Many Tricare Users Will Face Higher Out Of Pocket Costs In 2018

Military Benefits
U.S. Navy photo

Editor's Note: This article by Amy Bushatz originally appeared on, the premier source of information for the military and veteran community.

Many current Tricare users will likely see higher out of pocket fees for care starting in January due to a new plan announced Thursday.

Tricare for Life and Tricare Prime elderly and active-duty users are not impacted by the change.

Fast Facts:

Tricare for Life and Tricare Prime users are not impacted by the change.

Currently, both active-duty and retiree Tricare Standard users, as well as Tricare Reserve Select and Tricare Retired Reserve users pay deductibles based on a "percentage of allowable amount" system. The amounts differ widely and are based on several factors, including provider location and type of care. Those fees are paid annually until a user hits his or her "catastrophic cap."

The new system, which also combines the Tricare Standard and Extra plans into program known as "Tricare Select," will instead shift those users to a flat point-of-service fee that will count towards the deductible and annual caps. Those caps are $1,000 for active-duty and Tricare Reserve Select users and $3,000 for all others.

The new fees will be $27 for primary care and $34 for specialty care for Tricare Select and Tricare Reserve Select users, and $35 and $45 for both reserve and regular retiree Select users. The annual out-of-pocket caps are $1,000 for active-duty and Tricare Reserve Select users and $3,000 for all others.

Additionally, some primary and specialty care will be considered "high value" and carry its own set of lower flat fees. Tricare officials offered no additional information on what that care is or when that fee information will be released.

Although some preventative care, such as cancer screenings and vaccines, is currently free to those users, Tricare officials said they'll be adding to the list of free care. No information was readily available on what the newly free care is.

Other services, such as emergency room and urgent care visits will also carry flat fees regardless of location. In-network urgent care visits will be $27 for Tricare Select and Reserve Select users and $45 for retiree users, while in-network emergency room fees will be $87 and $116, respectively.

The fee amounts were chosen based on cost averages from across the Tricare system, officials said. That means that while some users will likely spend less at some providers, many will likely be spending more.

Troops who enter the service after Jan. 1 will see an entirely different -- and in many cases, lower -- set of fees based on the same flat-fee concept. Those costs were set by law in 2016.

New active-duty Select users will pay $15 for in-network primary care and $25 for specialty care, while future retirees who enter the service are currently scheduled to pay $25 and $40 respectively for primary and specialty care.

The change to a flat fee, Tricare officials said, gives users more clarity on the cost of a visit before it's time to pay the bill. Rather than fluctuating fees based on geography and provider, users will know what to expect before going to the appointment.

"We wanted to go to a fixed cost share," said Navy Adm. Raquel Bono, who heads the Defense Health Agency, which manages Tricare. "We felt that was something more predictable and more patient friendly, and we also felt it was an easier construct."

But military family advocates found the change both surprising and concerning. While other Tricare changes that will hit Jan. 1 had been previously announced or ordered through legislation, this change came as a surprise.

They said they are worried that the new flat fees will bring a surprise cost increase for many users. A series of changes made by Congress in 2016 were specifically designed to protect current Tricare users through a "grandfather" clause. The new fees, they said, circumvent that protection.

"By doing this cost share to co-pay conversion for the grandfathered group, they have made it more complicated, and walked away from the idea that your plan will remain same," said Karen Ruedisueli, a deputy director of government relations for the National Military Family Association (NMFA). "The fact is, some people will be paying more, which I think is against the whole concept of grandfathering."

More from

(Associated Press/Tom Williams)

Ronny Jackson, the former White House physician and retired Navy rear admiral who had a short run as the nominee for the Department of Veterans Affairs in 2018, now plans to run for a seat in Congress.

Read More Show Less

The Pentagon will implement an "operational pause" on the training of foreign students inside the United States as the military undergoes a review of screening procedures, according to senior defense officials.

Read More Show Less
In this Nov 24, 2009, file photo, a University of Phoenix billboard is shown in Chandler, Ariz. The University of Phoenix for-profit college and its parent company will pay $50 million and cancel $141 million in student debt to settle allegations of deceptive advertisement brought by the Federal Trade Commission. (AP Photo/Matt York)

WASHINGTON (Reuters) - The University of Phoenix, which is owned by Apollo Education Group, has agreed to pay $191 million to settle charges that it falsely advertised close ties with major U.S. companies that could lead to jobs for students, the Federal Trade Commission said on Tuesday.

The University of Phoenix will pay $50 million to the FTC to return to consumers and cancel $141 million in student debt.

Some of the advertisements targeted military and Hispanic students, the FTC said.

Read More Show Less
Shane Reynolds, UCF Research Associate demonstrates an AR/VR system to train soldiers and Marines on how to improve their ability to detect improvised explosive devices. (Orlando Sentinel/Ricardo Ramirez Buxeda)

As UCF research associate Shane Reynolds guides his avatar over a virtual minefield using his iPad, small beeps and whistles reveal the location of the scourge of the modern war zone: Improvised Explosive Devices, or IEDs. He must take his time to sweep every last inch of the playing field to make sure his character doesn't miss any of the often-deadly bombs.

Despite his slow pace, Reynolds makes a small misstep and with a kaboom! a bomb blows up his player, graphically scattering body parts.

Read More Show Less
US Navy

The Navy has posthumously awarded aviator and aircrewman wings to three sailors killed in last week's shooting at Naval Air Station Pensacola.

"The selfless acts of heroism displayed by these young Sailors the morning of Dec. 6 are nothing short of incredible," Chief of Naval Air Training Rear Adm. Daniel Dwyer said in a statement.

Read More Show Less