isn’t the sponsor, you will need to contact your local DEERS office to find out what to do to report the death. Depending on your situation, your plans might change.

Death in Family

When You Move

You will be sure to move many times during your military career. If you move to a new country, and/or cuty, region or a zip code, you will have 90 days from the date of your address change to change your plan. Know that you shouldn’t disenroll before you move, and you will be covered by your current plan on the way to your new location. What you need to do will depend on your current plan.

Moving

Other Qualifying Life Events

There are a few other qualifying life events that you might go through during your military career. Knowing what steps you need to take with TRICARE is important. You don’t want to lose any coverage because you didn’t fill out the right paperwork or you missed an important step. TRICARE explains exactly what you will need to do based on your own situation.

Life Events

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Healthcare When Going from Active Duty to National Guard

Healthcare From Active Duty to National Guard

There will be quite a few changes for those that make the decision to transition from active duty to National Guard. One of the biggest changes will be with healthcare when going from active duty to the National Guard or Reserves.

As an active duty service member, you probably have one of the following:

  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Select
  • TRICARE Select Overseas

You are probably not used to paying a monthly fee for your health insurance, and your out of pocket costs are most likely quite low.

It is important to keep in mind that this has been a big benefit as serving as active duty, and with your change in service, you will no long be eligible for what you had before. However, that does not mean you will be stuck with unaffordable health insurance. If you are making this transition, it is important to know what your options are.

Transitional Assistance Management Program (TAMP)

In a lot of cases, those who make the transition to national guard from active duty can qualify for TAMP or the Transitional Assistance Management Program. This program provides 180 days of premium-free transitional health care benefits after your regular TRICARE benefits end.

For you and your family members to be eligible for TAMP, you, as the sponsor, would need to be:

  • Involuntarily separating from active duty under honorable conditions which include members who receive a voluntary separation incentive (VSI,) or members who receive voluntary separation pay (VSP) and aren’t entitled to retired or retainer pay upon separation, or
  • National Guard or Reserve member who is seperating from a period of more than 30 consecutive days of active duty served for a preplanned mission or in support of a contingency operation, or
  • Separating from active duty following involuntary retention (stop-loss) in support of a contingency operation, or
  • Separating from active duty following a voluntary agreement to stay on active duty for less than one year in support of a contingency operation, or
  • Receiving a sole survivorship discharge, or
  • Separating from regular active duty service and have agreed to become a member of the selected reserve of a reserve component. You must become a selected reservist the day immediately following your release from regular active duty service.

TAMP eligibility can be viewed by going to MilConnect. You should also check with your service personnel department for information or assistance with TAMP eligibility.

The 180-day TAMP period begins when you seperate. During the TAMP period, sponsors and family members are eligible to use one of the following health plan options in addition to going to military hospitals and clinics:

  • TRICARE Prime
  • TRICARE Select
  • US Family Health Plan (enrollment required and must live in a designated location.)
  • TRICARE Prime Overseas (enrollment required)
  • TRICARE Select Overseas
  • Extended Health Care Option

What About During Terminal Leave?

During terminal leave, you will still receive active duty benefits and will be covered under TRICARE Prime, TRICARE Prime Remote, or TRICARE Select. In some cases you might be able to receive Line of Duty Care, and will need to contact your unit or service branch for more information or assistance.

TRICARE Reserve Select

If you want to keep your TRICARE benefits once you have moved to the national guard, and after TAMP expires if you qualify, you can do so with TRICARE Reserve Select. While you are serving in the national guard, your status will change during the time you are serving. This is important as it also changes the status of your TRICARE benefit.

Inactive

You are considered inactive when you are on military duty for 30 days or less. This includes when you go to your inactive duty for training, which is your weekend drills, during your annual training, and any other active service that is less than 30 days.

Members of the selected reserve as well as their families can qualify as long as they are not on active duty orders, not covered under TAMP, and not eligible for or enrolled in the Federal Employees Health Benefits Program (FEHB.)

TRICARE Reserve Select is a premium-based plan which means you will have to pay a monthly fee to have it. For a family, that cost would be $218.01 a month, for an individual the cost would be $42.83 a month.

When you have TRICARE Reserve Select you would schedule your appointments with any TRICARE-authorized provider. There are non-network providers, where you would pay higher cost shares and may have to file your own health care claims, and network providers, where you would pay lower cost shares and the provider will file the claims for you.

