TRICARE News

The new year is bringing big changes to military health care. Military officials are trying to streamline and simplify the Tricare health system, which will include fewer Tricare regions and fewer plan options. Eventually that will come with higher fees, but current service members and retirees are grandfathered into the existing structure, avoiding next year’s increases.

Most of the changes will go into effect Jan. 1., when all current Tricare beneficiaries will be enrolled automatically in the new versions of their respective plans. The Tricare Standard and Tricare Extra plans will be combined into one plan called Tricare Select. Tricare Standard Overseas will be called Select Overseas.

Active-duty family members using Tricare Prime or Tricare Select won’t pay an annual enrollment fee, but they may have to pay out-of-pocket for co-pays or cost shares when getting health care outside of a military treatment facility.

Tricare Prime is similar to a health maintenance organization, with lower out-of-pocket costs, but requires patients to use network providers and coordinate care through a primary care manager. Tricare Select is a preferred provider organization-style plan that provides access to both network and non-network Tricare-authorized doctors.

Among the biggest Tricare changes will be a bureaucratic shakeup requiring military families to find out whether their doctors are in the Tricare network. Under Tricare Select, beneficiaries will be eligible for certain extra preventive services without any out-of-pocket costs if they are offered by providers inside the network.

In addition, a 2016 law requires the Defense Department to improve access to health care, including:

• Offering urgent care services without preauthorization

• Keeping urgent care at military hospitals and clinics open until 11 p.m. daily

• Establishing Tricare provider network urgent care clinics in areas where there is no military hospital

• Expanding hours for primary care services at military hospitals and clinics in locations with high volumes of patients

• Establishing a standardized appointment scheduling system for military facilities, allowing patients to schedule appointments online and over the phone.

There are no changes planned for Tricare for Life, the benefit provided for retirees age 65 and older and their dependents.

Article from Military Times

Tricare allotment snafu hits more than 4,000 Prime beneficiaries

More than 4,000 Tricare Prime beneficiaries in the former North region must make a one-time payment to cover their January enrollment fees thanks to mistakes with their allotments during the transition to the new Tricare East region contractor.

Humana Military, the contractor for the new East region, will send a letter to the affected beneficiaries, Defense Health Agency spokesman Kevin Dwyer said. There will be no coverage lapses because of the error, no beneficiaries will be disenrolled, and the allotments will resume in February, Dwyer said.

Only beneficiaries who pay enrollment fees by allotment were affected by the glitch. Active-duty service members and their family members don’t pay enrollment fees in Tricare Prime.

On Jan. 1, Tricare North and Tricare South regions merged to become the new Tricare East region. The contractor for Tricare East is Humana Military, which formerly managed Tricare South.

During the transition process, as the beneficiary data files were transferred from the outgoing Tricare North contractor to Humana Military, all payments by allotment were stopped. However, 4,053 Prime beneficiaries in the former North region were not included in the data file to start new allotments with Humana Military, according to Dwyer.

In the letter from Humana Military, affected beneficiaries are instructed to call Humana Military at 800-444-5445 or visit its website (www.tricare-east.com) to make a payment.

Over the last month, there have been at least two incidents involving Tricare allotments and concerns about continued coverage. A retired Air Force lieutenant colonel in New Mexico told Military Times that he checked his retiree account statement Dec. 20 and discovered his retirement pay didn’t include the usual allotment to pay for his Tricare Prime coverage in Tricare West.

Earlier in December, Humana Military mistakenly sent a letter to an unknown number of military retirees in the then-Tricare North region notifying them that they would have to pay their Tricare Prime premiums electronically from their bank account or credit card, even though many of those retirees were paying by allotment from their retirement pay.

Humana Military subsequently sent letters to affected beneficiaries apologizing and notifying them of the mistake. The letter clarified that the affected beneficiaries were not required to take any action to continue their Tricare Prime benefit. Now, 4,053 Tricare Prime beneficiaries who were formerly part of Tricare North will indeed have to make those one-time payments.