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What TRICARE Beneficiaries Need to Know About Open Enrollment and the Health Insurance Marketplace

11/6/2015

It’s time for open enrollment; the time of year when people can enroll in or change their health insurance plan. The open enrollment period for HealthCare.gov is November 1, 2015 to January 31, 2016 for 2016 coverage. 

How does this affect you? Most TRICARE beneficiaries don’t need to worry about open enrollment. However, for beneficiaries who are not eligible for TRICARE coverage, have lost or are losing coverage, or may qualify to purchase a TRICARE premium-based health plan (TYA, TRRTRS or CHCBP) you can utilize this open enrollment period to see if there are other health coverage options that work best for you and your family.

If you want to explore your local coverage options outside of TRICARE, go to HealthCare.gov.  You can find out if you qualify for financial assistance and review coverage plans offered in your area without having to submit an application. Just indicate that you don’t currently have coverage when using the portal.

When using the portal, go to the ‘Individual and Families’ tab on HealthCare.gov, and click the ‘Get Coverage’ tab.  From there, click the ‘$ Will You Save?’ section near the middle of the web page.  After selecting your initial options, use ‘Get Ready to Apply’ where you can enter family size, income and your state and/or zip code of residence to get an estimate of available coverage and costs, including available plans, premiums, and cost shares. If you are under 30, you can get personalized health coverage options on HealthCare.gov here.

After exploring the Health Insurance Marketplace options, you can use TRICARE.mil to compare TRICARE premium based coverage and costs to the marketplace plans. You can also compare TRICARE plans online with our ‘Compare Plans’ tool. If you need additional help, call the HealthCare.gov toll free line (1-800-318-2596 or TTY: 1-855-889-4324) or contact a local person or group in your area for assistance. Visit their ‘Contact Us’ page to enter a zip code to find contact information for individuals and organizations in your area.

If you are currently enrolled in a premium based TRICARE plan and decide to use a non-TRICARE option, you need to submit a disenrollment request to your TRICARE regional contractor. Be sure not to disenroll from your current TRICARE coverage until you confirm the start date of your new coverage so that there is no gap in coverage and you aren’t penalized or pay a tax penalty for each month that you and the other individuals listed on your tax form do not have coverage. Once the Defense Enrollment Eligibility Reporting System(DEERS) A database of information on uniformed services members (sponsors), U.S.-sponsored foreign military, DoD and uniformed services civilians, other personnel as directed by the DoD, and their family members. You need to register in DEERS to get TRICARE. records your disenrollment date, the Defense Manpower Data Center responds to queries from the Federal Hub that you do not have minimum essential coverageBasic health care coverage that meets the Affordable Care Act requirement. If you don’t have coverage, you may have to pay a fee for each month you aren’t covered. (MEC) from the Department of Defense. 

Beneficiaries losing TRICARE coverage due to separation or discharge, divorce, aging out, etc., may qualify to enroll for alternate coverage during a special enrollment period. They must apply for marketplace coverage within 60 day of losing their TRICARE coverage.  You can find more information online at HealthCare.gov

Don’t forget that the Affordable Care Act requires most Americans, including TRICARE beneficiaries and DoD employees, have MEC. Most TRICARE plans meet this requirement, but if you want to explore health care options outside of TRICARE, make sure to visit HealthCare.gov during open enrollment.

Last Updated 5/3/2016