You can also request an appointment at a military hospital or clinic on a space available basis and you do not need referrals for any type of care, but you might need to get prior authorization from your regional contractor for some types of services.

In addition to paying for your monthly premiums, you will also have an annual deductible, and a cost share. You can read more about these costs here

Your prescriptions would be filled through the TRICARE Pharmacy Program. You and your family will also be able to enroll in the TRICARE Dental Program. Though, you will enroll separately from your family and pay separate monthly premiums.

You can enroll for TRICARE Reserve Select either online or by phone.

Line of Duty Care

Some will be able to qualify for Line of Duty Care. You may qualify if you incur or aggravate an injury, illness, or disease while in the line of duty. This also includes with you are traveling to and from your place of duty. Your unit will need to issue a Line of Duty (LOD) determination or a NOE if you are in the Coast Guard. In order to verify your eligibility contact your unit administrator or medical representative.

It is important to keep in mind that Line of Duty Care is separate from any other TRICARE coverage including TAMP, TRICARE Reserve Select, and pre-activation benefits when you qualify for them upon federal activation. Line of Duty Care is also not considered minimum essential coverage under the Affordable Care Act. Line of Duty dental care is provided through the Active Duty Dental Program.

Your Employer’s Insurance

Going with your new employer’s insurance is always an option too. You don’t have to go with TRICARE Reserve Select. However, in a lot of cases, doing so will be more affordable for you and your family. Trying to decide what to do?  Take a look at your options and go with the plan that works best for you and your family’s needs.

If You Become Activated

If you become activated as a someone in the national guard, you would then become eligible for the same health and dental benefits as active duty service members. Unless you qualify for early pre-activation benefits, you will start these new benefits on the first day of your orders. As far as the Dental program goes, you would be automatically disenrolled from the TRICARE Dental Program and will begin using active duty dental benefits. Your family will stay enrolled but have reduced premiums.

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TRICARE Adds A New Coverage For Babies

New TRICARE Coverage for Babies

TRICARE has added a new coverage for babies. They will now be covering some or all of the cost of breast milk for those in need of the milk for their new baby. Here is what you need to know:

When Will TRICARE Cover the Breast Milk?

TRICARE will cover banked donor breast milk under certain conditions and situations. If an infant is critically ill, if the mother’s breast milk isn’t available, or if there simply isn’t enough milk being made, using banked donor milk can be an option.

With TRICARE, the infant will need to have one or more of these conditions:

Being born at a very low birthweight, under 1,500g, having gastrointestinal issues, diagnosed with FTT (Failure-to-Thrive,) having a formula intolerance, having Infant Hypoglycemia, having Congenital Heart Disease, if they have had a pre-or-post organ transplant, or if they have another serious health condition when the use of the banked donor milk is medically necessary.

In addition to at least one of those above, the mother’s milk needs to be contraindicated, unavailable because of a medical or psychological condition, or available but lacking in quantity, or quality to meet the baby’s needs.

What Needs To Be Done To Receive This Coverage?

In order to receive your breast milk, a TRICARE-authorized provider will have to prescribe the banked donor breast milk, as well as manage the infant’s care. Know that each prescription is only good for 30 days, that it will have to show the amount and frequency of feedings, that families can only get up to 35 ounces a day, and coverage can be up to age 12 months, as long as it is medically necessary and appropriate.

Where Can I Buy the Breast Milk? Anywhere I Want?

No, you will have to go through a HMB, which is a human milk bank that is accredited by the Human Milk Banking Association of North America (HMBANA.) The HMBANA issues safety guidelines on processing human donor milk for member banks, to include locations outside of the US.

So basically, breast milk from non-HMBANA accredited milk banks, or peer-to-peer donations, sales, or other sources will not be covered.

What Is Covered When It Comes to the Cost of Breast Milk?

TRICARE reimbursement will cover the donor milk screening and processing charges. The breast milk itself is free of charge, but the charges are there to help protect and assure the safety and quality of the banked breast milk.

So, Will I Have to Pay Anything Out-of-pocket for Banked Donor Breast Milk?

