New TRICARE Co-Pays Leave Military Families in Sticker Shock

TRICARE Costs 360px

Military families are speaking out against the steep increase in their out-of-pocket health care costs. NMFA has received numerous emails from families experiencing sticker shock after receiving bills for their 2018 provider visits. The only groups not facing these higher copays are families of active duty service members (ADFM) on TRICARE Prime and TRICARE for Life patients over 65.

Many families are blaming TRICARE contractors for the increase, but this time, Humana and HealthNet are not to blame. These copay hikes are coming from our own Defense Health Agency (DHA). It’s just an unfortunate coincidence that the DHA decided to implement these copay increases during TRICARE’s contract transition. The resulting impact has left military families to weather this perfect storm without an umbrella.

There are several reasons NMFA is concerned about these copay increases.

  1. When it comes to cost sharing for office visits, military families no longer have a health plan that is on par with the high quality commercial plans found in the civilian community. If a military family member requires physical, speech, or occupational therapy on a regular basis, they will now face higher costs than those in a high quality commercial plan.

    “I took my daughter for her first occupational therapy visit yesterday and the therapist said TRICARE has not even been paying half (for office visits) and expecting patients to pick up the rest.” – TRICARE Select ADFM

    The resulting impact of these costs may end up discouraging military families from seeking medical care they need, simply because they can’t afford it.

  2. Mental health copays are now $30 per visit for TRICARE Prime Retirees, $31 for TRICARE Select ADFM, and $41 for TRICARE Select Retirees. These amounts are higher than those in high quality commercial plans. After 16+ years of war, we are appalled DHA would create a cost barrier for military families seeking mental health care, especially with such little notice.

    “Yes, changes to TRICARE were advertised. However, when copays are more than double, emphasis should have been placed on notifying Prime members that substantial out-of-pocket costs were being made to their insurance.” – TRICARE Prime Retiree beneficiary

  3. We are alarmed by DHA’s careless approach to setting copay amounts for TRICARE Select; a plan that covers more than two million beneficiaries.

    “The 20 percent (it costs) to see a non-network provider is actually cheaper than the $31 copay to see an in-network specialist for several of our doctors.” – TRICARE Select ADFM

    TRICARE Select was marketed as an improvement for military families, similar to a Preferred Provider Organization (PPO). But some copays are so high that it’s actually cheaper for families to see a non-network provider. A PPO is designed to steer care to network providers through lower out-of-pocket costs. Why would anyone choose to pay more out-of-pocket just to see an in-network provider? Will these dramatically higher copays impact a patient’s adherence to treatment plans? We don’t know the answer to that, but neither does DHA. They didn’t consider any of this as they were setting the copay amounts.

  4. Where is all the money going? Savings from copay increases aren’t even staying within the Military Health System (MHS) to improve health care for beneficiaries. The ‘savings’ are being ploughed into military readiness.

    We agree that readiness is critical, but military families shouldn’t be the ones to fund readiness or military family support programs through cuts to their own health plan benefits.

Premium free health care is a unique benefit. It’s a large part of the compensation and benefits package designed to recruit and retain service members, despite the extraordinary sacrifices of military service. We appreciate the fact that TRICARE is provided without hefty monthly premiums, but the value of this benefits is now being outweighed by higher out-of-pocket costs for military families.

How do you feel about the increased out of pocket costs?  How has your family been impacted? Please share your experiences in the comments below.

