Missed Open Season? How to Get TRICARE Coverage

12/22/2020

If you missed the Dec. 14 deadline for open season, you’ll have to wait until next year’s open season to change your existing coverage unless you have a Qualifying Life Event (QLE). A QLE—at any time of the year—allows you to enroll in or change your TRICARE Prime (including US Family Health Plan) or TRICARE Select plan. 

“A lot of TRICARE families may think they have to stick with the plan they have,” said Mark Ellis, chief of the Policy and Programs Section of the TRICARE Health Plan with the Defense Health Agency. “In many cases, this is true because of sponsor status or location. But for those who are eligible to switch from TRICARE Prime to TRICARE Select or able to enroll in either plan, QLEs allow you to change your health plan if you need to at a time other than the annual open season.”

With the next open season not set to arrive until the fall of 2021, you need to understand the options available to you now.

What is a Qualifying Life Event?

A QLE is a certain change in your life that would make you eligible to enroll in a TRICARE Prime option or TRICARE Select outside of open season. This type of major life event includes moving, getting married, having a baby, or retiring from active duty. These life events may open up TRICARE health plan options for you and your family. If you want to make any eligible changes, you’ll have 90 calendar days from the date of the QLE to do so. Your coverage will start on the date of the QLE and continue until you lose eligibility or disenroll. Keep in mind, a QLE for one family member means all eligible family members can make enrollment changes during the QLE period.

Check out the TRICARE Plan Finder to learn about which plans you may be eligible for based on your current or a future situation. For a list of the different types of QLEs, visit Qualifying Life Events. You can also download the TRICARE Qualifying Life Events Fact Sheet to learn more.

What if you don’t experience a QLE in 2021? Do you have other options?

You may. If you’re eligible for TRICARE, but don’t enroll in a plan during open season or within 90 days of a QLE, you’ll only be eligible for care and pharmacy services at a military hospital or clinic, if space is available.

If you’re a qualified member of the Select Reserve or Retired Reserve and you aren’t in an active status, you may be eligible to purchase a premium-based plan for you and your family. The same is true if you have an eligibility change, like aging out of regular TRICARE coverage. Available options include:

These plans differ from enrollment-based plans, like TRICARE Prime and TRICARE Select, because they require you to pay a monthly or quarterly premium. Open season rules don’t apply to these plans. You can purchase a premium-based plan at any time, except for the Continued Health Care Benefit Program (CHCBP). You can only purchase CHCBP coverage within 60 days of loss of eligibility for TRICARE. 

Are you eligible for TRICARE For Life? This is another option that doesn’t follow open season rules. Coverage is automatic if you have Medicare Part A and Part B.

Open season is over, but that doesn’t mean you don’t have TRICARE coverage options. If you have a QLE, you should take the opportunity to change plans if you want to, or enroll in a plan if you aren’t enrolled in one. Just make sure you make the switch within the QLE window. Take command of your health, and find a TRICARE plan that meets your needs.

If you’re a Group AIf you or your sponsor’s initial enlistment or appointment occurred before January 1, 2018, you are in Group A. retiree enrolled in TRICARE Select, don’t forget to set up payment for your new monthly 2021 enrollment fees. The deadline is Dec. 31 if you want to maintain your TRICARE Select coverage next year.

At the time of posting, this information is current. For the most recent information, contact your TRICARE contractor or local military hospital or clinic.

Last Updated 10/14/2021