Tricare Standard Copay 2020

Posted : admin On 1/3/2022

Many costs will be relatively stable in the coming year for military families in Tricare, and pharmacy costs won’t increase, according to new fee information from the Defense Health Agency’s Tricare website.

TRICARE Copayment Changes for 2020 October 09, 2019 The National Defense Authorization Act (NDAA) for fiscal year (FY) 2018 established changes to TRICARE prescription copayments every two years for the calendar years 2018 through 2027. These changes are for retail and home delivery only. Testing copayment waiver: Retroactive to March 18, 2020, TRICARE will waive copayments/cost-shares for medically necessary COVID-19 diagnostic and antibody testing and related services, and office visits, urgent care or emergency room visits during which tests are ordered or administered. Copayments and cost-shares are subject to change at the beginning of each calendar year. Copayments are per occurrence or per visit. Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services. Starting January 1, 2020 your copayments will be: Retail Network Pharmacy Copayment Changes (up to 30-day supply) Generic formulary drugs will increase from $11 to $13. Brand-name formulary drugs will increase from $28 to $33.

The notable exceptions are enrollment fees for Tricare Retired Reserve, Tricare Young Adult, and retirees in Tricare Select Group A. As previously reported, monthly enrollment fees are rising sharply for those in Tricare Young Adult, and retirees in Tricare Select Group A must start paying an enrollment fee in 2021.

Active duty families in Tricare Select will see increases of up to a few dollars in the cost-shares they pay for health care for certain services in 2021.

Across the board, pharmacy costs won’t change for all beneficiaries.

Some costs related to non-network inpatient hospitalization care haven’t yet been determined, and are expected to be released in December.

Active duty families in Tricare Prime only pay for care when they get care without a referral, or use non-network providers without authorization, or use a pharmacy other than a military pharmacy. There are no charges to active duty members for any type of health care.

There are differences in some costs for populations based on when the sponsor entered the military. Those who entered before Jan. 1, 2018, are considered Group A. Those who entered on or after Jan. 1, 2018, are considered Group B. It’s based on the Fiscal 2017 National Defense Authorization Act, which implemented Tricare reform. The law required that retirees in Group A start paying the enrollment fee, but delayed it until 2021. This doesn’t apply to those in the Tricare for Life plan.

By law, DoD is required to raise certain beneficiary out-of-pocket cost shares by an amount based on the annual cost of living adjustment, or COLA, for retirees. The COLA is 1.3 percent for 2021.

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There are about 4.9 million DoD beneficiaries enrolled in Tricare Prime plans, and about 2.1 million enrolled in Tricare Select plans.

Some examples of changes, based on information pulled from the Tricare website’s cost comparison tool, which can also be used for research for the upcoming enrollment open season, from Nov. 9 to Dec. 14:

Enrollment fees: Those in the Tricare Young Adult program will pay $459 per month for Prime, an increase of 22 percent; or $257 for Select, an increase of 12 percent.

• “Gray area” retirees using Tricare Retired Reserve will see enrollment fee increases by about $40 a month for individuals, to $484.83 a month; and by about $99 for families, to $1,165.01 a month. That’s an increase of nearly $1,200 a year for families. There are currently about 3,858 gray area reservist retirees under age 60 with Tricare Retired Reserve plans that cover about 10,400 people. Premiums for Tricare Young Adult, Tricare Retired Reserve and Tricare Reserve Select are set based on analyses of the actual costs in the previous year.

Tricare Standard Copay 2020

Tricare Rates 2020

• In addition, the previously reported new Tricare Select fee for retirees in Group A goes from 0 to $150 a year for individuals and $300 for families.

What Is Tricare Prime Copay 2020

• Of most other Tricare plans with enrollment fees, increases ranged from $3 to $10, depending on the plan. There are no enrollment fees for active duty families in Prime or Select.

Deductibles: These costs stay the same, or increase by amounts ranging from $1 to $8, depending on the plan. There is no deductible for active duty families in Prime.

Catastrophic cap: The catastrophic cap is the most amount of money you pay out of pocket each year for services covered by Tricare, before Tricare will start picking up 100 percent of the cost. It’s increasing for beneficiaries in most Prime and Select programs, except for Tricare for Life, where it remains at $3,000; active duty families in Prime and Select who are in Group A, where it remains at $1,000; and retirees in Tricare Prime, Group A, where it remains at $3,000.