Your costs will depend on your beneficiary category and provider type. Costs will also vary based on when you receive the breast milk as well. For example, if you are receiving it as a part of an inpatient stay. For those who receive the breast milk on an outpatient basis, copayments or cost-shares are the same as other outpatient medical supplies. You will also pay based on if your milk bank is a network provider or not.

You also might have to pay for the breast milk out-of-pocket and then submit a claim for the reimbursement.

Where Can I Go to Find Out More Information?

Donor milk banks that are accredited by HMBANA – https://www.hmbana.org/find-a-milk-bank/

TRICARE copays and cost-shares – https://tricare.mil/Costs/Compare.

Banked Donor Breast Milk- https://tricare.mil/CoveredServices/IsItCovered/BankedDonorMilk

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TRICARE Prime vs Select: How To Decide

TRICARE Prime vs Select

Trying to decide between TRICARE Prime vs Select?  This is a question a lot of military families face. There is always plenty of discussions each winter during the Tricare Open Season concerning the differences between TRICARE Prime vs Select. Here’s the breakdown.

TRICARE Open Season

TRICARE Open Season is the annual period when you can enroll in or change your TRICARE Prime or TRICARE Select plan. It occurs each fall, beginning on the Monday of the second full week in November to the Monday of the second full week in December. If you miss Open Season, you’ll only be able to make enrollment changes within 90 days of a Qualifying Life Event or during the next TRICARE Open Season. If you don’t want to change your plan, you don’t need to do anything during TRICARE Open Season.”

TRICARE Prime Overview

Active duty service members must enroll in TRICARE Prime. Active duty family members may choose to enroll in TRICARE Prime or TRICARE Select.

There are a few TRICARE Prime plans available:

TRICARE Prime is a managed care option, similar to a health maintenance organization (HMO) program, which offers affordable and comprehensive health care coverage. You will be assigned a provider who is your primary care manager (PCM). Your PCM will:

  • Manage your health care
  • Provide your routine health care
  • Get any referrals or authorizations you need
  • Refer you to a specialist when you need it
  • File your medical claims
TRICARE Prime Pros:
  • With TRICARE Prime there are no out-of-pocket costs if you’re an active duty service member. Additionally, there are no costs if you’re an active duty family member, unless you use the point-of-service option.
TRICARE Prime Cons:
  • With TRICARE Prime, you are assigned a primary care manager (PCM) who will manage your health. You do not get to choose your provider.
  • You must have a referral from your PCM in order to see a specialist. That specialist must also be in the TRICARE Prime Network.

TRICARE Select

TRICARE Select is a self-managed, preferred provider option. You manage your own health care without a PCM and choose which TRICARE-authorized providers you see. You don’t need referrals, but your regional contractor must authorize some services. Network providers will file claims for you. You may have to file your own claims if you get non-network care. For help with filing claims, visit the Filing Claims page.

You may enroll in TRICARE Select anywhere in the U.S. if you aren’t an active duty service member. If you live overseas, you may enroll in TRICARE Overseas Program Select.

Tricare Select now has two groups. Group A is for those who entered military service before January 1, 2018, and their family members and Group B is for those who entered after January 1st, 2018, and their family members.

TRICARE Select Pros:
  • Select doesn’t require a referral to specialists
  • You have the freedom to choose your doctor and have consistency with that same doctor.
  • You’ll pay less for care received from network providers, but you’re not required to use network providers.
TRICARE Select Cons:

When you use TRICARE Select, you can expect to pay:

  • An annual enrollment fee: Active duty and their family members do not have to pay an enrollment fee. Family members of Group A will need to pay $150 annually for an individual or $300 for a family as of 2021. For family members of veterans and retirees in Group B, there will be a $474 fee for individuals and $948 for family. 
  • An annual deductible: Group A’s fees for an E1-E4 would be $50 per individual and $100 per family. For E5 & above the fees would be $150 per individual and $300 per family. Retirees would pay $150 per individual and $300 per family. For active duty family members, Group B’s fees for an E1-E4 would be $52 per individual and $105 per family. For E5 & above they would be $156 per individual and $300 per family. Retirees would pay $158 per individual and $317 per family. 
  • A fixed fee for some outpatient services
  • A cost-share (a part of the total cost of each service you receive)
  • Once you reach your deductible a copay kicks in, but each family is capped at $1,000 per year out of pocket for active duty Group A, $1,058 for Active Duty Group B, $3,500 for retired Group A, and $3,703 for retired Group B. 

