New TRICARE Co-Pays Leave Military Families in Sticker Shock

MJ Boice, Staff Writer

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.

  • 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.

  • 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

  • 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.

  • 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.


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