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A closer look at recent TRICARE plan changes

Madigan Army Medical Center Commander

Published: 02:07PM April 5th, 2018
011117-A-ZN465-0001

Madigan Army Medical Center

Dr. Ronald Kreinbrink performs an evaluation of a newborn at Madigan Army Medical Center’s Puyallup Community Medical Home in Puyallup recently.

As anyone who uses TRICARE can attest, 2018 has ushered in a number of changes to TRICARE. In response to many inquiries from our patients, we want to address some of the recent TRICARE plan changes.

With changes from the regional contractor to types of plans available to copays, one question many ask is why so many changes are happening at the same time. The key reasons are the implementation of Congress’ 2017 National Defense Authorization Act legislation, which happened to fall on the same date as a change in the TRICARE support contracts.

One of the most noticeable changes is the creation of the TRICARE Select plan, which replaced TRICARE Extra and TRICARE Standard plans. If you enrolled for TRICARE Standard and TRICARE Extra on Dec. 31, you were automatically enrolled in TRICARE Select effective Jan. 1.

Because TRICARE Select is a self-managed, preferred provider network option, you are not required to have a primary care manager; this allows you to visit any TRICARE-authorized provider for TRICARE-covered services without referrals. TRICARE Select patients may also take advantage of plan improvements such as additional preventive care services.

It’s important to remember that with the change to active enrollment for all plans, patients may only enroll in a TRICARE plan or make changes during the open enrollment season which will be from Nov. 12 through Dec. 10 for health care coverage during 2019. If you choose not to enroll in a TRICARE plan or enroll and fail to pay enrollment fees, your only option for health care is in a military treatment facility in a space-available status; the network medical would not be covered.

Patients may also notice a change in copays. With the new TRICARE changes, many cost shares (the percentage of the allowed amount) were replaced with copays (fixed amounts) for in network care. While some may pay more out-of-pocket fees, the copay system does offer patients greater predictability on how much each visit will cost.

Please note as well that TRICARE shifted from the fiscal year to the calendar year for the administration of benefits, which means payments for deductibles along with other out of pocket costs are applied to catastrophic caps beginning Jan. 1 of each year. Depending on when you became eligible for TRICARE, you may need to pay an enrollment fee for TRICARE Select.

You can find your health plan costs at tricare.mil/costs/healthplancosts

Another significant TRICARE change this year was the change of our regional contractor to a new contractor, Health Net Federal Services. If you’re a TRICARE Prime patient, you should verify your doctor and other health care providers are still TRICARE certified.

In addition, due to a backlog of unprocessed routine referrals which Health Net Federal Services is processing, patients in our region have been granted an authorization waiver for network outpatient specialty care for referrals written between Jan. 1 and March 31.

In other words, if a doctor wrote a referral for you during this time frame for dermatology, for instance, you only need a copy of the referral and the waiver letter to be seen by a network dermatologist.

It is important to note that when we return to requiring authorizations for referrals made in April and later, you will no longer receive authorization letters in the mail. Instead, you should log onto tricare-west.com to view your referral authorization there.

Finally, you should know the TRICARE Retiree Dental Program is ending at the end of 2018. Beginning in 2019, dental and vision plans will be available through the Office of Personnel Management’s Federal Dental and Vision Insurance Program — tricare.mil/about/changes/FEDVIP. If you currently get your dental coverage through TRICARE, you will need to enroll in a FEDVIP Dental plan during the TRICARE open season to sustain coverage next year.

While this doesn’t cover all of the various TRICARE changes this year, these are some of the most impactful to our patients. For more information about these changes, please visit the TRICARE website at tricare.mil/changes.

You may also visit our beneficiary counseling and assistance coordinators at Madigan (in our Patient Assistance Center) who will help explain your TRICARE benefits, or call 253-968-1145, option 3.

Throughout all of these changes, we remain proud to provide you with the care that you deserve through Madigan and our community health care partners.