active duty

Big Tricare Changes On The Horizon

  Words by Wes O'Donnell.

Military troop numbers and veteran’s retirement benefits are not the only things that will be drastically affected by the new 2015 budget.  The proposed fiscal budget in 2015 will also bring about big changes to the military's Tricare program.  The current choices you have with Tricare being Tricare Prime, Standard and Extra would be eliminated and replaced by a single Tricare plan.  Under this plan a fee structure would be set in place that adjusts according to the location in which beneficiaries receive their medical care.

This single program plan, starting in January of 2016 will have a proposed budget of approximately $47 billion.  The main goal of the consolidation is to urge beneficiaries to receive care from military facilities or network providers.  Those who chose not to will find they have a higher out of pocket cost. 

Under this plan, fees will be required by those retirees who seek care at military treatment facilities.  Also, enrollment fees will be introduced for future beneficiaries of Tricare for Life as well as increases in the co-pays for prescription drugs received through Tricare’s retail and mail order pharmacies for all current and future beneficiaries.

Retiree’s will also see an increase in their enrollment fees for themselves and dependents along with higher catastrophic capes and cost-shared depending on the location of the treatment facility.  No charge will still be upheld for active-duty service members receiving care from military doctors and facilities and their dependents cost will remain unchanged as long as care is received at a military clinic or hospital. 

Active-duty members would, however, see an increase in their costs if they choose to receive care from a network provider.  Co-pays would increase from $0 to $10 for family members with sponsors E-4 and below and from $0 to $15 for those with sponsors E-5 and above.  They will also be seeing new fees or increased fees for specialty care, urgent cares and emergency room visits.  These fees will once again be dependent on rank and range from $20 to $50.  Out-of-network charges for active duty family members will increase from 15% to 20% of the Tricare allowable charge.


For retirees, the annual enrollment fees starting in January 2016 will increase for individuals by $17 from $269 to $286 and families by $33 bringing it from $539 to $572.  They will be required to pay co-pay fees at military care facilities with primary care visits costing $10 and other services such as specialty care, urgent care, emergency visits and outpatient surgery ranging from $20 to $50.  Receiving care from network providers will have co-pays costing $20 for primary visits to $100 for outpatient surgery procedures.  However, cost-shares for retirees using out-of-network providers will hold steady at 25% of the Tricare allowable amount.

There will also be increases in deductibles for out-of-network care.  Those with sponsors ranking E-4 and below will go from $50 to $100 for individuals and $150 to $300 for families.  All other ranks will experience increases from $150 to $300 per individual and $300 to $600 for families.  Expect increases to be reflected in catastrophic caps for both active duty and non-active duty members as well. 

Enrollment fees for Tricare for Life retirees would be initiated under this plan for new and future participants base on a percentage of their gross retired pay.  This percentage would see increases as the years progress.  Current members would not be subject to these fees.  These retirees are also responsible for paying Medicare Part B premiums.

The plan also calls for changes to prescription coverage for all beneficiaries.  Prescriptions received at military facilities will still be free of charge.  Generic drugs would still be available at no charge through the Tricare mail order system, however, brand name drugs would increase from $13 to $15 through the mail order system.  Generic drugs obtained at retail pharmacies will see a slight increase by 2016 but brand name drugs received at retail pharmacies will increase from $17 to $26 starting in 2015.  Non-formulary medications will be tightly restricted and co-pays for these medications by mail will increase from $43 to $54. 

Under this plan, active duty members and their families who are currently responsible for approximately 1.4% of their annual health care costs would now be covering 3.3% of their overall health care expenses.  Retirees and families currently paying approximately 9.3% of health care costs would be responsible for paying 10.8% of their overall health care expenses under this plan. 

Officials realize that they are expecting current and former service members to contribute more to their health care than they have in the past but are still trying to keep benefits affordable and generous. 

Pentagon officials state that if these changes as well as other proposals such as those involving pay raises, housing allowances and commissary benefits are not approved through Congress, the Department of Defense would see a drastic budget shortfall of over $2 million in 2015 which could grow to $30 billion by the year 2024. 

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