Tricare Lowers New Rates for Some Users

Doctor visit. Getty Images
Doctor visit. Getty Images

Some active-duty families and military retirees will be paying less than previously thought in the new year for doctor's appointments thanks to freshly recalculated rates from Tricare.

At issue is a series of major Tricare changes scheduled to hit Jan. 1, including a plan to charge flat fees to some users who see civilian providers rather than rates based on the current "percentage of allowable charge" system.

Another change moves users of the current Tricare Standard and Extra plans into a new plan, known as Tricare Select.

Officials announced early this fall that current Tricare Standard and Extra users will pay between $27 and $45 per primary and specialty care visit under the new Select plan, depending on whether they are active-duty families or retirees.

Instead, the new rates for active-duty families using the Select plan will be $21 per visit for in-network primary care and $31 for specialty care. Retirees will pay $28 for in-network primary care and $41 for specialty care.

The upcoming rates for emergency room visits, urgent care, ambulatory surgery and ambulance services also dropped by between $6 and $8 for users in both categories, as compared to the previously announced rates

Troops and future retirees who join the military after Jan. 1 will face a different set of fees mandated by Congress, as will current users of Tricare Reserve Select and Tricare Retired Reserve.

Tricare officials had said the previous flat rates were calculated based on a percentage of average out-of-pocket cost for each appointment from active-duty families and retiree users, respectively.

But when watchdogs with military and veteran service organizations pushed back with questions about which payments were included in the calculations, Tricare officials went back to the drawing board and produced new numbers.

The original calculation, officials with Tricare told Military.com on Friday, factored in users who paid nothing for doctor visits because they had reached their annual out-of-pocket max, known as a "catastrophic cap."

When officials removed those users and redid the math, the average cost per appointment went down, they said.

Other Tricare changes that start Jan. 1 include a change to the system's regional contractors and a shift from three Tricare regions to two.

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

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