Service members will be required to opt into TRICARE during next open enrollment period to continue to use the health care program.
The Defense Department announced Thursday that it will make a number of significant changes to the TRICARE health care program for military service members and their families.
According rules published in the Federal Register, beginning Jan. 1, 2018, new service members will need to actively enroll in TRICARE to receive care outside of military-run hospitals. Current TRICARE beneficiaries will be automatically enrolled for 2018, but will need to re-enroll sometime next year.
After 2018, current service members will only be able to change their TRICARE plan following a major life event or during an open enrollment period that will mirror that of the Federal Employees Health Benefits Program, which runs during November and December.
Additionally, the Defense Department will implement a new plan in the form of TRICARE Select, which will replace the Standard and Extra programs. All current enrollees in Standard and Extra will be automatically enrolled in Select on Jan. 1.
“The rule also sets up an automatic enrollment process, so on January 1 beneficiaries in Prime will automatically be enrolled in Prime or automatically be enrolled in Select if they are enrolled in Standard or Extra,” said Navy Vice Adm. Raquel Bono, director of the Defense Health Agency.
The new Select program also changes the way health care costs are paid for. While out-of-pocket costs traditionally have been calculated as a percentage of a cost negotiated by the government with the health care provider, patients with TRICARE Select will pay a fixed rate for health care, depending on what service or care is provided.
The various program and rule changes are mandated by the 2017 National Defense Authorization Act, approved in December 2016. TRICARE provides health care for 9.4 million service members, family members and dependents.
The new rules also shift the program’s calendar. Currently, TRICARE operates in line with the federal fiscal year of October to September, but beginning in 2018, it will transition to the calendar year.
And TRICARE Prime will see new rules ensuring that beneficiaries receive timely appointments and expanded access to care. Enrollees in the Select program also can access preventive care at no cost, something that Prime beneficiaries currently enjoy.
Defense Department officials said this week’s rule changes are just the beginning of an effort to reform the TRICARE program, as mandated by last year’s Defense authorization bill.
“We recognize that our work is not done,” said Tom McCaffery, acting assistant secretary of defense for health affairs. “The interim final rule is an important step in the whole process we will need to have continued, [with a] very intense focus until the formal transition takes place Jan. 1, and for months afterward.”
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