The biggest increase in catastrophic cap is for retirees in Tricare Select, Group A, where it increases from $3,000 to $3,500. That means these retirees will now pay an extra $500 out of pocket before Tricare will start picking up 100 percent of the cost.

Family members of active-duty sponsors who entered the military after Jan. 1, 2018, will see their catastrophic cap increase by $14, from $1,044 to $1,058, whether they are in Prime or Select, as do those in several other Tricare plans.

Primary care visits: Most costs stay the same, except for retirees in Prime, both Group A and B, with an increase of $1 (to $21) for in-network visits.

Urgent care: Where there are changes, the increases are by $1.

Mental health outpatient/partial hospitalization: Most costs stay the same, except for $1 increases in some plans.

Emergency care: Where there are changes, the increases range from $1 to $7.

Cost

Pharmacy costs are staying the same through 2021 for all beneficiaries:

• Generic (Tier 1) drugs are at no cost at a military pharmacy; for home delivery they are $10; at a network retail pharmacy they are $13.

• Brand-name (Tier 2) drugs are at no cost at a military pharmacy; for home delivery they are $29; at a network retail pharmacy they are $33.

Again, these are but a few examples; more information is available at the Tricare cost comparison tool.

Covered Services

Learn more about what we cover -
including health, dental, and pharmacy.
6/22/2020

UPDATE: There’s new information available regarding TRICARE Select enrollment fees. Visit www.tricare.mil/selectenrollmentfees to learn more.

Starting on Jan. 1, 2021, TRICARE Select Group A retired beneficiaries must pay monthly enrollment fees in order to maintain their TRICARE health coverage. This is a change, and the first time this beneficiary group will pay enrollment fees.

“In 2021, some TRICARE beneficiaries will pay enrollment fees for the first time, a change mandated by Congress,” said Dr. Danita Hunter, director of the TRICARE Health Plan at the Defense Health Agency. “We’re communicating this well before the change is implemented so beneficiaries can be informed about the change, as well as their TRICARE plan and cost options.”

Here are the key points you need to know.

What’s happening?

Retired TRICARE Select beneficiaries will have to pay enrollment fees. This change was mandated by Congress in the National Defense Authorization Act for Fiscal YearOctober 1 - September 30 2017. Congress granted the Defense Health Agency a delay in implementation to calendar year 2021.

Who’s impacted?

This change only affects Group AIf you or your sponsor’s initial enlistment or appointment occurred before January 1, 2018, you are in Group A. retirees and their family members enrolled in TRICARE Select. You’re in Group A if your initial enlistment or appointment or that of your uniformed services sponsor began before Jan. 1, 2018. Active duty family members enrolled in TRICARE Select will experience no change, and won’t pay enrollment fees.

If you use TRICARE For Life, TRICARE Prime, or a premium-based plan, like TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Young Adult, this change won’t affect you. To check your plan’s costs, use the TRICARE Compare Cost Tool.

This applies to me. When do I need to take action?

You must contact your TRICARE regional contractor to set up a monthly allotment withdrawn from your Department of Defense (DoD) pay center, where feasible, for your monthly payments to start on Jan. 1, 2021. Don't try to create an allotment directly through your pay center. For sponsors who don’t receive funds through a DoD pay center, you can establish payments via electronic funds transfer, credit card, or debit card.

What are the 2021 enrollment fees for TRICARE Select Group A retirees?

Tricare For Life Cost 2020

The enrollment fees will be collected via monthly installments from the sponsor’s military pay system where retired pay is disbursed.

Tricare Standard Copay 2020 Application

  • Individual plan: $12.50 per month
  • Family plan: $25 per month

Tricare Standard Copay 2020

How can I stay informed and prepare for this change?

Visit the TRICARE Select Enrollment Fees page on the TRICARE website for updates and sign up for email alerts. TRICARE will inform you of specific actions you need to take in the coming months. Take command of your health and your health care benefits in 2020.

At the time of posting, this information is current. For the most recent information, contact your TRICARE contractor or local military hospital or clinic.

Last Updated 2/17/2021