TRICARE Select

TRICARE Select (previously named TRICARE Standard) is a preferred provider organization (PPO) health plan. A PPO provides the greatest choice in health care providers in exchange for some extra costs. Unlike a health maintenance organization (HMO) like TRICARE Prime, a PPO does not assign you to a specific health care facility or doctors.

TRICARE Select allows you to go to any doctor, hospital, or clinic that accepts TRICARE Select insurance. There is no primary care manager; you are responsible for your own care management.

TRICARE covers services that are medically necessary — meaning appropriate, reasonable, and adequate for your condition and through proven, accepted procedures. In other words, services considered experimental or new age that are not commonly accepted practices are not covered. If you have questions, review TRICARE’s covered services.

Specialist referrals are not needed as long as services are necessary and follow accepted medical procedures.

It is to your advantage to use TRICARE network doctors. Find doctors online.

TRICARE Select Enrollment

 

TRICARE Select requires enrollment in the Defense Enrollment Eligibility Reporting System (DEERS) and reoccurring annual enrollment during the open season in November and December. If you are enrolled in Select during the year, no additional enrollment action is necessary during future open seasons as it is assumed you automatically will continue in the Select plan until you choose otherwise.

If you want to switch TRICARE plans — Select to Prime or vice versa — this must be done during the open season period unless you require TRICARE enrollment due to a qualifying life event. These include a death, marriage, divorce, loss of another health care plan, etcetera. View the complete list of qualifying life events.

You can choose to drop from all TRICARE plans if you prefer to use a different health care plan. We suggest you always enroll in a TRICARE plan as a backup. TRICARE Select works as a backup because there are no costs if you don’t use Select because of another plan.

Eligible Beneficiaries
 

Those eligible for TRICARE Select coverage include:

 

  • active duty family members,
  • retired servicemembers and their families,
  • family members of activated National Guard/Reserve members ordered to active duty service for more than 30 days in a row,
  • nonactivated National Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program,
  • retired National Guard/Reserve members at age 60 and their families,
  • survivors,
  • Medal of Honor recipients and their families, and
  • qualified former spouses (see https://tricare.mil/Plans/Eligibility/FormerSpouses).
TRICARE Select Costs
 
Annual fee

 

There is no enrollment fee associated with TRICARE Select at this time. However, there is an annual deductible and coinsurance costs. An annual fee will start in January 2020. The fee is expected to be $150 for individuals and $300 for families and will be in addition to deductibles and copayments.

Fees based on military status and group
 

Separate fees apply to members who entered military service prior to 2018 (Group A fees) and those who entered military service in 2018 or after (Group B fees).

 

  • Active duty Group A costs: The annual deductible for active duty ranks E4 and below is $50 per individual and $100 per family. The annual deductible for active duty ranks E5 and above is $150 per individual and $300 per family. Learn more. Active duty family members pay a $21 copayment for network primary care visits and a $31 copayment for specialty visits. A non-network visit is 20 percent of TRICARE allowable charges. Learn more.
  • Retiree Group A costs: Retiree annual deductibles are $150 for individuals and $300 for families. Learn more. Retirees pay a flat copayment fee of $28 for primary in-network care and $41 for specialty in-network care. Out of network, you pay a 25 percent of TRICARE allowable charges. These copayments are after your deductible has been met. Learn more.
  • Active duty Group B costs: Visit TRICARE’s website.
  • Retiree Group B costs: Visit TRICARE’s website.
How copayments work
 

If a practitioner accepts TRICARE, they accept the TRICARE payment amount for their services. Copayments stated as a percentage are based on the TRICARE approved amount, not the retail amount charged by the service provider. For example: A doctor charges $1,000 retail price for a service and bills TRICARE Select. TRICARE states they pay $400 (illustration only) for the procedure and the doctor who accepts TRICARE payment rates accepts the $400 for the service. Your copayment is 25 percent, so you pay $100 of the bill and TRICARE pays $300.

Catastrophic cap
 

The catastrophic cap represents your maximum annual out-of-pocket expense before TRICARE pays in full. For active duty families, the catastrophic cap is $1,000 per fiscal year. For retirees, it is $3,000. Starting in 2020, the catastrophic cap will be increased by the annual COLA amount.

Positives

 

  • No enrollment fee
  • Greatest choice of providers in the community
  • Manage your own health care
  • Control your costs based on usage
Negatives

 

  • No primary care physician; managed care
  • Higher out-of-pocket expenses
  • Deductible/copayments paid by beneficiary
  • If the provider does not file the claim, the beneficiary must file a claim for payments to providers; you might have to pay costs up front until reimbursed by claim
Keys to Continuing Eligibility
 

Notify DEERS of any changes in personal information, including address, marital status, other health insurance, etcetera. You can notify them online.

Maintain an up-to-date uniformed services identification card. You can locate your nearest ID card issuing facility through the DoD RAPIDS Site Locator.

MEDIPLUS® TRICARE Supplement Insurance

To help reduce your unexpected out-of-pocket expenses, MOAA sponsors the MEDIPLUS® TRICARE Supplement Insurance Plans that help cover cost-shares not fully reimbursed by TRICARE for covered doctor visits, hospital stays, surgeries, prescription drug cost-shares and excess charges (up to 15% above the TRICARE allowed amount), once any applicable TRICARE and MEDIPLUS deductibles have been met.

MEDIPLUS has you covered:

 

  • Pays cost-shares and co-pays
  • Pays excess charges (up to 15% above the TRICARE allowed amount)
  • Affordable members-only group rates
  • Guaranteed acceptance for eligible MOAA members and their families – you’re covered immediately for all new health conditions. Any current injuries or illnesses are subject to the Pre-Existing Conditions Limitation and are covered after six months.

For more information on the MOAA MEDIPLUS TRICARE Supplement Plans, call 1-800-247-2192, e-mail moaa.service@mercer.com, or visit www.moaainsurance.com.