Still Interested In Switching?

Here’s what you need to do during TRICARE Open Season:

RELATED:

 

TRICARE Dental and Vision Updates for 2022

New FEDVIP Dental and Vision Rates

It is almost time for the 2022 FEDVIP Open Enrollment season!

From November 8th through December 13, 2021, the window will open allowing you to add a plan or make changes to your existing plan.

As with most things lately, premiums for the dental and vision plans did increase slightly.

2022 Rates by Dental Plan

The following rates will take effect on 1 January, 2022. The rates are taken from the documents published by each of the following companies. They are presented here for your information.

If you’re interested in any of these companies, please follow the provided links to read their 2022 policy information.

Nationwide/International:

Aetna Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $16.07 $32.15 $48.24 $34.82 $69.66 $104.52
2 $17.69 $35.41 $53.11 $38.33 $76.72 $115.07
3 $18.83 $37.68 $56.51 $40.80 $81.64 $135.09
4 $20.77 $41.56 $62.35 $45.00 $90.05 $135.09
5 $22.56 $45.13 $67.70 $48.88 $97.78 $146.68

 

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $8.98 $17.95 $26.94 $19.46 $38.89 $58.37
2 $9.87 $19.75 $29.61 $21.39 $42.79 $64.16
3 $10.50 $21.00 $31.49 $22.75 $45.50 $68.23
4 $11.57 $23.13 $34.69 $25.07 $50.12 $75.16
5 $12.54 $25.09 $37.63 $27.17 $54.36 $81.53

Blue Cross Blue Shield FEP Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self +1 Self & Family Self Only Self + 1 Self & Family
0 $18.05 $36.11 $54.16 $39.11 $78.24 $117.35
1 $18.05 $36.11 $54.16 $39.11 $78.24 $117.35
2 $20.22 $40.44 $60.66 $43.81 $87.62 $131.43
3 $22.01 $44.03 $66.04 $47.69 $95.40 $143.09
4 $23.84 $47.68 $71.52 $51.65 $103.31 $154.96
5 $26.68 $53.35 $80.03 $57.81 $115.59 $173.40

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
0 $9.22 $18.44 $27.67 $19.98 $39.95 $59.95
1 $9.22 $18.44 $27.67 $19.98 $39.95 $59.95
2 $10.10 $20.12 $30.31 $21.88 $43.79 $65.67
3 $11.48 $22.95 $34.40 $24.87 $49.73 $74.53
4 $12.39 $24.76 $37.12 $26.85 $53.65 $80.43
5 $13.68 $27.37 $41.05 $29.64 $59.30 $88.94

Delta Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $17.67 $35.35 $53.02 $38.29 $76.59 $114.88
2 $19.38 $38.76 $58.13 $41.99 $83.98 $125.95
3 $21.26 $42.52 $63.79 $46.06 $92.13 $138.21
4 $22.63 $45.25 $67.88 $49.03 $98.04 $147.07
5 $26.37 $52.73 $79.10 $57.14 $114.25 $171.38

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $9.20 $18.40 $27.61 $19.93 $39.87 $59.82
2 $10.02 $20.05 $30.07 $21.71 $43.44 $65.15
3 $10.81 $21.61 $32.42 $23.42 $46.82 $70.24
4 $11.40 $22.80 $34.19 $24.70 $49.40 $74.08
5 $13.05 $26.10 $39.16 $28.28 $56.55 $84.85

GEHA Connection Dental Federal

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $17.28 $34.56 $51.85 $37.44 $74.88 $112.34
2 $19.43 $38.85 $58.28 $42.10 $84.18 $126.27
3 $21.24 $42.48 $63.72 $46.02 $92.04 $138.06
4 $23.73 $47.46 $71.19 $51.42 $102.83 $167.20
5 $25.72 $51.45 $77.17 $55.73 $111.48 $167.20

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $9.56 $19.13 $28.68 $20.71 $41.45 $62.14
2 $10.72 $21.43 $32.15 $23.23 $46.43 $69.66
3 $11.74 $23.43 $35.15 $25.44 $50.77 $76.16
4 $13.10 $26.16 $39.25 $28.38 $56.68 $85.04
5 $14.18 $28.36 $42.53 $30.72 $61.45 $92.15

