Most Tricare Fees Could Change Again in January

A student assists during a well baby check-up. (U.S. Navy/David D. Underwood, Jr.)
A student assists during a well baby check-up. (U.S. Navy/David D. Underwood, Jr.)

Tricare's out of pocket flat rate care fees, deductibles and, for working age retirees, enrollment fees could change Jan. 1, a newly released policy update notes.

The changes would not impact Tricare for Life users.

The potential for annual fee increases or decreases is authorized in a law passed by Congress last year. But until now very little has been known about how or if those annual changes will happen.

Services and fees offered by Tricare are governed by the agency's policy manuals, which lay out the Pentagon's interpretation of rules set by Congress.

For example, when Congress ordered Tricare to provide referral-free Urgent Care access to Tricare Prime users, officials developed and published in the policy the rules for doing so.

And when Congress last year ordered Tricare Standard moved to Tricare Select, with a specific set of fees for troops and retirees who joined the military after Jan. 1 of this year, Tricare policy dictated how much current troops and retirees would be charged.

The policy manuals official public updates for coverage and reimbursements generally lags behind a major new rule's roll-out. For example, while Tricare's major updates went into play Jan. 1, the policy and reimbursement manual was only publically updated June 15.

That update highlights a Tricare plan to annually alter up or down the flat rate cost shares and deductibles for currently serving troops and the flat rate cost shares, deductibles and enrollment fees for retirees.

"All fees (including enrollment fees, deductibles, and cost-shares) are subject to review and annual updating on the calendar year," the reimbursement manual states. "This section provides the policy regarding fees and the Calendar Year (CY) 2018 amounts. Annual updates thereafter will be published on the Defense Health Agency (DHA) website."

Just what those updates will be based on going forward is not stated in the manual. The cost share fees were originally based on a complicated calculation that factored average spending on each type of service, among other factors, officials said last year,

We also don't know when those new fees will be released. Officials originally published the planned fees for January of this year in late fall last year. But then different, lower fees were instead put in place just a few weeks before the changes started.

Tricare officials did not respond to a request for details on when any fee changes might be released.

For troops and retirees who joined the military after Jan. 1 or for those who use Tricare's purchased plans, including Tricare Reserve Select, fees changes are set by law, not by policy. That law says that the rates must be "annually indexed to the amount by which retired pay is increased," the reimbursement manual notes.

In other words, any fee increase will be directly tied to the annual Cost of Living Adjustment for military retirees. The higher that bump, the more the fees will go up.

You can bet officials with military advocacy organizations, like the National Military Family Association (NMFA) or the Military Officers Association of America (MOAA) will be watching this issue closely.

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