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Many Tricare Users to Pay Enrollment Fee under Congressional Proposal

Doctor greets a patient with a handshake.

Many Tricare users would face annual enrollment fees in a newly named plan under a draft proposal released Monday by the House Armed Services Committee.

Under the plan, current users of Tricare Standard and Tricare Extra would fall into the newly minted Tricare Preferred plan. Users would continue to be permitted to self-refer to providers, but doing so would come with an annual enrollment fee of $100 for individuals and $200 for families starting in 2020.

New Tricare users would pay even greater fees. Active-duty family members would pay $300 for an individual or $600 for families to enroll each year, while future retirees who joined the service after 2020 would pay $425 for an individual or $850 for families.

New beneficiaries who want to use Prime can do so, but also at a cost. Active-duty families would pay $180 for an individual or $360 for a family, while retirees would pay $325 for an individual or $650 for a family. Current users would not pay to use Prime.

Under the new Preferred option, users would have no annual deductible, but would pay set fees out of pocket. For example, emergency room visits would cost $40 in network for active-duty families, and $60 for retirees. The catastrophic yearly cap would be at $1,000 for active-duty families and $3,000 for retirees.

For Prime users, no annual deductibles would apply unless users chose to receive care without a referral. In that case, they would face a $300 for individuals or $600 for families deductible, with the same catastrophic cap as Preferred users. Other services, such as emergency room use, would continue to be free.

According to the legislation, the fees would not affect current Tricare users who choose to use the new the Preferred program instead of Prime until at least 90 days after the U.S. comptroller general submits a report to Congress on Tricare access to care, which could be as late as February 2020, the legislation says. All new Tricare users who join the military after January 1, 2018, would immediately face the new fees.

The bill also includes proposals that would provide better access to care, including an order that some military treatment facilities operate urgent care centers until at least 11 p.m. each night. Beneficiaries who don't have access to on-base urgent care, the bill says, must be able to use urgent cares off-base without referrals.

That order comes on the heels of a Tricare plan announced early this month to allow two referral-free urgent care visits per year, per beneficiary starting in late May.

Before becoming law, the House proposals face a rigorous examination by lawmakers, as well as consideration and a vote in the Senate. The measures are unlikely to fully pass or fail until late this year.

Editor's Note: This story was corrected on April 26 to reflect that only currently serving beneficiaries and retirees who opt to use the Preferred plan after 2020 would face annual enrollment fees.

-- Amy Bushatz can be reached at amy.bushatz@military.com.

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