MetLife Federal Dental Plan

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $18.82 $37.43 $56.45 $40.78 $81.53 $122.31
2 $19.85 $39.70 $59.55 $43.01 $86.02 $129.03
3 $22.04 $44.09 $66.13 $47.75 $95.53 $143.28
4 $23.98 $47.96 $71.49 $51.96 $103.91 $155.87
5 $26.70 $53.39 $80.09 $57.85 $115.68 $173.53

Standard
Bi-Weekly
Plan
Standard 
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $10.25 $20.51 $30.76 $22.21 $44.44 $66.65
2 $10.90 $21.79 $32.69 $23.62 $47.12 $70.83
3 $12.15 $24.30 $36.45 $26.33 $52.65 $78.98
4 $13.40 $26.81 $40.12 $29.03 $58.09 $87.12
5 $14.18 $28.37 $42.55 $30.72 $61.47 $92.19

United Concordia Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $15.80 $31.60 $47.38 $34.23 $68.47 $102.66
2 $17.72 $35.45 $53.17 $38.39 $76.81 $115.20
3 $19.68 $39.34 $59.03 $42.64 $85.24 $127.90
4 $21.61 $43.23 $64.84 $46.82 $93.67 $140.49
5 $23.55 $47.10 $70.62 $51.03 $102.05 $153.01

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $10.38 $20.75 $31.13 $22.49 $44.96 $67.45
2 $11.65 $23.29 $34.92 $25.24 $50.46 $75.66
3 $12.91 $25.81 $38.71 $27.97 $55.92 $83.87
4 $14.16 $28.33 $42.49 $30.68 $61.38 $92.06
5 $15.42 $30.83 $46.24 $33.41 $66.80 $100.19

UnitedHealthcare Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $19.47 $38.93 $58.38 $42.19 $84.35 $126.49
2 $20.87 $41.74 $62.60 $45.22 $90.44 $135.63
3 $23.81 $47.61 $71.42 $51.59 $103.16 $154.74
4 $25.89 $51.78 $77.67 $56.10 $112.19 $168.29
5 $29.05 $58.09 $87.15 $62.94 $125.86 $188.83

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $10.15 $20.30 $30.45 $21.99 $43.98 $65.98
2 $10.88 $21.76 $32.64 $23.57 $47.15 $70.72
3 $12.39 $24.78 $37.17 $26.85 $53.69 $80.54
4 $13.46 $26.93 $40.39 $29.16 $58.35 $87.51
5 $15.09 $30.16 $45.25 $32.70 $65.35 $98.04

Regional Plans:

Dominion National

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $9.39 $18.77 $28.16 $20.35 $40.67 $61.01
2 $10.42 $20.84 $31.25 $22.58 $45.15 $67.71
3 $13.85 $27.70 $41.55 $30.01 $60.02 $90.03

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $5.58 $11.14 $16.72 $12.09 $24.14 $36.23
2 $7.11 $14.23 $21.34 $15.41 $30.83 $46.24
3 $8.18 $16.35 $24.53 $17.72 $35.43 $53.15

EmblemHealth Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$22.55 $45.07 $67.62 $48.86 $97.65 $146.51

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$19.26 $38.50 $57.76 $41.73 $83.42 $125.15

HealthPartners Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $20.74 $41.48 $62.23 $44.94 $89.87 $134.83
2 $21.77 $43.53 $65.30 $47.17 $94.32 $141.48

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $14.94 $29.89 $44.82 $32.37 $64.76 $97.11
2 $17.04 $34.09 $51.12 $36.92 $73.86 $110.76

Humana Dental

High
Bi-Weekly
Plan
High
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $17.30 $34.16 $51.91 $37.48 $74.99 $112.47
2 $19.01 $38.03 $57.04 $41.19 $82.40 $123.59
3 $19.96 $39.91 $59.86 $43.25 $86.47 $129.70
4 $21.33 $42.68 $64.01 $46.22 $92.47 $138.69
5 $23.45 $46.89 $70.34 $50.81 $101.60 $152.40

Standard
Bi-Weekly
Plan
Standard
Monthly
Plan
Rating Area Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
1 $11.19 $22.38 $33.57 $24.25 $48.49 $72.74
2 $12.07 $24.13 $36.20 $26.15 $52.28 $78.43
3 $13.01 $26.03 $39.03 $28.19 $56.40 $84.57
4 $14.29 $28.58 $42.87 $30.96 $61.92 $92.89
5 $16.39 $32.78 $49.18 $35.51 $71.02 $106.56

Triple-S Salud

High
Bi-Weekly
Plan
High
Monthly
Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$4.80 $9.60 $12.61 $10.40 $20.80 $27.32

FEDVIP Vision Plans

In addition to dental benefits, FEDVIP has great vision coverage. The plans offer routine exams and correction without a referral, and other low-cost options for ocular care.

