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Tricare Updates Rules to Address Concerns About Access to Care

Amy Bushatz |

Tricare officials on Thursday announced an addition to a list of circumstances under which users will be permitted to switch plans after a new rule takes effect late this year.

Currently, military families enrolled in Tricare Select or Tricare Prime can change plans for any reason.

But a new rule ordered by Congress in 2016 and set to kick in late this year will block users from switching plans at will. Instead, users will be permitted to make plan changes only within a 90-day window of a "qualifying life event" (QLE) or during an annual open enrollment period.

Those qualifying events include moves, the birth of a child, the loss of other health insurance, retirement, marriage and divorce.

But early this year, military advocates raised concerns that the original QLE list, which was not dictated by Congress but instead set by Tricare policy, was not friendly to the special life circumstances caused by military life.

A policy update released Thursday addresses at least one of those problems. Newly included is a rule allowing military families who have been ordered to change from an off-base primary-care provider to one within the Military Treatment Facility (MTF) system or vice versa to switch plans.

That change, said Karen Ruedisueli, a deputy director of government relations for the National Military Family Association (NMFA), is a step in the right direction.

"We've been urging the Defense Health Agency to include additional QLEs for situations unique to the military health system," she said in a statement to "We are glad they have evolved the list to address [primary-care manager] changes that would move a beneficiary in or out of the MTF for primary care."

Still, the addition doesn't address all of NMFA's concerns, she said. For example, the organization also has asked Tricare to let users switch plans if they experience quality-of-care problems within the MTF system.

"We think it's critical that families don't feel trapped in a medical facility that isn't meeting their needs," she said.

The system's first-ever open enrollment period will run this year from Nov. 12 to Dec. 10. During that period, military families will also be able to enroll in a Federal Employee Dental and Vision Insurance Program (FEDVIP) vision plan for the first time, thanks to a separate expansion ordered in 2016.

Mental Health
Physical Well-Being