TRICARE Open Season: Time to Pick a Plan
The second annual TRICARE Open Season will take place from Nov. 11 through Dec. 9. During this time, you can enroll in or change your TRICARE plan. Choose from TRICARE Prime (including the US Family Health Plan) or TRICARE Select. Picking a health plan is an important and personal decision. For example, do you seek more flexibility in your choice of providers? Do you want a primary doctor to manage and coordinate your overall care? As you prepare for open season, here are some things to think about as you compare TRICARE Prime and TRICARE Select.
TRICARE Prime is similar to a health maintenance organization, or HMO plan. As described in the TRICARE Plans Overview, TRICARE Prime generally features the use of military hospitals and clinics and greatly reduces out-of-pocket costs for authorized care provided outside military hospitals and clinics by TRICARE network providers.
Active duty service members (ADSMs) must enroll in TRICARE Prime. Depending on eligibility and where they live, eligible active duty family members (ADFMs) may have a choice between a TRICARE Prime plan and TRICARE Select. TRICARE Prime is only available in certain stateside areas called Prime Service Areas. Entering your ZIP code into the TRICARE Plan Finder will tell you if TRICARE Prime is an option where you live.
With TRICARE Prime, you’ll get most of your routine care from an assigned or selected primary care manager (PCM). Your PCM’s role is to manage your care, file your medical claims, and refer you to a specialist when needed. If you need specialty care, your PCM will work with your TRICARE regional contractor for referrals and authorizations. If you’re an ADFM, retiree, or retiree family member, you can see a specialist without a referral from your PCM under the point-of-service (POS) option. With the POS option, you can get non-emergency health care from any TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS without a referral, but you’ll pay more. If you’re an ADSM, you can’t use the POS option.
As outlined in the TRICARE Costs and Fees Sheet, ADSMs, ADFMs, and transitional survivors have no enrollment fees. And you’ll pay no out-of-pocket costs for TRICARE-covered services as long as you see a TRICARE network provider in your enrolled TRICARE region and with the appropriate referral or authorization.
Retirees, their families, and others must pay an enrollment fee and any copayments for covered health care services from network providers in their enrolled TRICARE region. However, out-of-pocket costs are limited by the catastrophic cap amount for that calendar year.
Because there’s no deductible, TRICARE Prime generally has the lowest out-of-pocket costs of all the TRICARE health plans.
TRICARE Select is available everywhere and is like a preferred-provider organization, or PPO plan. That means you aren’t assigned to a PCM. You can see any TRICARE-authorized provider you choose. But with this flexibility in your provider options, you do have some additional out-of-pocket costs. As described in the TRICARE Plans Overview, you’ll save money if you use TRICARE network providers.
You don’t need referrals for most health care services. But you may need pre-authorization from your regional contractor for some services. Network providers will file claims for you. If you get non-network care, you may have to file your own claims.
If you’re an ADFM, you don’t have a yearly enrollment fee. For retirees, their family members, and others, you may have enrollment fees based on when the military sponsor initially joined the military. Once enrolled, you have a yearly deductible for TRICARE–covered services. Once the deductible is met, you pay per-visit cost-shares or copayments for most services. When following the rules of your plan, your out-of-pocket costs are limited to your yearly catastrophic cap.
Visit Health Plans to learn more about TRICARE Prime and TRICARE Select in order to help you make informed decisions about your health. You can compare plan features using the TRICARE Compare Plans tool. If you want to enroll in or change your TRICARE Prime or TRICARE Select plan, don’t miss your chance to do so during TRICARE Open Season.
Last Updated 6/23/2020