Posted March 8, 2018


From: Alison on: March 21, 2018
I have always been so grateful for TriCare and the health benefits provided during and after our family's 22 years of active duty service. Each of our 4 sons was born in a military hospital. We too have been hit hard by all the new co-pays and coverage changes. Sometimes I really wonder where the decision makers think the money comes feels like they just look at numbers on paper and neglect to consider the millions of impacts each decision they make will have on living breathing families. To C. Joyner who commented on March 12th that only the person wearing the uniform should get the benefits...phooey on you. Our 4 sons and I served this country alongside my husband every day of that 22 years and my husband would be the first one to say so. Where would you suggest we get our coverage? Kind of difficult to set up any kind of serious career when you're constantly moving or your presence is required at home...because there is no one else there to handle things. These are sacrifices we took on willingly; patriotism, honor, good healthcare and a retirement check are some of the reasons we thought it was a reasonable decision.
From: Jaime on: March 13, 2018
My family is under Tri-Care prime retiree and I share the same opinion as many others on the price hikes. I understand that increases were coming to keep with inflation and the challenging times that we live now in 21st century. However, these increases were done incorectly without proper management. It's hard for many to accept double the price and some cases even more than they can afford. I will really have to pay attention my medical needs. It's shame this action toward our military community. God Bless to all.
From: Karen on: March 13, 2018
I gave up 30 years of my life so my husband could serve his country..with honor.. Just found out my husband has cancer..more than likely from being around all the fuel and crap from flying and now we have $30 coming out of our pocket for all his we can afford this crap!!! UGH!! GRRRR!!!
From: C. Joyner on: March 12, 2018
There is absolutely NO we can continue to do business the way we have in the past without some sort of sacrifice, especially for those receiving benefits who did not don a uniform to earn them but rather due to their association with someone who actually did. Rationalize how you will; however, costs associated with providing services for association beneficiaries are almost triple of those who actually earned them. Your anger is misdirected. It's high time copays increased but the tragedy is it doesn't include everyone it should. Bottom line up front is if YOU wore the uniform YOU should receive free care. The rest should pay and should have been paying long ago.
From: April on: March 12, 2018
My husband is medically retired from a catastrophic injury while deployed to Iraq in 2008. I was shocked at my co-pay for a mental health visit for myself last week. I have been left as his full-time caregiver and I need that space to vent, and get feedback and encouragement. It doesn't just sadden me, it ticks me off that I was left with this burden and that the DOD/TriCare/Military doesn't seem to get what it is like to be the caregiver for a young person who will NEVER be the same. My husband died on the battlefield and I was left with a shell of who he used to be. This is insult to injury.
From: Melissa on: March 10, 2018
My kids have had to cut their weekly mental health appts in half because of the drastic increase in copays. My husband has TFL secondary to Medicare and they keep denying everything so we have gotten tons of medical bills. He had a life threatening ER visit that they haven't paid a dime on. It's not his fault he was medically retired. All these changes are so disappointing and discouraging.
From: Kim on: March 10, 2018
I just found out yesterday at the therapist's office when they told me the new copay. Evidently, no one knew, and it has been left to the doctor's office to inform their patients rather than the insurance company. It is shameful. Plus, they told me that they don't know how much longer they will take TriCare Prime because it cut what they receive by 30% which means that they don't make anything from seeing these patients. If this doesn't get fixed soon, I am afraid that we will be searching for a new therapist in a difficult to find field already. People keep pushing single payer health care. They should look to this disaster to see what their future would be like if they got it. Fewer doctors and higher fees, that is what they will get.
From: Gary on: March 10, 2018
My wife and I have Tricare Prime and our co-payments have increased. To make matters worse my wife is going to have to have surgery and that will cost us $150 per night. Now we find out Express Scripts is going to charge a co-payment, we still don't know what's happening there. Our primary care doctor still isn't on the list, we're about to lose all our specialist and if that happens, we have to get all new specialist. Since our primary doctor hasn't been accepted yet, we are without a doctor, my wife became very ill and we had no Dr.! This is totally unacceptable. Forget calling, you can never get someone to answer and when they finally answer they have no answers for your questions. This is so pathetic.
