Editor’s Note: This article is part of MOAA’s 2023-24 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). A version of the guide appeared in the November 2023 issue of Military Officer magazine.
One of the many steps to take in retiring from the military is choosing a TRICARE plan for you and your family. The transition to retiree status can mean significant changes in health care options and potentially higher costs.
Here’s what to know as you make the transition:
Steps to Take
- Before your retirement from the military, compare the TRICARE plans available so you can select the best one for you and your family. (See the following brief description of plans.)
- Within 90 days of your retirement date, enroll in a TRICARE plan so your coverage transitions smoothly.
- Check to see that your status is updated to “retired” in the Defense Enrollment Eligibility Reporting System.
- Contact the specific contractor that manages the program in your area. Enroll online, by telephone, or through U.S. mail.
- Spouses may sign up for a different plan than the military retiree and pay an individual rate for their plan versus the family rate.
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Qualifying Life Events
Retiring from active duty is one of the qualifying life events (QLEs) that allow you to change TRICARE coverage. Keep in mind, other QLEs allow you to change your TRICARE benefits outside of the “open season.” The QLEs include a household move, birth of a child, marriage, divorce, or death.
A primary care manager (PCM) provides most of your care in Prime service areas. Retiree beneficiaries pay enrollment fees and network copays. Consider these options for health care:
- Military treatment facility (MTF): Check with the contractor to see whether an MTF near you, within a 30-minute drive, accepts new retirees and families. Check on the status of your preferred MTF during the next open season or QLE.
- Civilian care: In many metropolitan areas, TRICARE contracts with medical providers to offer this option. You will incur copays for civilian care.
- Specialty care: With TRICARE Prime, you should get a referral for a specialist. An option to reduce costs is to look for a TRICARE provider who can provide the specialty care. A deductible and higher copays are charged for point-of-service care. These costs do not count against your catastrophic cap.
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Select is the most flexible TRICARE program. Here’s what to expect:
- This is a preferred provider organization (PPO) plan. You manage your own care and don’t need a PCM. You will need to find medical care providers who accept TRICARE, which contracts with a network of doctors, hospitals, and other providers.
- Copays are higher than for TRICARE Prime.
- Retirees pay annual enrollment fees based on COLA. The fee for 2023 is $172 for individuals and $345 for families.
- Fees and deductibles count against the catastrophic cap.
Your Catastrophic Cap
The catastrophic cap is the most you pay out of pocket for covered services in a calendar year before TRICARE picks up additional covered costs. TRICARE Prime and Select enrollment fees count against the catastrophic cap. In your retirement year, the amount accrued on active duty rolls into the retirement catastrophic cap.
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The catastrophic cap for Prime goes up from $1,000 for active duty to $3,000 for retirees. The catastrophic cap for Select is adjusted for COLA each year; for 2023, it is $4,028.
Group A and Group B Designations
These categories determine the fee structure you pay for enrollment, deductible, copays, and catastrophic cap. Group A includes all servicemembers and their families who entered service prior to Jan. 1, 2018. Group B includes those entering on or after Jan. 1, 2018.
A retiring servicemember stays enrolled in TRICARE Prime at their last duty station until retirement date.
Here’s where they can get care:
- Any military hospital or clinic, but limitations and/or pre-authorizations are required for non-urgent care.
- VA medical facilities with a referral/pre-authorization.
- For routine medical care during terminal leave, or if you plan to leave the area of the last duty station at that time, consult with the TRICARE referral office at your MTF or the Defense Health Agency-Great Lakes at (888) 647-6676.
Military families are covered by their TRICARE plan until the date of retirement. Families enrolled in an MTF stay enrolled with current providers until the retirement date unless there is a reason to change PCM, such as a PCS move. Family relocation during terminal leave is a QLE. The family can switch TRICARE plans or remain with their current plan and enroll with a TRICARE Prime PCM at their new location.
The family will not need to update to their retiree TRICARE coverage until the retirement date.
TRICARE Select Overseas
TRICARE Select Overseas is available for retirees and their dependents living overseas. (TRICARE Prime Overseas is only for active duty and their families.)
The enrollment fee is the same as TRICARE Select. For 2023, it is $172 for individuals and $345 for families. Enrollment fees will count against the $4,028 catastrophic cap.
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