Paycheck Chronicles

Everything You Need to Know About Tricare Open Season

Hand writing inscription Open Enrollment with marker, concept

When it comes to military health care -- for retirees and active duty -- this year is a little different. As you read this article, we are amid the first-ever Tricare open season.

From Nov. 12 -- Dec. 10, 2018, retirees as well as those currently serving and their families will have an opportunity to change health plans.

Additionally, the Tricare Retiree Dental Program ends on Dec. 31, 2018. The Federal Benefits Open Season runs concurrently and allows some Tricare beneficiaries to add vision and/or dental coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP).

The overhaul of dental offerings caught my eye. While active duty and reserve component service members and their families will continue to get dental care through their military clinic or Tricare Dental Program, retirees interested in having dental coverage, or those wanting to add it, will need to sign up for one of the 10 dental carriers available through the FEDVIP.

Yes, 10 dental carriers -- with 15 options! Because this seems a bit overwhelming it had me scrambling to explore and understand some of the key differences in the plans. So, let's dig in. The numbers I'll share below are based on the 2019 FEDVIP dental plan offerings in the San Antonio area.

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. If that FEDVIP premium is paid via payroll deduction, it will be a pre-tax deduction. FEDVIP dental plan premiums vary from plan to plan, but in my area, premiums range from as little as $20 per month for individual coverage up to around $120 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. To give you an idea, The FEP BlueDental, PPO-High came with premiums of approximately $40, $80 or $120 per month.

Standard Versus High

Did you see the "High" in the plan name I mentioned above? Don't miss this one. 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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