A series of changes to Tricare caused by a contractor update and new legislation passed by Congress will have a major impact on current and future members of the Guard and Reserve, as well as retired Guard and reservists under age 60.
The plans used by Guard and Reserve members and retirees, known as Tricare Reserve Select and Tricare Retired Reserve, require a monthly premium as well as annual deductibles and other out-of-pocket costs.
The plans cost $217.51 a month for a family, or $47.82 a month per individual for currently serving members, and $1,013.36 a month for a family or $403.81 per individual for retirees.
Those users pay up to $300 in annual deductibles per family, plus additional out-of-pocket costs until they hit their annual maximum, known as a "catastrophic cap." That cap is $1,000 for currently serving families, and $3,000 for retirees.
But starting in 2018, all users will see a change in out-of-pocket costs as well as how service fees are calculated, while some will also see a change in where they send their monthly premiums.
Fast facts:
- Tricare region borders and managing contractors are changing Jan. 1.
- All Tricare Reserve Select and Tricare Retired Reserve users will see point-of-service fee changes.
- All Tricare Reserve Select and Tricare Retired Reserve users will see monthly premium changes.
- Tricare Retired Reserve users' annual out-of-pocket cap will increase from $3,000 to $3,500.
Read how the changes impact other users, including active-duty families and retirees.
Increases to Monthly Premiums
Monthly premiums for Tricare Reserve Select and Tricare Retiree typically change each year.
In 2018, those fees will increase to $221.38 monthly for families on Tricare Reserve Select, but go down slightly for individuals to $46.09.
For those on Tricare Retired Reserve, monthly premiums for a family will increase to $1,038.31 and $431.35 for an individual.
Update Monthly Premium Payment Information
Starting Jan. 1, a regular Tricare contract update is ushering in changes to Tricare's regions and contractors.
Rather than the three-region system used today, Tricare will divide into two regions -- Tricare East and West.
Tricare East will be managed by Humana Military. Tricare West will be managed by Health Net Federal Service.
That means all Tricare Reserve Select and Tricare Retiree users outside the current Tricare South region will have a new managing contractor starting Jan. 1 -- and must update their monthly payment information or risk losing coverage.
Users in the western U.S. under HealthNet must update their information by Dec. 20, while Humana users in the eastern U.S. have until Dec. 24, the notices state. Read more.
Increase Annual Cap for Retirees
Right now, Tricare Retired Reserve users pay a maximum of $3,000 for care out-of-pocket each year. Starting on Jan. 1, however, that max will increase to $3,500.
The annual cap for Tricare Reserve Select users will remain $1,000.
Flat-Rate Out-of-Pocket Costs
Thanks to a change in how point-of-service charges are calculated, some users may see higher out-of-pocket fees in the new year, while others will see fees lowered.
Currently, those costs are based on a "percentage of allowable charges" system predicated on a variety of factors, such as region, type of doctor and type of appointment.
Going forward, however, Tricare is moving to a flat-rate system based on average costs across the system. That means while some users will pay less at appointments, others will pay more.
Starting in January, Tricare Reserve Select users will pay $15 per visit for in-network primary care and $25 per visit for in-network specialty care until they hit their cap. In-network emergency room visits will run $40, and in-network urgent care use will cost $20.
Retired Reserve users will pay $25 per visit for in-network primary care; $40 for in-network specialty care; $80 for in-network emergency room use; and $40 for in-network urgent care.
All other fees are available on Tricare's website.
-- Amy Bushatz can be reached at amy.bushatz@military.com.
