Some military families and retirees can add Tricare to their list of costs that are increasing in the current economic environment.
Generally speaking, if a Tricare beneficiary paid out of pocket for Tricare before, that cost will be going up. Active-duty families in Tricare Select will see some increases in co-payments, generally by a few dollars, starting Jan. 1, 2022. There are also increases coming in co-payments and annual enrollment fees for retirees, their families and others, according to fee schedules just released by the Defense Health Agency.
These cost increases don’t apply to active-duty families in Tricare Prime, who only pay when they get care without a referral, use non-network providers without authorization, or use a pharmacy other than a military pharmacy. There are no charges to active-duty members for any type of health care.
The Tricare open season began Monday and ends Dec. 13. This is the only time of year when you can make changes to — or enroll in — Tricare Prime or Tricare Select, outside of a qualifying life event such as marriage, birth of a baby, or retirement from active duty. You can also switch plans entirely. Changes you make go into effect Jan. 1, 2022. Visit www.tricare.mil/openseason for more information and to make changes.
If you’re not already in a plan and don’t enroll during open season, you’ll only be eligible for care at a military hospital or clinic — if space is available. Defense health officials advise that even if you don’t plan to make changes in your Tricare coverage for next year, you should check for any cost changes that could affect you.
By law, DoD is required to raise certain beneficiary out-of-pocket cost shares by an amount based on the annual cost of living adjustment for retirees, which is 5.9 percent for 2022. Cost increases also reflect changes in the cost of health care services and drugs, and other factors, according to the Defense Health Agency.
There are also differences in some costs based on when the sponsor entered the military. Those who entered before Jan. 1, 2018, are part of Group A, while those who entered on or after Jan. 1, 2018, are part of Group B.
For active-duty families in Tricare Select, co-payments generally increase by a few dollars for various services. For example, in-network primary care outpatient visits for families in Group A increase by $2, from $22 to $24. For this group, co-pays for outpatient specialty care will increase by $4, to $38. Outside of the Tricare network, the patient pays 20 percent of the cost.
Enrollment fees
There are no yearly enrollment fees for active-duty service members and their family members or for retirees enrolled in the Tricare for Life plan, but there are enrollment fees for other retirees and their families, and those are increasing in 2022.
A working-age retiree in Tricare Prime will pay a $323 annual enrollment fee for an individual, an increase of $20 per year, and $647 for a family, an increase of $41. In Tricare Select, a working-age retiree generally will pay an annual enrollment fee of $158 per individual and $317 per family, increases of $8 and $17, respectively.
Annual deductibles
There are no annual deductibles in Tricare Prime. But there are deductibles for those in Tricare Select, and those costs are also going up for some members. Example: For active-duty family members and Tricare Reserve Select members who entered the military after Jan. 1, 2018, the annual deductible for those in paygrades E-4 and below has increased by $4, to $56, for an individual; and by $7, to $112, for a family. The annual deductible is the amount you must spend before the Tricare cost-sharing begins.
Catastrophic cap
The catastrophic cap is the maximum amount of money you pay out of pocket each year for covered services before Tricare will start picking up 100 percent of the cost. It’s increasing for beneficiaries in most Prime and Select programs, except for active-duty families in Prime and Select who are in Group A, where it remains at $1,000; and retirees in Tricare Prime, Group A, where it remains at $3,000. For active-duty families in Group B, the catastrophic cap has increased by $62, to $1,120.
The catastrophic cap for Group A retirees and their families in Tricare Select increases from $3,500 to $3,706.
Premium plans
Monthly premium costs will increase for the Tricare Retired Reserve plan (about 4 percent) and the Tricare Young Adult plans (12 percent for TYA Prime and 3 percent for TYA Select.) They will decrease slightly for the Tricare Reserve Select plan.
Who can participate in Tricare open season?
Anyone enrolled in or eligible for Tricare Prime, Tricare Prime Remote, Tricare Select, Tricare Overseas Program Prime, Tricare Overseas Program Select and U.S. Family Health Plan are eligible to participate in the open season.
Open season doesn’t apply to active-duty members, who have full health coverage, and it doesn’t apply to retirees who are in Tricare for Life. Coverage is automatic if you have Medicare Part A and Part B.
Those who have premium-based plans — Tricare Young Adult, Tricare Retired Reserve and Tricare Reserve Select — can buy these plans at any time. But those in Tricare Young Adult with the Prime and Select plan options can only change plans during an open enrollment season or qualifying life event.
Tricare Prime is a health maintenance organization-style plan, where you get most of your care from a primary care manager, and referrals are required for specialty care. There is no deductible. Active-duty service members and their family members, and transitional survivors don’t pay enrollment fees or out-of-pocket costs for covered services. Retirees, their families and all others pay enrollment fees and out-of-pocket costs for covered services except for preventive care.
Tricare Select is a preferred provider organization-style plan where you choose your Tricare-authorized provider and don’t have to get referrals for most services. There are deductibles, co-payments and cost-shares.
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Drug costs
As previously reported, pharmacy costs will increase in 2022, with co-payment increases ranging from $1 to $8. The increase doesn’t affect active-duty service members, who pay nothing for their covered medications through military pharmacies, retail network pharmacies and through the home delivery benefit. The increase also doesn’t apply to survivors of active-duty service members, or to medically retired service members and their family members.
The military pharmacy is still the lowest cost option for military beneficiaries; there’s no cost for covered generic and brand-name drugs at these pharmacies.
Dental
Family members of active duty, National Guard and Reserve — as well as Guard and Reserve members who aren’t on active duty — are eligible for the Tricare Dental Program, which requires separate enrollment.
Most retirees and their family members are eligible for dental and vision coverage under the Federal Employees Dental and Vision Insurance Program, or FEDVIP, which is administered by the Office of Personnel Management.
The open season for FEDVIP also runs from Nov. 8 to Dec. 13. The same number of vision and dental insurance options are offered for 2022; the cost for the options will increase, on average, by less than 1 percent. There are 23 dental plans offered by 12 carriers, seven of which provide nationwide coverage, while the remaining five offer regional coverage.
If you’re already enrolled in a FEDVIP dental and/or vision plan and don’t want to make a change, your enrollment will automatically continue.
Vision
You must be enrolled in a Tricare health plan to be eligible for FEDVIP vision coverage. Those eligible include active-duty family members, retirees and their eligible family members, and Selected Reserve members and their family members. There are 10 vision insurance plans available from five national providers.
Visit www.benefeds.com to enroll in FEDVIP and to get more information.
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.
