ACA Won't Change Tricare - What You Should Know

The Affordable Care Act, popularly known as "Obamacare", should have little to no impact on military members enrolled in Tricare, since Congress passed legislation that both excluded Tricare from the ACA's various requirements of insurance companies and considers Tricare as meeting the ACA's individual mandate.

This has led to a few disparities between the legally required coverage from private and state-run insurers and the benefits offered to Tricare members, however. The biggest differences are currently in the areas of mental health and weight management.

According to the Affordable Care Act, mental health and substance abuse diagnosis and treatment should be "comparable to general medical and surgical coverage", although it does not specifically define necessary care. Tricare, however, places limits on such coverage, with in-patient mental health care restricted to 30-45 days per year, and non-active duty soldiers who request more than 8 outpatient visits per year requiring authorization.

In the area of weight management, Tricare has the advantage of covering bariatric surgery for those considered morbidly obese, which is not present in most insurance plans. Tricare does not include less-intensive options for weight loss such as nutrition and diet counseling, weight loss medication, and non-surgical options. Many of which are present in plans run by private insurers or state exchanges.

One advantage that Tricare enrollees have is the predictability of their co-pays and enrollment fees. For example, smokers using private or state-run exchanges can be charged up to 50% more than non-smokers but beneficiaries personal habits have no bearing on the cost they pay for health insurance.