Editor’s Note: This article is part of MOAA’s 2021-22 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Mercer Consumer. A version of the guide appeared in the November 2021 issue of Military Officer magazine.
When you transition into military retirement, you will need to navigate substantial changes in health care. Here is a look at what’s ahead.
Transitioning From Active Duty to Retiree
- Decide which TRICARE program works best for your family.
- Watch for your status to be updated to “retired” in the Defense Enrollment Eligibility Reporting System (DEERS).
- Then, contact the specific contractor that manages the program in your locale. Enroll online, via telephone, or through U.S. mail.
- To avoid a break in TRICARE coverage, enroll in a TRICARE plan within 90 days of retirement date.
Options for TRICARE Prime
Check with the contractor to see if a military treatment facility near you (typically a 30-minute drive) accepts new retirees and families. Each MTF has a limit on retirees and families they can accept. If one MTF isn’t available, the contractor will tell you if another MTF in your area is accepting new retirees and families.
Check on your preferred MTF at the next open season or qualifying life event (QLE). TRICARE contracts with medical providers to offer a civilian care Prime option in many metro areas. This option is more expensive than enrollment at an MTF, with copays for medical services.
Under TRICARE Prime, you will incur point-of-service charges for any specialty care you receive without a referral. Try to find a specialist who accepts TRICARE to reduce costs. You will incur a deductible ($300 individual/$600 family) that will not apply to your catastrophic cap. After the deductible is reached, you can expect co-pays that are typically 50% of the allowable TRICARE fee.
Options for TRICARE Select
TRICARE Select is the most flexible TRICARE program, though you will need to find medical care providers who accept TRICARE, and copays are higher than TRICARE Prime copays.
TRICARE Select began charging an enrollment fee for military retirees in 2021: $150 for individuals and $300 for families per year. Also, enrollment fees now count against the catastrophic cap, as do deductibles.
TRICARE Select’s annual deductible is $300 for families. For individuals, the first $150 in medical charges must be picked up by the retiree.
Spouses may sign up for different plans, and they will be charged at the individual rate for their plan versus the family rate.
Qualifying Life Events (QLEs)
QLEs allow you to make changes to your TRICARE benefits outside of the open season. These events include a move, birth of a child, marriage, divorce, and death. Your retirement from active duty also allows you to change TRICARE coverage if desired.
[AT TRICARE.MIL: Qualifying Life Events]
A Higher Catastrophic Cap
The catastrophic cap (CC) is the most you will pay out of pocket for covered services each year before TRICARE picks up all additional covered costs. The CC is reset every calendar year, and the amount amassed on active duty during a retirement year rolls into the retirement CC.
The CC increases in retirement from $1,000 to $3,000 for Prime and $3,500 for Select. TRICARE Prime and Select enrollment fees count against the CC.
Group A and Group B Designations
Group designations determine which fee structure for enrollment, deductible, copay, and catastrophic cap each beneficiary must pay.
- Group A: All servicemembers and their families who entered service prior to Jan. 1, 2018.
- Group B: Those entering on or after Jan. 1, 2018.
Pharmacy Benefit Changes
Military retirees now have a copay when filling prescriptions via commercial pharmacies or home delivery through Express Scripts. Dependents’ coverage is the same; they have copays for commercial pharmacy and Express Scripts and free prescriptions through the MTF system.
TRICARE During Terminal Leave
Retiring servicemembers remain enrolled in TRICARE Prime at their last duty station until the date of retirement. They can get medical care from any military hospital or clinic, but there are limitations and/or pre-authorizations required for non-urgent care. They can also get care at VA medical facilities with a referral/pre-authorization.
Those who may need routine medical care during terminal leave, or plan to leave the area of their last duty station, should consult with the TRICARE referral office at their MTF or the Defense Health Agency-Great Lakes at (888) 647-6676.
A military family remains covered by their TRICARE plan until the date of retirement. If they are enrolled in an MTF, they stay enrolled with their current providers until the retirement date — unless there is another reason for a PCM change, such as a provider PCS.
TRICARE Select Overseas (TSO) is available for retirees and their dependents living abroad. There is a TRICARE Prime Overseas, but that is restricted to active duty and their families.
The TSO enrollment fee is the same as TRICARE Select ($150 individual/$300 family). Enrollment fees will count against the $3,500 catastrophic cap.