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Veterans View: Military retirees, active duty families have health care choices | COMMENTARY

Military pensioners and family members of Active Duty personnel can switch their health care options between Nov. 9 and Dec. 14. Beneficiaries under the age of 65 have three major choices in TRICARE programs called Select and Prime. Users are locked into their option the entire calendar year unless they experience a qualifying life event.

TRICARE Select

Program changes do not affect most active duty families; however, there are big changes for retirees in terms of cost. This Preferred Provider Organization (PPO) option allows use of any civilian provider without referrals. This level of freedom and flexibility can be expensive in the form of annual deductibles, cost-shares, and now monthly premiums for retirees who prefer this option in 2021.

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The annual deductible is $150 or $300 if two or more family members use this option. Then, users pay up to 25% of the cost of medical services when rendered. In January, the maximum out-of-pocket expense paid by retirees annually will increase from $3,000 to $3,500. The out-of-pocket cap for active duty families remains unchanged at $1,000. Once a family reaches its cap, TRICARE will pay all medical expenses for the entire family for the rest of the calendar year.

In 2021, single retirees will also pay $12.50 each month or $25 if two or more use this plan. Select will still be premium-free for Active Duty spouses and their kids under 21. Children of active duty members that are enrolled in school full time will continue to be covered under their parents' plan until graduation or their 23rd birthday.

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Both retired and active duty parents can purchase TRICARE Young Adult (TYA) Select for kids aged 21 through 25. TYA Select monthly premiums will increase from $228 to $255 per child on Jan. 1. While these premiums seem low, parents will also pay the deductible and cost-shares until they reach their annual out-of-pocket cap.

Current Select users will be disenrolled Jan. 1 if they fail to set up an automatic payment plan for premiums. They should call Humana Military at 1-800-444-5445 before the end of the year. Those who miss the deadline can re-enroll during the first 180 days of 2021.

TRICARE Prime

Cheaper options are available under a Health Maintenance Organization (HMO) program called TRICARE Prime. Beneficiaries must use a specific network of providers and get referrals for specialists. Those who want this option can get their care through a network of military bases and Humana Military providers or through an all-civilian network of doctors in the Johns Hopkins US Family Health Plan.

There are no deductibles, no monthly premiums or doctor co-pays for active duty families, and families rarely, if ever, reach out-of-pocket caps since the program does not require expensive cost-shares for service. Retiree monthly premiums are $25 for a single person or $50 for a family of two or more. Retirees do remit a small co-pay whenever they see civilian providers, typically $20 for primary care and $31 for a specialist or urgent care.

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Both retired and active duty parents can purchase TRICARE Young Adult Prime for kids aged 21 through 25. TYA Prime monthly premiums will increase from $376 to $459 per child Jan. 1. While these rates are higher than TYA Select, parents only pay a co-pay for services — not expensive deductibles and cost-shares.

Those who want Prime coverage through the military network should visit www.tricare.mil or call Humana Military at 1-800-444-5445. Those who prefer all civilian providers in the Johns Hopkins network should visit www.HopkinsUSFHP.org or call 1-800-801-9322. This benefit is earned after years of service to our nation and it is far cheaper than expensive civilian medical plans.

Steve Whisler is a retired Naval Officer who currently serves on the Carroll County Veterans Advisory Council. He is also the Military Liaison and Field Services Manager for a major health system in our region.

On the first Tuesday of each month, the Times publishes as its editorial a Veterans' View, an opportunity to draw attention to veterans' issues as well as to inform and educate the community and all veterans about the multitude of available services.

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