TRICARE is Minimum Essential Coverage for Affordable Care Act

Story Number: NNS131002-05

Release Date: 10/2/2013

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs

BREMERTON, Wash. (NNS) -- There has been a steady stream of expected questions at Naval Hospital Bremerton'sTRICARE Service Center concerning the pending Affordable Care Act.

"We've had active duty as well as retirees asking about the Affordable Care Act and how it relates to their TRICARE coverage," said Renee Proctor-Brown, RN, BSN, Clinical Liaison Nurse and Manager of NHB's TRICARE Regional Appointment Center.

The Affordable Care Act, also known as the health care reform law, requires a person to maintain basic health care coverage-called minimum essential coverage. Beginning in 2014, if a person does not have minimum essential coverage, a fee will have to be paid for each month not covered.

"The main thing people need to understand is that TRICARE is an entitlement. The Affordable Care Act does not impact TRICARE, although TRICARE does meet all the minimum qualifications needed for the act," Proctor-Brown said.

Proctor-Brown noted that although TRICARE already complies with many Affordable Care Act provisions, TRICARE has added a program to match the health care law's provisions extending health insurance coverage to dependent children until age 26, with the TRICARE Young Adult program from existing TRICARE Prime or Standard coverage. Even beneficiaries who have lost health care at up to age 23 and are enrolled in an institution of higher learning can now purchase coverage up to age 26.

Bottom line, attests Proctor-Brown, the TRICARE program is considered minimum essential coverage. If a person is using any of the following health plan options, they have the coverage required by the health care reform law:

TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas, TRICARE Standard and Extra, TRICARE Standard Overseas, TRICARE For Life, TRICARE Reserve Select (if purchased), TRICARE Retired Reserve (if purchased), TRICARE Young Adult (if purchased)and US Family Health Plan.

Additionally, a person has minimum essential coverage if they are covered by either transitional health plans such as Transitional Assistance Management Program (premium-free, 180 days) or Continued Health Care Benefit Program (if purchased, 18-36 months).

Simply being eligible for premium-based TRICARE benefit plans such as TRICARE Young Adult (TYA), TRICARE Retired Reserve (TRR), TRICARE Reserve Select (TRS) and the Continued Health Care Benefit Program (CHCBP), does not constitute minimum essential coverage. Eligible beneficiaries must purchase and be in good standing, by paying their premiums to have coverage in force, to qualify for minimum essential coverage under these TRICARE programs.

If a person qualifies for one of TRICARE's purchased plan options, then they will only meet the requirements for minimum essential coverage if they purchase it.

It is recommended that everyone checks that they are getting the most affordable coverage for themselves and their family that best meets their health and wellness needs. The Health Insurance Marketplace is a new way to find health coverage that fits a person's budget and needs. Open enrollment begins October 1, 2013 with coverage beginning as early as January 1, 2014. A person can compare TRICARE's purchased plan options with their current employer's health insurance or other civilian options offered through the Health Insurance Marketplace at 800-318-2596, TTY: 855-889-4325 or, https://www.healthcare.gov/

Additionally, for those civilian government employees with Federal Employees Health Benefits (FEHB), they are covered by a plan that satisfies the requirement to maintain essential health coverage (MEC) for each month.

If a civilian government employee does not maintain MEC for each month or qualify for an exemption, then the Affordable Care Act requires that an individuals shared responsibility (including children) is to make a payment when filing his or her federal income tax return.

The Department of the Navy, Office of Civilian Human Resources, notes that the Affordable Care Act does not change any regulation regarding eligibility to enroll in the FEHB. Employees who are on appointments that do not confer eligibility for FEHB are not eligible to make an election and are encouraged to review coverage options in the Health Insurance Marketplace.

Although most TRICARE health plan options already meet the requirements for minimum essential coverage, those dis-enrolling from TRICARE and their dependents have the option of using the new Health Insurance Marketplace to get affordable coverage. They may get lower costs on monthly premiums or out-of-pocket costs. They could also be eligible for free or low-coat coverage through Medicaid or the Children's Health Insurance Program (CHIP).

TRICARE beneficiaries who are eligible for, but have not purchased TRS, TYA, TRR or CHCBP, have several options for getting quality affordable health insurance: if qualified and eligible, purchase one of TRICARE's premium-based plans such as TRS, TYA, TRR or CHCBP; purchase coverage from a state Marketplace (beginning Oct. 1 2013 for coverage Jan. 1, 2014); get coverage through a family member; get coverage through the employer; get coverage from a federal program such as Medicare Part A or Veterans Affairs, etc., or coverage under a state Medicaid or Children's Health Insurance (CHIP) program; purchase any other coverage that qualifies as minimum essential coverage.

"Those who have Medicare also are not impacted by the Affordable Care Act," Proctor-Brown pointed out.

It is also recommended that TRICARE eligible beneficiaries are also qualified for other health insurance (OHI) may choose health care coverage through their TRICARE eligibility or OHI. The law requires most individuals and their dependents to have minimum essential coverage. Those TRICARE eligible beneficiaries that have a choice in health care coverage may elect the health care options that best meet their needs.

Naval Hospital Bremerton'sTRICARE Service Center is located in Bldg 14, in the Mt. Adams Parking Lot across from the main hospital and is open Monday through Friday, 7:30 a.m. to 4:30 p.m.

The TRICARE Regional Appointment Center (TRAC) can be reached at (800) 404-4506, and is open Monday through Friday from 6 a.m. to 8 p.m., and Saturday and Sunday from 7 a.m. to 3:30 p.m., and closed on federal holidays.

For more information, visit http://www.navy.mil, http://www.facebook.com/usnavy, or http://www.twitter.com/usnavy.