As the cost of everything has been increasing, health care costs for some military families will also increase in 2024.
Generally, if you’ve been paying out-of-pocket for Tricare in 2023, you’ll pay extra in 2024, according to fee schedules just released by the Defense Health Agency.
For those who make co-payments for covered services such as primary care visits, specialty care outpatient visits and urgent care, the co-pays will generally go up by $1 to $3 a visit. And those who pay annual enrollment fees will also see increases. Annual deductibles will increase for some, which means the families will pay more out of pocket before Tricare kicks in.
Active duty service members don’t have out-of-pocket costs. Their family members may have costs, depending on the Tricare health plan they’re enrolled in, their sponsor’s pay grade and when the sponsor entered active duty, the type of care they get, and where they get it.
Thus, as Tricare open enrollment season starts Nov. 13 and ends Dec. 12, it’s important for families to review their costs that go into effect Jan. 1. “Families really need to do their homework, look at their out-of-pocket costs, think about their situation, and figure out which plan is right for them,” said Eileen Huck, senior deputy director of government relations for the National Military Family Association.
“I’m glad DoD put out the new rates this week, as we’re coming up on open season.”
This is the only time of year when those eligible for, or enrolled in, Tricare Prime or Tricare Select can make changes to their health care coverage unless they have a qualifying life event during the year, such as a marriage, birth, permanent change of station move or retirement.
If you don’t want to make a change, you don’t have to take action.
Active duty service members and their families in Tricare Prime (including U.S. Family Health Plan) don’t pay annual enrollment fees, annual deductibles or out-of-pocket costs for covered services. Families pay only when they get nonemergency care without a referral, use non-network providers without authorization, or use a pharmacy other than a military pharmacy.
Active duty families in Tricare Select don’t pay annual enrollment fees either, but working-age retirees, their family members and most others do, and those fees are going up.
Tricare for Life members don’t pay enrollment fees.
By law, there are differences in some costs based on when the sponsor entered the military. Those who entered before Jan. 1, 2018, are part of Group A, while those who entered on or after Jan. 1, 2018, are part of Group B.
There are no costs for covered preventive care visits.
Some examples of in-network co-pays for services:
♦ Primary care outpatient visits in the Tricare Select network: For active duty families, the cost increases by $2, to $27, for those in Group A, and remains at $18, for those in Group B. For working-age retirees, it increases by $2, to $36, for those in Group A. For Group B, it increases by $1, to $31.
♦ Primary care outpatient visits for working-age retirees in Tricare Prime: Co-pay increases by $1, to $25.
♦ Urgent care center visits in Tricare Select: For active duty families in Group A, co-pay increases by $2, to $27; and by $1, to $25, for Group B. For working-age retirees in Group A, it increases by $2, to $36.
♦ Urgent care center visits in Tricare Prime for working-age retirees: Co-pays increase by $1, to $37.
Tricare Prime: Annual enrollment fees for those in Group A will increase from $351.96 to $363 for the year for individuals; and families’ costs will increase from $703.92 to $726. For those in Group B, the individual’s cost goes from $426 to $438.96; and families’ costs go from $852 to $879.
Tricare Select: Annual enrollment fees for those in Group A will go from $171.96 for individuals to $177.96; and for families, from $345 to $355.92. For those in Group B, the fee will go from $547.92 for individuals to $564.96; for families, from $1,095.96 to $1,131.
Deductibles are the amount the beneficiary must pay before Tricare starts to pay. There is no annual deductible for Tricare Prime.
Active duty family members in Group A, grades E-4 and below, pay $50 per individual and $100 per family (no change). Group B members pay $62 per individual, up from $60; and $125 per family, up from $121.
Active duty family members in Group A, grades E-5 and above, pay $150 per individual and $300 per family (no change). Group B members pay $188 per individual, up from $182; and $377 per family, up from $365.
Working-age retirees in Group A pay $150 per individual and $300 per family (no change). Group B members pay $188 (in network) for individuals, up from $182; and $377 (in network) per family, up from $365.
The catastrophic cap is the maximum amount beneficiaries pay out of pocket in a year for covered services before Tricare starts picking up 100% of the cost. The cap is increasing for some beneficiaries in Prime and Select programs, except for active duty families in Group A, where it remains at $1,000, and retirees in Tricare Prime Group A, where it remains at $3,000.
The catastrophic cap for certain active duty family members and working-age retirees will increase by about 3.2%. By law, DoD is required to raise certain beneficiary out-of-pocket cost shares by an amount equal to the annual cost of living adjustment for retirees, which is 3.2% for 2024.
For active duty families in Group B, the catastrophic cap increases to $1,256, up from $1,217 in 2023. For Group A working-age retirees in Tricare Select, the cap increases by $129, to $4,157 for the family. For those in Group B, the cap increases by $137, to $4,399, for the family.
Increases for premium-based plans
As announced earlier, the rates have increased for the Tricare premium-based programs — Tricare Young Adult, Tricare Reserve Select and Tricare Retired Reserve — as determined earlier by the Defense Health Agency. Those increases take effect Jan. 1, 2024.
The new monthly premiums are:
♦ Tricare Young Adult:: For TYA Prime, an increase of 11.8% to $637 a month, compared to the current $570 a month. For TYA Select, the monthly premium increases to $311, a 6.9% increase from the $291 in 2023.
♦ Tricare Reserve Select: The monthly premiums increase by 7.2% for both individual service member coverage and family coverage. It increases to $51.95 for the individual, from the $48.47 in 2023. For the family option, the premium is $256.87, up from $239.69 in 2023.
♦ Tricare Retired Reserve: The premiums increase by 6.5% for both individual and family coverage. For individuals, it increases to $585.24, up from $549.35 in 2023. For the Tricare Retired Reserve family, it’s $1,406.22 starting in 2024, up from the $1,320.76 in 2023.
“We continue to be really concerned about the Tricare Young Adult costs,” said Huck, of the National Military Family Association. “We feel that’s not sustainable, not a good option for our young people who lack the benefit that their civilian neighbors and friends have, the ability to stay on their parents’ plan.
“Families may not be aware. If they have an older child or a child who is going to be graduating from college, they need to be thinking about this, trying to figure whether this is something they can afford within their budget.”
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.