Paycheck Chronicles

Everything You Need to Know About Tricare Open Season

Hand writing inscription Open Enrollment with marker, concept

Every year from mid-November to mid-December all Tricare participants will have an open season, meaning they can make changes to their Tricare coverage. Normally, you can only make changes if you have what is known as a "qualifying life event".

Open Season

Long a part of the civilian benefits routine, Tricare Open Season now offers the opportunity to enroll in Tricare Prime or Select, sign up for Tricare Reserve Select or enroll in Tricare for Life.

And of course, this is the first year military retirees will have a chance to sign up for a FEDVIP dental plan as part of the Federal Benefits Open Season. If you are an active duty family member, you also will have a chance to sign up for a FEDVIP vision plan.

To enroll in FEDVIP vision, you must be enrolled in a Tricare health plan. Barring a qualifying life event -- marriage, moving out of a service area, losing coverage, a new baby, etc. -- this is the only time until next year's open season that you can make these moves.

Premium

Everybody is familiar with this monthly payment. FEDVIP dental plan premiums vary from plan to plan, premiums range from as little as $20 per month for individual coverage up to around $150 per month for a family.

Enrollment Types

With FEDVIP dental, there are three options. In order of cost: self-only coverage; self plus one (probably, but not necessarily, your spouse); and self and family coverage. The ability to limit coverage to yourself and your spouse is slick. 

Standard Versus High

Standard plans come with lower monthly premiums but provide a lower maximum annual benefit and require you to pay more agreed-upon costs.

For example, in my area the FEP BlueDental High plan is $37 per month more than the standard for a couple. However, the standard plan caps out individuals at $1,500 in benefits for the year, while the high plan has no cap. Furthermore, while both plans cover 100 percent of in-network preventive care (check-ups, cleanings, etc.), if you need a filling or something more serious like a root canal, you'll pay 15 percent less of the negotiated costs if you've got the high plan.

Health Maintenance Organization Versus Preferred Provider Organization

Like health care, the FEDVIP dental plans comes in what is typically a less expensive HMO package. These options usually have lower monthly premiums and fewer ongoing, out-of-pocket expenses. However, if you don't use doctors that are part of the plan, barring an emergency, you aren't covered.

In-Network Versus Out-Of-Network

In a PPO-type plan, you pay less if you use doctors in the provider network. You can typically choose any licensed doctor, but go out of network, and you'll likely have to dig a little deeper into your wallet. For example, if you visited a non-network provider, you are responsible for a larger percentage of the allowed charge and any amount the non-network provider charged over the plan's allowed amount. This highlights the need to carefully select your dentist. Out-of-network annual benefit caps might also be lower.

Pre-Certification

Some plans require you to get approval prior to care. Procedures expected to surpass a certain cost threshold may need to be reviewed in advance of care. Certain services, such as crowns and bridges, may also need to be approved in advance.

You can learn more about open season and the new FEDVIP dental options at tricare.benfeds.com. Dig into details of all the available plans using the tools and info there. If you're not eligible for the FEDVIP plans or would just like explore other options, check out USAA's dental offerings at usaa.com/dental.

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