What Eligible Military Survivors Need to Know About the TRICARE Changes

Author: TAPS

Updated Jan. 3, 2018

Surviving spouses and children eligible for TRICARE can expect to see stories of changes to the military’s health care system in the coming months, as mandated by the 2017 National Defense Authorization Act.

The current TRICARE Standard and TRICARE Extra plans will be merged into a single plan, called TRICARE Select. The various TRICARE Prime programs may each experience some changes.

Nurse Checking a patient pulse

One of the most obvious differences for eligible families on the new TRICARE Select plan is a requirement to enroll, which was formerly the case only for TRICARE Prime. The 2018 year will be considered a transition period. Beneficiaries will be automatically enrolled on Jan. 1 for the 2018 year only if they already have a plan or are eligible as of Dec. 31, 2017. Additionally, changes can be made to the plan selected throughout the 2018 transition year.

Although 2018 is being treated as a transition year, beneficiaries will need to enroll for 2019 and beyond during an open enrollment period each November and December. Changing plans outside of the open enrollment period will only be allowed if you have a qualifying life event. Beginning in 2020, TRICARE Select will also have an enrollment fee.

Because of the new open enrollment period, the plan year now begins on Jan. 1 instead of Oct. 1. This means your deductible will reset on Jan. 1, 2018, and you don’t need to meet a new deductible between now and then.

TRICARE Select beneficiaries also will now pay a flat fee for a doctor visit rather than a cost share.

Other changes include combining the North and South regions into a new East Region, changes to regional contractors, expanded coverage and improved access, including extended hours with certain providers. To prepare for these changes, beneficiaries can:

  1. Check current information in DEERS and update their records with any new information.

  2. Update payment information if the beneficiary uses electronic payments.

  3. Sign up for TRICARE benefit updates via email.

New provider directories are now available, and the new regional contractors’ call centers are open to address enrollment questions. For more information on the ways specific changes may affect you, or to sign up for email updates, visit tricare.mil/about/changes.

As always, the TAPS Casework Assistance team is here to help you navigate these waters.

How TRICARE Changes Will Impact Eligible Surviving Spouses and Children:

  • All surviving spouses and children currently on TRICARE are included under any “grandfathered” categories referenced in enrollment fees or elsewhere. “Grandfathered” beneficiaries are those whose servicemember entered the military before Jan. 1, 2018; note this is the date the military member began service and NOT when family members entered survivor status. This is referred to as Group A.

  • Surviving spouses remain eligible as a “transitional survivor” for three years following the sponsor’s death and will have active-duty family member (ADFM) benefits and costs. After three years, surviving spouses remain eligible as a “survivor” and pay retiree rates under TRICARE Prime or the new TRICARE Select. Those fees freeze at the rate in place when first enrolling in Prime and paying an enrollment fee. They remain frozen at that rate, unless there is a break in Prime coverage. If there is a break and the spouse returns to Prime at a later date, the fees freeze at the rate in place at the time of the new enrollment. A surviving spouse pays Group A retiree Prime costs. Under TRICARE Select, when the Select enrollment fee is in place Group A retirees/family members, anticipated to be in 2021, surviving spouses won't have to pay the fee. They will now pay Group A retiree Select costs (cost shares, etc.).

  • Surviving children whose sponsor died on or after Oct. 7, 2001, remain eligible for TRICARE benefits as an ADFM. Unlike spouses, eligibility won’t change after three years, and children remain covered as ADFMs until eligibility ends due to age limits (an unmarried child under age 21 or under 23 if a full-time college student) or for another reason, such as marriage. Children with disabilities may remain eligible beyond normal age limits.

  • Surviving spouses and eligible children of retirees will remain on retiree status as a beneficiary. For now, TRICARE Prime enrollment fees will remain unchanged, but if the beneficiaries have been using TRICARE Standard, they will be subject to the new TRICARE Select rules.

  • TRICARE Young Adult beneficiaries will experience no changes if enrolled in TRICARE Prime, but if the beneficiary has been using TRICARE Standard, will be subject to the new TRICARE Select rules.

  • TRICARE For Life beneficiaries will experience no changes.