A reader requested I do a post on TRICARE because she had a troop comment on TRICARE Standard and realized she didn’t know anything about it. As it turns out – neither did I.
Why? Because as a single-no-dependents active duty officer who enjoys pretty good health, I’ve never needed to understand TRICARE. I get sick, I go to the clinic. Bada bing, bada boom. I’ve never had to think about what is or isn’t covered, or deductibles, or even premiums for that matter.
But one of the goals for this blog is to make all of us a little smarter on all military issues related to personal finance; not only so we can help ourselves, but so we can help each other. So here we go. I’m digging into TRICARE. Pray for me – they like to cover everything in 192 page PDFs! Send popcorn.
Bonus: learning this will make me super useful to have around as a coworker if anything ever happens to you. Right? Right?
Because there is so very much to cover with TRICARE, I will follow my usual tactic of breaking it up into chunks. Today I’m just going to do an overview of TRICARE as a whole. In future posts, I’ll cover each of the different types of TRICARE coverage in depth.
What is TRICARE?
TRICARE was established by law as a military benefit in 1993, although it existed in different forms prior to that. It is the healthcare program for US uniformed service members, retired service members, and their families.
TRICARE serves 9.5 million (!) active duty, Guard, and Reserve members, retirees, families, survivors, and qualified former spouses worldwide.
There are three TRICARE regions in the United States. If you are overseas, a contractor works with the TRICARE Regional Office to coordinate medical services through civilian providers and the military treatment facilities (MTFs). If you are in a remote area that isn’t serviced by an MTF, the overseas contractor develops a plan for how you will receive care.
NOTE: beginning January 1st, 2018, there will be two TRICARE regions within the US, down from the current three. The current regions are North, South, and West. In 2018 the North and South regions will consolidate into TRICARE East.
How does TRICARE provide service?
TRICARE uses “direct care,” network, and non-network facilities to provide healthcare services. Direct care refers to the Uniformed Services healthcare resources, usually military treatment facilities. Network and non-network facilities can include civilian healthcare professionals, institutions, pharmacies, and suppliers.
TRICARE uses what they call a “family of health plans” to provide service to beneficiaries. Which one you fall under is a matter of your status, as well as choices you may make for your family.
The three main health plans are TRICARE Standard, Extra, and Prime.
Then, there are a variety of more specific plans that cover different situations:
- TRICARE Prime
- TRICARE Prime Remote
- TRICARE Prime Overseas
- TRICARE Prime Remote Overseas
- TRICARE Standard and Extra
- TRICARE Standard Overseas
- TRICARE For Life
- TRICARE Reserve Select
- TRICARE Retired Reserve
- TRICARE Young Adult
- US Family Health Plan
Does TRICARE meet the Minimum Essential Coverage requirements for the Affordable Care Act?
Short answer: yep.
Long answer: yes it does.
What is minimum essential coverage? Under the Affordable Care Act, Americans must have healthcare coverage that meets minimum standards. That is known as the minimum essential coverage. Failure to meet the minimum means you would have to pay a penalty for each month you aren’t adequately covered. Luckily, TRICARE meets this standard, so you and your covered dependents shouldn’t have to worry.
Simple, right? You will meet minimum essential coverage requirements as long as you are covered by TRICARE. Of course, that’s always subject to change if TRICARE itself changes, but with the current rules that’s how it works. And of course, you need to keep up with payments and make sure your enrollment doesn’t lapse.
Each year, you should receive an IRS Form 1095. I was able to pull mine up via myPay. This is the form that confirms your TRICARE coverage for each month of the year. Make sure you receive this form or you might face that penalty!
Changes coming to TRICARE
In addition to the above mentioned consolidation of TRICARE regions, there are several other changes coming soon.
The first is the establishment of TRICARE Select, a self-managed, preferred provider network option. I’ll cover this in more depth later, but here are some quick points. TRICARE Select replaces TRICARE Standard and Extra, so it isn’t an option for active duty members. Most beneficiaries currently enrolled in Standard and Extra will automatically switch to Select on January 1st, 2018. They will remain in Select unless they choose to change coverage, or if they lose eligibility.
Also in 2018, there will be new regional contractors administering healthcare. In TRICARE West it will be Health Net Federal Services. In TRICARE East, it will be Humana Military. Most of this will probably be transparent to you, except that you may get a new primary care manager. If you use network providers instead of MTFs, those may change as well.
Additionally, TRICARE is making some improvements to the communication between military and civilian providers. In my opinion, the most exciting change is that referrals will now be processed electronically, meaning less paperwork and faster specialty care. It’s about time!
The communication improvements also say they will be sharing more data across the military health system. Do you think that means you won’t have to fill out your entire family’s medical history every time you go to the doctor? Too much to ask for?
Finally, TRICARE will be “increasing use of analytics and standardized metrics.” There isn’t much more detail than that provided, so I don’t know exactly what they plan to do. I’ll try to find out more as I continue to dig into this.
Leave a Reply