Where Do YOU Stand in the Game of TRICARE Reform Coming in 2018?

That’s it….I’m switching to STANDARD!”

If you haven’t uttered those words yourself at one time or another, you’re probably one of the many who at least felt good knowing you had an out if you weren’t getting the health care treatment you deserved.

But, like other TRICARE reform changes coming down the pipeline, this option will soon be a thing of the past.

How will YOUR military family fair in all of this sea of healthcare reform? Here’s a quick breakdown of some of the upcoming changes in TRICARE land. 

Choose Wisely

In the past, if you didn’t like the treatment you were receiving at your Military Treatment Facility (MTF) –assuming you could ever get an appointment when you actually needed it – you could call the TRICARE line and switch from Prime to Standard. How many fellow MilSpouses do you know that switched over to Standard the second they found out they were prego? Yea…A LOT.

But with the new annual open enrollment period, you’ll have to choose between TRICARE Prime and TRICARE Select (which takes the place of TRICARE Standard and Extra), and you had better choose wisely. Once you move from one plan to the other, you are LOCKED IN to that plan until the next annual enrollment period. Thankfully, TRICARE is giving families a break by allowing a “grace period” for the first year of all these changes. So, for now (2018), if you want to ditch Prime for Select (or vice versa) you can still switch until the next open enrollment period.

But, starting in 2019, your only chance at escape is if you have a “Qualifying Life Event” (QLE), like a PCS move or having a baby. So, let’s say you’re not happy with your provider at the MTF, or you’re sick of calling all over creation for a referral, or you can never seem to get an appointment when you actually need it. Well, unfortunately, you’re stuck unless you have a QLE or until the next enrollment period rolls around.

Military advocates are really concerned that this open enrollment thing just might trap military families in the MTF, whether they’re getting crappy care or not. So yea…if you’re receiving crappy care, you’re screwed until the Defense Health Agency (DHA) decides to add “crappy care at the MTF” as a QLE. Thoughts?

Hurry Up or Wait

 If you’re planning on switching at all before the end of the year, there are a few things you really need to know.

For starters, if you can hold off from ditching Prime until after January 1, you might actually save some money. You see, if you switch between now and January 1, you’re going to end up paying the deductible twice in a matter of months. The first will be once you change plans and the second will be when the plan year resets on January 1.

But if you absolutely MUST switch plans before then because you just can’t take it anymore, then you need to do it no later than NOVEMBER 21, 2017. This is because TRICARE is getting ready for a contract change-over (more on that below), so they’re blacking out enrollment from November 21 through the end of the year. So any enrollment changes or provider changes need to be done stat, pronto, YESTERDAY…(or, you know, before November 21).

And Then There Were Two  

Beginning January 1, 2018, the TRICARE North and South regions will combine to become TRICARE East and will be managed entirely by Humana. The TRICARE West region will stay the same and will be managed by Health Net Federal Services.

On the upside, it might be a smoother transfer of medical care when you PCS from one duty station to another, as long as you stay within the same region.

The question now becomes whether or not you can keep your current doctor. That would depend on whether or not your provider decides to stay in the TRICARE network under the new contract changes. But unless you have TRICARE Prime, that shouldn’t be a problem on any other plan as long as the provider is TRICARE authorized.

You Won’t Always Get What You Pay For

The DoD also made some interesting changes to what you’ll pay for medical care. The cost share categories for those who join before and after January 1, 2018, are vastly different from one another; and not in a good way.

For example, if you have TRICARE Standard right now, you probably already know you pay a percentage of what a provider will charge. Under Select, however, you’ll pay a fixed amount. So what’s the difference? Basically, it means some TRICARE Select families will end up paying more for their healthcare than others. (Check out the TRICARE cost table here).

The National Military Family Association broke it down perfectly in this real life example:

“Under the current Standard cost shares, one active duty family member on TRICARE Standard recently paid $66.30 for an ER visit that resulted in a hospital stay. On another ER visit for an acute issue, that family member only paid $28.86 and went home with some medicine. But under the new “grandfathered” cost shares, each time she visits the ER, her cost will be $87, no matter how severe the medical issue.

For military families on a budget or trying to get better care for their family by being on Standard, this could result in a much more expensive health care option.”

We couldn’t have said it better ourselves. 

URGENT CARE (Comment Period)

Under the current Urgent Care Pilot Program, if you have an urgent medical need and can’t get a same-day appointment with your doctor, TRICARE will pay for up to two (2) urgent care visits a year without having to track down a referral from your PCM.

Under the new changes, you’ll still be able to access urgent care without a referral, BUT, the number of urgent care visits you can have will change…every single year. In fact, Congress authorized referral free urgent care without restriction, but is allowing the DHA Director to choose the number if they wish.  The language specifically states:

“There is no referral requirement for urgent care services for a certain number of visits per year (zero to unlimited), with the number specified by the Director.”

So the DHA decided to interpret that as a way to change how many urgent care visits you’re allowed every year, (as if accessing urgent care isn’t confusing enough, right?).  So one year you might be allowed two (2) visits and the next you might not be allowed any without a referral. We’ve yet to find the reasoning behind the need to change the number of allowed urgent care visits each year, and will update you when we hear something. In the meantime, go here and give them your feedback before the comment period ends on November 28, 2017. Let DoD know how these restrictions impact your military family.

These are only a handful of the many changes TRICARE will be rolling out come January 1. Some of you will be winners and some will end up losing out based on these changes, but the one thing you CAN do is stay up to date on TRICARE reform by signing up for email updates here. You could also reach out to the DHA directly at dha.tricare-changes@mail.mil and tell them how these changes will help or hinder your family’s healthcare access and quality.

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