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 Military.com, 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 Military.com:

Army and Air Force Exchange Service officials are warning soldiers and military families to be aware of scammers using the Exchange's logo.

In a news release Wednesday, Exchange officials said scammers using the name "Exchange Inc." have "fooled" soldiers and airmen to broker the sale of used cars, trucks, motorcycles, boats and boat engines.

Read More Show Less

KABUL (Reuters) - The Islamic State (IS) militant group claimed responsibility on Sunday for a suicide blast at a wedding reception in Afghanistan that killed 63 people, underlining the dangers the country faces even if the Taliban agrees a pact with the United States.

The Saturday night attack came as the Taliban and the United States try to negotiate an agreement on the withdrawal of U.S. forces in exchange for a Taliban commitment on security and peace talks with Afghanistan's U.S.-backed government.

Islamic State fighters, who first appeared in Afghanistan in 2014 and have since made inroads in the east and north, are not involved in the talks. They are battling government and U.S.-led international forces and the Taliban.

The group, in a statement on the messaging website Telegram, claimed responsibility for the attack at a west Kabul wedding hall in a minority Shi'ite neighborhood, saying its bomber had been able to infiltrate the reception and detonate his explosives in the crowd of "infidels".

Read More Show Less
U.S. Air Force/Tech. Sgt. Brian Kimball

Editor's Note: This article by Oriana Pawlyk originally appeared on Military.com, a leading source of news for the military and veteran community.

Calling aviation geeks in New York City: The British are coming.

In their first visit to the United States since 2008, the Royal Air Force "Red Arrows" will perform an aerial demonstration next week over the Hudson River, according to an Air Force news release. F-35 Joint Strike Fighters, the Air Force Thunderbirds and Navy Blue Angels demonstration teams will also be part of the show.

Read More Show Less
U.S. Air National Guard/Staff Sgt. Michelle Y. Alvarez-Rea

Frances and Efrain Santiago, natives of Puerto Rico, wanted to show their support last month for protesters back home seeking to oust the island's governor.

The couple flew the flag of Puerto Rico on the garage of their Kissimmee home. It ticked off the homeowners association.

Someone from the Rolling Hills Estates Homeowners Association left a letter at their home, citing a "flag violation" and warning: "Please rectify the listed violation or you may incur a fine."

Frances Santiago, 38, an Army veteran, demanded to know why.

Read More Show Less
Todd Rosenberg/AP

A West Point graduate received a waiver from the U.S. Army to sign with the Philadelphia Eagles on Friday, and play in the NFL while serving as an active-duty soldier.

The waiver for 2nd Lt. Brett Toth was first reported by ESPN's Adam Schefter, who said that Toth signed a three-year deal with the Eagles. Toth graduated from the U.S. Military Academy in 2018.

Read More Show Less