From: Lonnie A on: March 9, 2018
One of my major complaints is the co-pay for physical therapy and mental health, have almost tripled from $12 to 30. Now that my daughter had knee surgery and my husband is recovering from shoulder surgery both of which need three times a week Physical Therapy. We are paying for six visits weekly. Thats $720 a month for physical therapy for proper, healthy and effective recovery! AND then, there is calling in to get answers to questions of which their websites are NOT functioning the way we were told AND.....being a TRICARE PRIME retired from active duty, being told be a chat person 'trying to help me' that my Tricare select does not cover 'that'! WTF! And to have this other 'person' ARGUE with me!? Untrained at itz best! BUT all hope is not lost. This too shall pass and those who are incorrectly teaching/informing others will have there judgement day!
From: Karl on: March 9, 2018
just curious. How much did co-pays for congress healthcare increase? Why do we keep taxing the little guy... higher healthcare cost mean less people will get the care they need because they can’t afford it. This will lead to pre-mature deaths, decreasing the patient population thus saving money because they will have less beneficiaries... it’s win win for the DHA!!!
From: Aaron on: March 9, 2018
I have a child with special needs and his appointments have gotten much more expensive. We had to cut some of his planned therapy. I have never had to pay so much for healthcare under Tricare. The worst thing is that if any of us need to see a doctor it has gotten more expensive. It was frustrating since my wife is a diabetic and her medications are not covered 100% anymore. This extra cost for lifesaving medication make us make a decision on food or medication. That is a sad state of affairs for a soldier that has faithfully served his country for years. I don't see the reason for the change. This is a WTF moment for my family.
From: Carrie on: March 9, 2018
I broke my ankle in November and waa paying the normal copay. Once 1 January 2018 came I could only see PT once a week and the Orthopedic every 6 weeks. Since Fort Knox has become a Healt Clinic instead of a hospital it took 2 weeks to see an Orthopedic for my ankle. Now Ft. Knox will stop seeing Retirees within the next year. What the heck am I supposed to do? The VA takes care of my disabled husband, Thank Goodness. Our copays have gone up over 50% and these brave men and women should have free health or very low cost health care and the very best of it.
From: Phyllis on: March 9, 2018
I am a widow of a retired army service member who had agent orange. I am on Tricare for life at age 71. I think they just want all the older members to die as my co-pays on my prescription drugs has sky rocketed. I have c.o.p.d. am diabetic and now cannot afford all my medications.
From: Curt/Eunice on: March 9, 2018
A person should have been notified of the change from free to 7 dollars for each generic prescription and higher for brand names. What is next! We should be kept informed of changes.
From: Thom on: March 9, 2018
Thank you for your service. No more free anything. NOW PAY UP OR ELSE. Thanks republicons.
From: Lucy on: March 9, 2018
My husband is retired, 20 years, we have never received free health care. We have always paid our premiums, on time, for tricare prime. This year we were informed that our premiums would increase. That's it. Third week of January, I'm at an appointment, my co pay more than doubled! I couldn't believe it. It wasn't on the website, we werent notified. Needless to say, I left in tears, unable to go to my appointment. I have many health issues, that have required multiple surgeries. I have had over 25 appointments in one month before. Now I have had to cut all my appointments, delaying my treatment and healing. It's not affordable. There was no gradual increase. No notification to plan for it. God forbid, I get in a situation, or worse, my husband gets in one where he has to to the emergency room. That went from 30.00 to 150.00. This will cause more deaths in my opinion because nobody can afford the treatment they need. My husband served our country so he has to now pay a substantial amount to be healthy. Shame, shame, shame.
From: Clara on: March 9, 2018
“I will take care of the veterans like you wouldn’t believe.” —- Trump on the campaign trail. Enough said.
From: J on: March 9, 2018
Our daughter's therapy went from 12 dollars a session to now 30! Once a week at two hours at a time it's like 240 dollars! We can't do that, it's outrageous. Now, we have to cut that in half and our daughter won't get the help she needs. WTF? And don't forget the much higher costs of urgent care and "specialty" appointments that are also 30 dollars. It's insane! We thought that 20 years in the military, fought in 2 wars would get us at least much discounted healthcare and prescriptions. We DID get that, NOW we are not.
From: Cindy on: March 9, 2018
Express scripts copays are up as well. It's come to a point that you have to decide to take your meds or not. Bralder
From: Terry on: March 9, 2018
