When I first became a military spouse I never even thought twice about healthcare.
Mainly because my parents made sure I had good doctors and paid the bills all the way through my college years. I went to my wonderful doctor I had always had, who knew me and my healthcare needs well, and I trusted her. She was like an old family friend.
When I married my Navy sailor right after college I had no idea about what it meant to choose a healthcare plan.
I didn’t even know there were plans to choose from and neither did my husband. All he knew is he had free healthcare as an active duty service member. We were totally clueless!
Being clueless isn’t the best thing, especially when you’re used to having the same doctor all your life and now you have to find a new doctor and the right healthcare plan for your needs!
There are many challenges you will face as a new military spouse. One of those being unraveling the military healthcare benefit called TRICARE.
As a new spouse, it is key that you are armed with the most important information to make the best decision for you and your family quickly after your military spouse status begins.
So while I could write a book, a large one at that, about all the aspects of the Military Healthcare system, TRICARE, I want to keep this post as short as possible. I will cover other parts of the TRICARE benefit as a series. So stay tuned for more posts to come.
How Do You Get Military Healthcare?
After you get married your service member, who is called your sponsor, will enroll you in DEERS. You will then receive an ID card that will act as your healthcare card as well. Might I add that the picture won’t be very flattering, but it’s ok because no ones are!
Once you are enrolled in DEERS you can then start using the military clinics, medical centers, and hospitals. Our military medical treatment facilities provide an excellent standard of care and are great places to be seen.
However, there are times when you will be stationed where there are no military treatment facilities or you may just want a more personalized experience. This is where the military healthcare plans of TRICARE come in.
TRICARE Has a New Look as of 2018
TRICARE moved from three regions to two this past year.
Each is run by a different company so when you need to speak to a representative make sure you are contacting the correct region based on where you are living.
One important piece of information that you need to know is that if you PCS from one region to another, you have to re-enroll if you want to stay in Prime because the companies do not talk or share information with each other. Unfortunately, that could also mean that you will have to start over and wait for referrals from your new doctor after you PCS.
New Enrollment Process You NEED to Know!
Another important change is the military healthcare system has moved away from the fiscal year (October-September) that the Department of Defense runs on. The TRICARE benefit has aligned their year with the civilian healthcare system running from January-December.
In doing so there is now an Open Enrollment period where you can sign up for a new plan or change your current plan. The open enrollment period will begin on the Monday of the second full week in November through the Monday of the second full week of December each year. All new enrollees and any changes to existing plans must be made during this time. They will take effect on 1 January the following year.
The only time outside of this period you can make changes to your plan is if you have a Qualifying Life Event (QLE). You will have 90 days from that event to enroll in TRICARE. If you miss this period you will need to wait until another QLE or the Open Period. Some of them are below and you can find the full list here.
- Birth or adoption of a child
- Relocation to a new country, city, region, or zip code
- Gaining or losing permission (command sponsorship) to have family members accompany service member during an assignment overseas.
Other Determining Factors in the Plans
TRICARE has further broken down the benefits based on when your sponsor entered the military.
- Group A: Your sponsor entered the military BEFORE 1 January 2018
- Group B: Your sponsor entered the military AFTER 1 January 2018
It is important that you know what group you are in when it comes to enrollment because it will make a difference in your fees and out-of-pocket expenses in your plan.
Generally, you will find Group B has slightly higher deductibles and catastrophic caps, but slightly lower out-of-pocket expenses than Group A.
There Are Many Military Healthcare Options
Another change you probably have noticed is TRICARE has renamed some of their core programs.
There are several options to choose from depending on your sponsor’s military status, where you live, what your family situation is, and your preferences.
- TRICARE Prime
- TRICARE Prime Remote
- TRICARE Select
- TRICARE Select Overseas
- TRICARE Prime Overseas
- TRICARE Prime Remote Overseas
- US Family Health Plan
So in the interest of keeping things brief, I will be informing you of the most popular plans military families choose – TRICARE Prime or TRICARE Select.
Active duty service members are automatically under TRICARE Prime and pay nothing out-of-pocket for their care. That even includes if they receive a referral to specialists.
TRICARE Prime is an HMO-like option where you have an assigned primary care manager (PCM) who provides most of your care.
If you need care by a specialist for care they cannot provide, your PCM must refer you. This is easy because your PCM works with the regional contractor for referral authorizations so you don’t have to do anything but go to the appointment when you make it.
Prime is in specific areas of the United States with the care being provided mainly at military healthcare facilities or network providers. The choice between a military facility and network providers depends a lot on where you live and the proximity of the nearest base/post with medical facilities to meet your healthcare needs.
Some of the plan’s In-Network features are:
- No enrollment fees
- No annual deductible
- No co-payments for healthcare services in-network
- Low-cost prescriptions
Keep in mind that although there are no out-of-pocket costs associated with in-network, TRICARE Prime is like an HMO. So it IS a managed healthcare option. You will not always be able to choose your provider. Not to mention you most likely will have longer wait times for appointments. This is especially true for seeing specialists.
Active duty service members cannot participate in this plan, but their dependents may.
TRICARE Select is a PPO-type plan. This was formerly known as TRICARE Standard and TRICARE Extra in which they combined those two plans into Select.
This plan is more like a self-managed option where you can choose your own doctors and use the benefits as long as the doctors are an authorized provider under TRICARE.
Some of the plan’s In-Network features are:
- No enrollment fees, but does have an Enrollment Open Season (See Above)
- Deductibles vary by rank and group
- Fixed fee co-payment for healthcare services in-network
- Low-cost percentage non-network co-pays
- Enrollees don’t need referrals but may need prior authorization
- Low-cost prescriptions
To see all the costs for the benefits of this plan, visit the TRICARE Co-Pay and Cost-Share Sheet.
It’s important to note that while a particular doctor may accept TRICARE Select, they may not necessarily be an in-network provider. There are also approved authorized providers who are non-network and can charge more for their services.
What Really Matters
It’s hard enough to navigate the military life and then not get the type of medical care you and your family need. I can remember looking at the TRICARE website as a new military spouse and thinking to myself how confusing everything is. There were links to here and there and it was just information overload! How was I possibly going to make the right decision?
Ultimately it is up to you and your service member who must decide on your family’s military healthcare coverage. Be sure to do your own research, but I provide a good starting point here.
This is why I have made a worksheet with pertinent questions to help guide you in the right direction. Whether that be TRICARE Prime or TRICARE Select is the right choice. You get the free worksheet. But I also cheat sheets with the most important information needed on the two plans.