TRICARE Select Group A beneficiaries – those whose uniformed services sponsor entered service before Jan. 1, 2018 – who have not paid the new enrollment fee are no longer enrolled in the health care plan.
If you’re part of that group, you can request reinstatement and set up a payment plan. Once you’ve paid any fees owed, your coverage will be retroactive to Jan. 1. Contact your regional contractor to request reinstatement and make payment arrangements:
- Humana Military (TRICARE East): Online or 1-800-444-5445
- Health Net (TRICARE West): Online or 1-844-866-9378
- International SOS (Overseas): Online via your regional call center
MOAA pushed for a 12-month reinstatement period to ensure no TRICARE beneficiaries were locked out of their earned coverage because they didn’t pay the fee. After engaging with the Defense Health Agency in the fall, DHA officials agreed to extend what had been a 90-day period to 180 days, and will consider further extension based on the midyear enrollment rate.
"Our perspective is that military retirees have without a doubt earned this TRICARE benefit after decades of service and sacrifice," Karen Ruedisueli, MOAA's director of government relations for health affairs, told Military Times in a Jan. 8 article. "Losing TRICARE coverage right now especially is an unreasonably harsh policy, if they failed to get communication on a new enrollment fee."
Nearly 175,000 beneficiaries have not set up payment plans for the new fee, per the Military Times report, which cited Defense Health Agency (DHA) figures. That's about 20% of those in TRICARE Select Group A.
Need more information? Check out some answers to frequently asked questions below. You can also visit TRICARE’s FAQ site at this link.
Q. How much is the fee?
A. $12.50 per month ($150 annually) for individuals, $25 per month ($300 annually) for family plans.
Q. I’m under TRICARE For Life/TRICARE Prime/another TRICARE plan. Do I have to pay this fee?
A. No. This enrollment fee applies only to TRICARE Select Group A beneficiaries. It does not apply to other TRICARE Select users, those in other TRICARE coverage plans, or those on TRICARE For Life. Also, TRICARE Select Group A members in one of the following groups are exempt from the fee:
- Active duty family members (includes transitional survivors)
- Survivors of members who died while on active duty
- Medically retired servicemembers and eligible family members
Q. How do I pay the fee?
A. Those receiving retirement pay from a military pay center can set up a monthly allotment. Other beneficiaries (to include unremarried former spouses) can set up recurring credit or debit card payments, or pay by electronic funds transfer (EFT).
Q. Why am I hearing about this from MOAA instead of from TRICARE?
A. TRICARE’s outreach efforts included several direct-mail and email campaigns. If you didn’t receive notice, check your contact information in the Defense Enrollment Eligibility Reporting System (DEERS) and make sure it’s current. You can find instructions and links at TRICARE.mil/DEERS.
Q. My coverage lapsed, but I’ve been reinstated. How can I get reimbursed for care received while I was disenrolled?
A. If you paid the provider up front, you will need to submit a claim to TRICARE after your coverage is reinstated so you can get reimbursed for covered charges less any applicable cost shares. If the provider submitted the initial claim and it was denied, you can ask them to resubmit or you can submit the claim yourself.
Q. I submitted a claim for care received while I was disenrolled, but TRICARE did not reimburse me. Why not?
A. Remember, the TRICARE annual deductible resets each calendar year. The charges may have been applied to your deductible. Check your TRICARE Explanation of Benefits statement for details and call your managed care support contractor with questions.
Q. I received care while disenrolled but I probably won’t be reimbursed because the deductible has reset. Should I bother to submit a claim?
A. Yes! If you don’t submit a claim, the charges from care you received while disenrolled will not be applied to the deductible.
Q. I don’t remember any debate or legislation regarding new fees.
A. The debate took place in 2016, with MOAA and other groups successfully fighting proposals during the FY 2017 National Defense Authorization Act (NDAA) process that would’ve resulted in massive upticks in fees and beneficiary cost shares. Plans called for enrollment fees up to $900, and even an annual TRICARE for Life enrollment fee of up to $632.
Instead, the FY 2017 NDAA grandfathered retirees who entered service before Jan 1, 2018 (Group A) by reducing the TRICARE Select enrollment fee for those beneficiaries to the more modest fees now being implemented. Those who entered service on or after Jan 1, 2018 (Group B) will face significantly higher TRICARE Select enrollment fees in retirement. (Group B Retiree enrollment fees for 2021 are $948 per year for family and $474 per year for individual coverage.)
MOAA has continued to fight further fee increases.
Q. Why did MOAA fight for a longer reinstatement period?
A. The longer reinstatement period helps ensure that no beneficiary is locked out of TRICARE coverage in 2021 because they don’t pay their fees. DHA will conduct an analysis of TRICARE Select retiree enrollment as the 180-day mark approaches and has agreed to consider a further extension based on the enrollment rate at that point.
[RELATED: MOAA's 2020-21 TRICARE Guide]