The cost of care for someone that give their life for all of us and the families that fellow through the years shouldn't have to worry about medical. 20 years my husband did and the healthcare is roller coster of payments. When my husband was active with full pay give me the copay but now he makes less then half of that pay, plus we have to pay a yearly fee you charge us like we are rolling in the money. Some can't afford all of the fees and now care will go down because of it. I paid 60 for a ER visit for my son because he got sick in the middle of the night. Who just has the extra funds, even if you have a saving well that will be spent fast because retires and family has to be seen off post and bam copays. Thanks for my husband and family that did 20 years moving and being without a father at home at times. We shouldn't be paying those that retire give up to protect us, why can't we find funds support those that served this country.
From: Lisa on: March 9, 2018
I have a child with special needs who has multiple therapy appointments a week. I was not aware that there would be a copay increase. My son needs the therapy and I’m trying to figure out how we can do this! I’m afraid we are going to have to cut his therapy!
From: Lorna on: March 9, 2018
I've had three mental health appointments. With a cost of $30-60 a week I won't be continuing.
From: Andria on: March 9, 2018
The claim by DHA our co-pays would be going up is completely untrue in our family's case. We were completely taken off guard. The doctor's office told me there were already three other people that morning that also had no knowledge. My husband is a disabled vet after 23 years of service and unfortunately I am disabled as well. We have numerous medical appointments. Now, everyone is considered a specialist outside of your primary care doctor. My husband recently had a major surgery and requires Physical Therapy 3 times a week. One of my specialist physicians recommended physical therapy for me as well. I declined it as we would be spending $180 a week just in PT costs. Furthermore, the referral process is a nightmare . In the hospital, you can have many different medical staff seeing you and then find out later they are not in network There is so much waste in military spending which could be eliminated and put toward our care. I am angered they expect those who have served to cover mismanagement. Call your representatives, senators and any other groups , organizations that impact military care! It is tragic that are veterans, and all the families have a fight of another kind after already doing so serving our country.
From: Brandy on: March 9, 2018
I have 2 autoimmune diseases. I went for my infusion for one of those diseases, to be told I have to pay $700. My oral medication and inhalers have tripled the cost. We can't afford this!!!
From: Julia on: March 9, 2018
I work in a small, private, Mental Health Office and I feel your pain. It is horrendous. However, not only have they increased your copays, they have DRASTICALLY cut what they pay the In-network providers. They dropped the allowable charge $37. So, providers have lost $37 per visit, per client. With 70% of our clients being Tricare, it has impacted us hard. I am sorry that they have done this to you, and us. For all you veterans have been through for our safety as American citizens, the sacrifices by you and your families, this really is a slap in the face. This needs to be fought from both sides - Tricare users and physicians!
From: Angela on: March 9, 2018
With the increased copay for retirees $30.00 per visit is quite high. It really discourages beneficiaries to get services or continue to receive services because it's so costly. I am considering reducing services received on a weekly basis because of the increase. It's a financial hardship
From: 6ft8incyclist on: March 9, 2018
Thank you Republicans.. During the Obama years. Ted Cruz in the senate, and PAUL Ryan in the house, in there Republican budget one of the ways to pay for huge tax cuts for the ultra rich and huge corporations was To End Military Disability pay and end Military retirement pay until you turn 65 .. Plus tear apart Tricare (stand by this is just the beginning) .. The Justification for this was we are an all volunteer force.. But the senator can retire after 2 terms, with much better benefits . And they only work 120 days a year if that...
From: Annette Maldonado Lawrence on: March 9, 2018
It has made a considerable impact on our family. My daughter has several medical issues and the increase of the copays has really hit us hard. She will no longer be able to attend her weekly therapy sessions, we can't afford them with all of her other appointments. We were promised free health care when we joined the military and now we don't even get affordable health care. What a great way of thanking us for our service.
From: Daniel on: March 9, 2018
As an Air Force retiree, I was appalled after finding out my monthly medical charges had innreased by over thirty dollars. Doesn't seem like much until you start including the family. We were told that Tricare for Life personnel were excluded - thanks so much for the warning.
From: Tammie on: March 9, 2018