The following rate information is posted here for your information. Please contact the carrier for questions or concerns.

Aetna Vision Preferred

High Bi-Weekly Plan

High Monthly Plan

Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$5.67 $11.32 $16.99 $12.29 $24.53 $36.81

 

Standard Bi-Weekly Plan Standard Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$3.15 $6.30 $9.45 $6.83 $13.65 $20.48

 

Blue Cross Blue Shield FEP Vision

High Bi-Weekly Plan High Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$5.55 $11.09 $16.64 $12.03 $24.03 $36.05

 

Standard Bi-Weekly Plan Standard Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$3.56 $7.11 $10.67 $7.71 $15.41 $23.12

MetLife Federal Vision Plan

High Bi-Weekly Plan High Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$5.62 $11.23 $16.85 $12.18 $24.33 $36.51

 

Standard Bi-Weekly Plan Standard Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$3.37 $6.73 $10.10 $7.30 $14.58 $21.88

 

UnitedHealthcare Vision

High Bi-Weekly Plan High Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$5.06 $9.88 $14.70 $10.96 $21.41 $31.85

 

Standard Bi-Weekly Plan Standard Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$3.40 $6.62 $9.86 $7.37 $14.34 $21.36

 

VSP Vision Care

High Bi-Weekly Plan High Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$6.71 $13.44 $20.17 $14.54 $29.12 $43.70

 

Standard Bi-Weekly Plan Standard Monthly Plan
Self Only Self + 1 Self & Family Self Only Self + 1 Self & Family
$3.57 $7.13 $10.71 $7.74 $15.45 $23.21

 

Get Ready to Enroll for 2022

Beginning November 8th, 2021, you will have the opportunity to enroll in a new plan, or change your current plan.

Check out the BeneFeds website to find out how to get started.

Previous Dental and Vision Plan Changes from 2021

On August 11, 2020, the Office of Personnel Management (OPM) announced that they have expanded the list of insurance carriers in Federal Employees Dental and Vision Program (FEDVIP).

  • Dental Carriers – increase from 10 to 12
  • Vision Carriers – increase from 4 to 5

The number of dental carriers available will increase from 10 to 12, and the number of vision carriers will increase from 4 to 5 in the coming year. All vision carriers are offered nationwide, while five of the dental carriers will be offered on a regional basis only.

The new national dental carrier is UnitedHealthcare Dental PPO. The new regional dental carriers are Dominion Dental EPO, and HealthPartners. The new national vision carrier is MetLife Vision.

“The competitive application process allowed OPM to strengthen the FEDVIP program through increased focus on wellness and education. OPM improved quality assurance, financial reporting processes, and enhanced fraud waste and abuse requirements,” OPM said in a news release.

Even before these improvements, results of a 2019 survey of federal benefits indicated solid levels of satisfaction among FEDVIP enrollees. Those survey results are meaningful given that a total of 6.9 million federal employees, members of the military, retirees, and family members are currently covered under the dental and vision insurance programs.

If you’re eligible for the FEDVIP program you’ll be able to enroll, cancel, or change your coverage during the 2021 open enrollment season, which lasts from November 9 to December 14 this year. New and newly eligible employees, military members and retirees can enroll within the 60 days after they become eligible.

Belated Enrollment

You also might be able to qualify for Belated Enrollment. You can use the FEDVIP plan comparison tool to see what these changes mean for you.

FEDVIP has not been available to Department of Defense beneficiaries before but now will be to those who have been eligible for TRDP. This includes most retirees, as well as dependents up until age 21 if they are not a student, and 23 if they are. Active duty families can qualify for FEDVIP Vision but will need to wait until 2022 for FEDVIP Dental. Active duty service members are not eligible.

Please note that FEDVIP is the same plan that is used by Civil Service and Government Retirees.

RELATED:

 

 

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