With a new year comes big shifts and switches. Our military healthcare is no different. Make sure that you’re tracking all of Tricare’s 2020 changes!
Are You Tracking Tricare’s 2020 Changes?
The new year is bringing changes to covered benefits and services, pharmacy options and more. You’ll want to double-check your specific plan to make sure you’re covered for the healthcare you need.
Tricare Pharmacy CoPayments Change in 2020
If you’ve filled a prescription this year, you might have noticed that the price jumped up a bit compared to 2019. That’s because it has.
Effective January 1, Tricare updated its copay cost-share for beneficiaries. Here’s the breakdown:
- Military Treatment Facility (MTF): no changes to current plan
- All Active Duty Service Members: no cost at MTF or network pharmacies
Tricare Pharmacy Home Delivery: 90 day supply
- Generic Formulary: 2019 rate – $7; 2020 rate – $10
- Brand-Name Formulary: 2019 rate – $24; 2020 rate – $29
- Non-Formulary: 2019 rate – $53; 2020 rate – $60
- Non-Covered: not available
Retail Pharmacy: 30 day supply
- Generic Formulary: 2019 rate – $11; 2020 rate – $13
- Brand-Name Formulary*: 2019 rate – $28; 2020 rate – $33
- Non-Formulary*: 2019 rate – $53; 2020 rate – $60
- Non-Covered: full cost
*Note: brand-name and non-formulary prescriptions can only be filled twice via retail network pharmacies; following this they must be filled at an MTF or via Tricare Pharmacy Home Delivery.
Make Early Breast Cancer Detection Easier with New Covered Screening
Starting January 1, Tricare has expanded access to preventative breast cancer screening measures to more female beneficiaries. More women can now be screened for breast cancer with an annual 3D mammogram.
Previously, this option was only available for patients deemed “at risk.” All other patients received a 2D mammogram by default.
This change comes in response to ongoing research and data about breast cancer from the American Cancer Society. Currently, 1 in 10 American women will be diagnosed with breast cancer in her lifetime. This makes it the second most prevalent cancer among women, coming after skin cancers.
While coverage has expanded significantly, 3D mammograms will not be standard practice for every female Tricare beneficiary.
In order to receive a 3D mammogram, you must meet one of the following criteria:
- Age 40 or older
- Age 30 or older with high-risk factors; have a 15% or greater likelihood of breast cancer occurring
This new cancer screening option is covered under the Provisional Coverage Program. This Tricare program covers the cost of certain new or developing medical procedures and medications as part of a clinical trial or study.
Tricare can extend the coverage of this option for up to 5 years. At that time, Tricare will review their data to determine if the program should become a covered benefit.
More Provisional Coverage Programs You Should Know
It’s not just 3D mammograms that are being covered by the PCP. There is also a new treatment for osteoarthritis of the knee and tennis elbow being piloted.
If you have a diagnosis of mild to moderate chronic osteoarthritis of the knee or lateral epicondylitis, also known as “tennis elbow,” you might qualify for this new treatment.
Speak to your PCM to discuss treatment options if you meet the above criteria.
Picking a Tricare Plan for Your Family
When considering changing your Tricare plan(s), there are a few things you should be aware of:
- Changes can typically only be made during open enrollment season, which typically falls between October and November
- Changes can also be made for a qualifying life event, such as retiring, PCSing, marriage or adding a child to your family
Before committing to a Tricare plan, it is advised that you consider their plan comparison tool. This helps beneficiaries better understand out of pocket costs, if any, as well as where they can access care.
Beneficiaries can also use an interactive Tricare Plan Finder. This online quiz determines your current benefit status and healthcare needs, as well as plans available in your current location.
It is important that you understand all the different programs and options for care available to you in order to make an informed decision about your health.
hearing aids
glasses
Thank you for the update on medications under Tricare.
Why can’t we have Pap smears every year like we use to have it? Need to have a test for ovarian or cervical cancer for women.
I am on Tricare for Life and use the local pharmacy. There are 15 prescriptions I have and my wife has 12. Should I use home delivery I would have to pay 270 dollars every 90 days or 1080 dollars a year. That may not sound like much to pay but for people who are on a fixed income, it can mean the difference between taking meds or eating. The system is upside down charging people more as they age and having lower incomes. The ability to use a military base pharmacy without having a copayment makes more sense than getting hit with a copayment for every prescription. Additionally, I have received mail order prescriptions that were damaged, the capsules were broken open and had to be reordered and then wait for a refill.
We use the base pharmacy as much as we can. I too am on Tricare for Life. And have had serious problems with Express Scripts. Not only sending too many, but even sending items that we never requested. And Express Scripts tell us that TOUGH, no sending back. The people of Express Scripts are extremely rude on the phone and have a Don’t Care about your needs attitude. They even have had NUMEROUS lawsuits against them.
Wake up Military and dump Express Scripts.
Chiropractic care is needed
Why is it impossible for Federal employees who are Reservists to have Tricare again? Federal insurance costs are VERY high. We are still serving the country being in the Guard and Reserve and I think its not fair that this benefit was taken away! Is dental still available at least?
I have two different insurance companies and one wants to fight Tricare over my meds, they are trying to force to get mail order. However, I keep telling the other insurance I cant get mail order on either side bc neither will let me bc I have dual insurance. So the one I had to take back to the base bc of the issue with my primary insurance. I agree that insurance should cover yearly paps for females. my new obgyn out in town believes in yearly paps over having one every 3 years bc she believes that she might be able to catch the cancer before it gets to a bad level by doing annual screenings. which is fine with me. Tricare needs to get rid of the quakes at the mtf’s also bc they don’t want to listen and they just want to prescribe motrin and that’s it
Therapeutic massage
Would be nice if Tri Care for life would cover Silver Sneakers. Being active and moving (exercise) can keep you healthy. Bases are not always convenient or offer what we retirees need. It could save Tricare if we were healthier. It would also be a good Financial decision for Tricare.
Eye exams used to be no copay. Now they are considered a “specialist “ and the co-pay is now $30.00. Co-pays went from $12.00 to $20.00/$30.00 ….and an eye exam is allowed once every two years. I’m diabetic, so I have to get a referral every other year. Doctors have busy schedules and it’s ridiculous to have to keep asking for referrals. If they are in network, I should be able to schedule without a referral. I had to quit physical therapy because at $30 bucks a pop I couldn’t afford it. Went up 2.5 times and retirees on a fixed income can’t afford that. I then have to pay out of pocket for my glasses and that’s $500 bucks ! But wait…there’s more. I recently had a prescription called in for a medication and it took 7 days to process and another 5-10 days to receive in the mail. I could have organ failure in that amount of time. It should have been processed and mailed ASAP ! I’m a 2 year breast cancer survivor, but Tricare doesn’t cover 3D mammo ? I see that is one of the recent changes so that’s great. I could go on, but sleepy time…she comes. Goodnight and have a pleasant tomorrow.
Eye Exams & Dental care is important is equally as important as Cancer screening.
please answer the program about dental to replace dental plates
please answer the program about dental to replace dental plates