I finally received notice in the mail that I will have to start paying copays for my medication. We are tricare prime adfm. This was to start Jan 1 but I only got the notice last week. They pushed us to go on this home mail order program with express scripts for our free prescriptions only to now start charging us. Now I’m fighting over a billing issue I didn’t even know about and I’m going to have to start switching all my meds back to base. Sad.
From: Jenn on: March 8, 2018
I was shocked to learn that we have to pay a copay for prescriptions as active duty family members with Tricare Prime Remote. I was even more shocked when the prices went up at the beginning of the year. We have three Class II prescriptions which cannot be ordered from Express Scripts, so we now pay $33/mo for those. Additionally, we are now being charged a copay for Express Scripts, which is another $21 every 3 months. Families stationed in remote locations should not have to face expenses those near military installations do not.
From: Paula Kay on: March 8, 2018
Not right most retirees went in the service for benefits, one of them being free medical. How can you start charging for it, most can't afford it.
From: Naikeya seabury on: March 8, 2018
We retired just as the transition was taking place and they somehow managed to switch us from prime to standard first screw up.. we have a child inn the spectrum who requires Speech and PT.... no matter how many time I have called they still have not paid for all of his therpahy.. leaving us now with a $650. Bill for the ones they didn't pay and the new $30 copays.. 28 yrs of service and this is how the screw over the retirees family.. we are about to drop therapies cause it's becoming to much..
From: Jane Ellen on: March 8, 2018
I was shocked when I went to my mental health appointment and found it the co-pay went from $12 to $30 without any notice. I called TRI care to check if this was indeed correct. The person told the reason for the increase they had not been one in years.. I think it awful when people cannot afford get counseling due to the increase.
From: Kris on: March 8, 2018
Ginny. I'm so sorry for your loss. I cannot imagine your pain. I pray there can be positive resolution so that we can all have affordable access to desperately needed services. The entire situation is apalling and shocking that such little light has been shined on the subject. I have been writing for almost 2 months to newstations, newspapers, NC representatives and calling every single US Senate Committee on Armed Services..... to no avail. Thank you NMFA for this article!!! Ginny, I know this may sound strange, but I have found great comfort, coping strategies and peace by following Trent Selton on Youtube. I lost my Momma 5 years ago and I miss her more everyday! This video and countless others have taught and comforted me so very much. I pray they will help you too until you are able to resume your counseling as well!
From: Jen on: March 8, 2018
Physical therapy jumped up to $30 copay which usually requires multiple visits a week for multiple weeks. That comes out to $240 out of pocket for one month assuming you only need 2 days a week. Again, discouraging people to get proper care which could lead to surgery or other severe treatments which would cost tricare more....doesn't add up.
From: Kristin on: March 8, 2018
As a medically retired family of 6 on select our costs have gone through the roof, and co-pays were just the start. Our medication costs have tripled overnight, and we have had to choose between food and essential medications like ventolin and inhaled steroid asthma controller, the two medications were $74. In 22 years we have never seen a cost for Medications like that. Someone needs to stand up for the retirees who live on a limited budget.
From: Diana on: March 8, 2018
I have tricare prime and I also work at a physical therapy office. I can say first hand how disappointed tricare patients are when they are informed of the cost increase. I understand we get by cheaper than commercials plans but an increase from $12 a visit copay up to $30 is a little too steep.
From: Rachel on: March 8, 2018
My son has been going to the same office for speech and occupational therapy for almost three years. Up until February, we had only been paying about $15/$24 a week. Now it’s $62 for two 30 minute sessions a WEEK. Tricare isn’t even covering half of his bill now either. Also, the provider was not aware of the change and had us pay on “the deductible” Oct-Dec and is now making us back pay... but is not considering what she charged us Oct-Dec to 2018. Where did that money go? $15 to $62 a week and not even covering half is a huge difference for something my son cannot go without. Dealing with the doctors, referrals, and the entire system on post is ridiculous or we would switch. Extremely disappointed and, sadly, not surprised!
From: Valerie on: March 8, 2018
I’m confused. Co-pays, even at $30 or 40, really aren’t that much when compared to the cost of other things. And with Prime you know there aren’t going to be any surprises. You don’t get a bill for anything else when in the network with proper referrals. My network provider copays this year have still been just the $12 or $15 (I don’t remember, except that it hasn’t gone up much in a decade).
