New Name, New Costs. New TRICARE?

By: Shannon Prentice, Content Development Manager


It’s happening. Everyone stay calm.

On September 29, the Department of Defense (DoD) released the most detailed information to date on major changes for TRICARE users taking effect in 2018. These changes are supposed to simplify TRICARE, but may take some getting used to—especially for current TRICARE Standard users who go to civilian providers off base.

The good news for TRICARE Prime families who use Military Treatment Facilities (MTF) and clinics is that not much will change for you.

TRICARE Standard users, DoD’s newly released changes will affect you. Here’s how:

We now know the exact dollar amounts TRICARE Select users will pay for most services.

Your out-of-pocket cost is based on when your service member first joined the military. Everyone whose enlistment or appointment occurred before January 1, 2018 (i.e., everyone already in a uniform or retired) will be “grandfathered” in to TRICARE Standard’s existing cost shares, which we expected to stay the same.

The bad news is that this is NOT how DoD followed through.

To make out-of-pocket costs more predictable, DoD made some changes to what grandfathered TRICARE Standard/Select families will pay out-of-pocket. Unlike Standard, where you pay a percentage of what the doctor charges, Select users will pay a fixed amount. DoD has set those fixed amounts for primary care, urgent care, specialty care, Emergency Room, and other types of visits.

This means some Select beneficiaries will end up paying more out-of-pocket than they would if they paid a percentage of the doctor’s fee, and some will pay less.

Here’s what that could look like for your family: under the current Standard cost shares, one active duty family member in Standard recently paid $66.30 for an ER visit that resulted in a hospital stay. On another ER visit for an acute issue, that family member only paid $28.86 and went home with some medicine. But under the new “grandfathered” cost shares, each time she visits the ER, her cost will be $87, no matter how severe the medical issue.

For military families on a budget or trying to get better care for their family by being on Standard, this could result in a much more expensive health care option.

Additionally, based on charts (TABLE 1: TRICARE Select and TRICARE Prime Cost Sharing for ADFMs for 2018, TABLE 2: TRICARE Select and TRICARE Prime Cost Sharing for Retiree Families for 2018) provided by the DoD, many currently serving military families in Select will likely pay more for health care costs than families whose military member will join the Uniformed Services after January 1, 2018.  

For example, the Emergency Room Visit copay for new active duty family members is $40 while grandfathered families will pay $87.

Right now, we still don’t know how these fixed cost-shares will affect things like maternity care, lab fees, and other specialty care, like physical therapy. But we’ve asked DoD leaders for more information on how they came up with the dollar amounts for each of these services.

Just like your high school algebra teacher, we’d like to see the “work” and not just the answer!

The take away?

We are sending our thoughts and suggestions to DoD to ensure these changes to TRICARE don’t cause undue stress for your family… but we need your help.

TRICARE Standard families, what did you pay out of pocket for your last pediatrician’s visit? Your last visit to a specialist? Your last trip to the ER? Give us your thoughts in the comments.

These new TRICARE changes can be a bit confusing, and we want to keep you in the loop with information that could affect you. Sign up for TRICARE email updates, and follow NMFA’s Facebook page for posts and articles about how TRICARE changes will affect your military family.


Posted September 29, 2017


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