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TRICARE Select Group A beneficiaries to pay enrollment fees in 2021

Medical technician giving a man a vaccine shot; both wearing masks TRICARE 2021 open season deadline is Dec. 14. One change for 2021 is that TRICARE Select Group A beneficiaries will need to pay enrollment fees in 2021. (Photo by Jacob Sippel, Naval Hospital Jacksonville.)

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TRICARE open enrollment for 2021 closes Dec. 14, leaving only a few weeks for beneficiaries to decide to enroll or change their voluntary health care coverage. Open season decisions go into effect Jan. 1, 2021, and are available to eligible beneficiaries in TRICARE PrimeA managed care option available in Prime Service Areas in the United States; you have an assigned primary care manager who provides most of your care.TRICARE Prime, TRICARE Prime RemoteA managed care option for active duty service members and their families who live in designated remote locations in the U.S. (usually more than 50 miles or one hour's drive time from a military hospital or clinic).TRICARE Prime Remote and TRICARE SelectStarting on January 1, 2018, TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider.  Enrollment is required to participate. TRICARE Select.

One change to watch for is that those who have chosen TRICARE Select Group A (in military service before Jan. 1, 2018) will be required to pay congressionally mandated enrollment fees. There are approximately 850,000 retirees, families and survivors in Group A.

The Select enrollment fees for 2021 will be $12.50 monthly ($150 yearly) for individual beneficiaries in Group A or $25 monthly ($300 yearly) for families.

Additionally, the annual catastrophic medical expenses cap will increase to $3,500 from $3,000.

Another important change is that enrollment fees will be paid by monthly allotment through their defense pay center, where feasible. Beneficiaries must set up a payment method by Dec. 31 to avoid being disenrolled in TRICARE Select, and should contact their regional contractors as soon as possible to set up the enrollment fee payment. Retirees who do not set up enrollment fee payments by Dec. 31 will be disenrolled from TRICARE Select.  Beneficiaries can be reinstated within 180 days (no later than June 30, 2021) by contacting their regional contractor. Do not attempt to set up an allotment directly through your defense pay center.

If a monthly allotment through the retiree’s pay center is not enough to cover the enrollment fees or for survivors who do not receive pay through a pay center, sponsors can pay the enrollment fees via a debit/credit card or electronic fund transfer.

At a Nov. 16 TRICARE media roundtable, Mark Ellis, chief, Policy and Programs Section, TRICARE Health Plan Design Branch, said roughly 21% of Group A have so far responded about the new allotment system, and “we are watching the numbers carefully.” The response rate “is about the same as in the past when there was no enrollment fee,” he added.

TRICARE has made arrangements to reach out again to the Group A cohort to publicize the change. Contractors will execute additional notifications after Jan. 1. These will include three telephone calls to retirees’ home, work and mobile numbers that will alert them they have been disenrolled but are eligible to be reinstated. TRICARE contractors sent out notices on the allotment system in August, September and October.

There are no changes for TRICARE Select Group B retiree beneficiaries. Enrollment fees will still be required of beneficiaries and their families for those who enlisted or were appointed to the military on or after Jan. 1, 2018.

For TRICARE For LifeMedicare-wraparound coverage for TRICARE-eligible beneficiaires who have both Medicare Part A and B.TRICARE for Life, there are no changes, and beneficiaries will pay no enrollment fees in 2021.

Dental and Vision plans open season also taking place

The period that opened Nov. 9 is also Federal Benefits Open Season, which means eligible beneficiaries can enroll in FEDVIP, the Federal Employees Dental and Vision Insurance Program. FEDVIP offers a range of carriers with comprehensive coverage and varying costs. Coverage is not automatic; beneficiaries need to decide if they want dental and/or vision coverage on or before Dec. 14.

TRICARE Young AdultA premium-based plan for qualified adult children.TRICARE Young Adult and TRICARE Reserve fees to rise

The premium-based TRICARE Young Adult (TYA) coverage will see a change in fees that correspond to the full cost of the program. This change will affect almost 38,000 enrollees, mostly on the TYA Select program. TYA is a program for qualified young adult dependents under the age of 26 who are no longer eligible for TRICARE coverage. Because this group has been using more medical services, the premiums will rise Jan. 1, a cost increase mandated by law.

TYA Select premiums for 2021 will be $257, up 12.7% ($29) from 2020, while TYA Prime premiums will rise 22% to $459 per year from $376. The changes in premiums were calculated based on health care costs for enrollees during 2018 and 2019.

TYA Prime enrollees’ premiums are rising at a greater rate because they tend to use medical services more than TYA Select enrollees. Less healthy enrollees are choosing TYA Prime, while healthier enrollees have been covered by TYA Select.

TRICARE Reserve SelectA premium-based plan for qualified Selected Reserve members and their families.TRICARE Reserve Select (TRS) also will see rises in premiums next year. The premium rate change for members will increase $3.03 (5.8%) and will go up by $10.72 (4.4%) for members and their families. TRS is a premium-based plan for qualified members of the Retired Reserve and qualified survivors and their eligible families. By law, enrollees must pay premiums that equal 28% of the total amount based on actuarial tables.

Additionally, premiums will rise for TRICARE Retired ReserveA preimum-based plan for qualified Retired Reserve members and their families.TRICARE Retired Reserve Premium members. TRR members will pay $484.83, up 9.1% ($40.46), and members and their families will pay $1,165.01 (up 9.3%, or $98.75).

More information about TRICARE can we found on the TRICARE website.

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