From: Bryan on: March 8, 2018
I used to pay $12 per visit for our daughters PT/OT/Speech/ABA. She saw the provider twice a week totaling $24 per week and resulting in $1,248 out of pocket per year without the additional visits on days school was closed and summer break which was manageable. On January 1st, TriCare changed the rules and the provider must now charge per service vice per visit so it is now $120 ($30 per service) per visit or $240 per week totaling $12,480 per year. Fortunately we have a $3,000 cap but at this pace, we will hit it by the first week of April. I completely understand increases but this much this quick puts an undue financial burden on families.
From: Mary on: March 8, 2018
I think some research should also be done into what the new contract allows for a Mental Health visit....from what I have seen and heard, that amount dropped by 30-35%. So along with a steep increase in copays....the message is sent and received that our Mental Health doesn’t matter that much....going backwards again...... I have also heard that new Mental Health visits have to be pre authorized ....the Benefit as defined by Tricare is that 8 visits are authorized before authorization needs to be given for more....
From: Sharon on: March 8, 2018
Our son is a rare disease kiddo who needs multiple specialties and therapies. We dropped ou patient therapy because no one in our area will even bill Tricare now. We can’t afford the out of pocket costs. So he will suffer. His specialist most are now no longer in network which is okay since the 20% is lower but it would have been nice if they would have explained the higher out of network deductible and that it does not count to the in network deductible (ie it is in addition, you are required to pay both) so now we are getting hit for out of network deductible and in network deductible all at the same time. Tricare has totally screwed over retirees who do not live near a military base. We have zero options. We live in SC and the closest geneticist for our son with a rare disease is in Tennessee.
From: Kressa on: March 8, 2018
This is unacceptable!!! I have Tricare prime. I have to go to go see the doctors on base but the quality service is so bad that i have question why i even have it but i also cant afford all the out of pocket expenses. I have to go to patient advocate to get any kind of response regarding my health care. This should not be happening every time i need help. No military family should have to suffer with worrying about health care costs or the quality of health care they receive. The sacrifices the military and their families make for this country are so great, there should not be a price put on that to keep our military and their families taken care of.
From: Mary on: March 8, 2018
Doctor I've had for 6 plus years is now all of a sudden out of network and the surgery I have scheduled at hospital is now said to be "out of network" so I'm going to be hit with huge chuck of the cost. In addition I had imaging done prior to this and could not understand my bills till now, again "out of network".. SO WHAT IS IN NET WORK. NO ONE. I went through the so called list of in net work and it's a joke. No one that can do surgery and no one Id trust with my care.
From: Andrea on: March 8, 2018
We have a special needs child and another child that should go 2x per week for OT and Speech therapy but we've had to cut it to 1x per week. Our copay would have been $240 each week just for both children. Oir copay is $120 each week. We struggle and no one has answers. It's helpless and infuriating.
From: Nicole on: March 8, 2018
SAD; why is the cost of military readiness being pushed onto the families and veterans health care? Many including myself are reluctant to go to the Dr. If in need. Even beyond this issue, we are retired, live in a military college town with multiple Drs and facilities but still have to drive 50 to 60 miles to a primary Dr unless we switch to select. This would make our copays and out of pocket to much to seek care unless an emergency and mental health, I thought was suppose to be a priority for these men, women, and their families. The health and welfare of our families should be top priority. Healthy families make for healthy soldiers and productive members when readiness is a need, but we should not pay for that.
From: Rose on: March 8, 2018
As a disabled veteran, I've seen my co-pays literally double for 2018. Being on a fixed income, this is terrible! DHA - taking affordable military healthcare and making in unaffordable in one fell swoop. Shame on them!
From: Ginny on: March 8, 2018
The hikes seemed to hit mental health care providers unaware as well. We lost my husband from a service connected illness Dec 31st. I have my daughter and myself in counseling. In February we were hit with a major bill for both of our weekly counseling Fees for almost two months of visits. Luckily the office allows payments and were understanding at our surprise in the fee hikes. I cancelled my visits so my daughter can attend weekly.
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