DHA cuts increases to TRICARE copayments

TRICARE recipients will see slightly lower copays in 2018 thanks to a recalculation done by the Defense Health Agency.

Members of the TRICARE Select plan who joined the military before 2018 will see their copayments for primary care, specialty care, urgent care, emergency room visits and ambulance services reduced slightly from what was originally expected.

Active-duty military families will see copays drop from $27 to $21 and retirees will see costs go down from $35 to $28.

The Veterans of Foreign Wars lobbied for DHA to reexamine its copay costs for 2018.

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“The VFW is pleased that DHA listened to our concerns and took a second look at their calculations,” said VFW National Commander Keith Harman in a statement. “Many TRICARE beneficiaries, especially junior enlisted families, live off fixed incomes or from paycheck to paycheck, so every reduction — especially in health care costs — can help make a big difference in household budgets and their overall quality of life.”

TRICARE Select is a completely new plan under the TRICARE system that is new in 2018.

DoD is merged the existing TRICARE Standard and Extra benefits — the department’s fee-for-service options — into a single plan called TRICARE Select.

Like Standard and Extra, Select lets patients use any authorized medical provider, but cost shares are lower when beneficiaries see in-network providers. In most ways, it will operate like the plans it’s replacing, but with changes to the ways in which patients pay out-of-pocket costs.

Previously, the cost shares were based on a percentage of TRICARE’s negotiated costs with a network provider (or of that provider’s “allowable costs” if they’re out-of-network). Starting next year, patients will pay a fixed, per-visit rate for in-network providers that varies according to the type of medical care they’re receiving.

For example, under Standard and Extra, a family member of an active-duty service member was responsible for 15 percent of the bill for an outpatient visit from an in-network doctor and 20 percent for an out-of-network doctor. The new Select plan charges a flat fee for an in-network provider. It’s those fees that the government is reducing after the recalculations.

“We thought this was something that would be a little more predictable and a little more patient-friendly, and we also thought it was an easier construct for our providers to use,” said Vice Adm. Raquel Bono, the DHA director. “What we tried to do was take an average, so it should be close to what people are currently paying.”

Health care copayments aren’t the only thing changing for TRICARE recipients.

Starting Feb. 1, copayments for drugs will increase for TRICARE Pharmacy Home Delivery and retail pharmacies.

Retail in-network copayments for 30-day generic supplies will increase from $10 to $11 and brand-name drug copays will increase from $24 to $28.

Home delivery copays for 90-day supplies of generic drugs will go from being free to costing $7. Brand-name drug copays will increase from $20 to $24 and copays for drugs that are not on the insurer’s preferred list and are not medically necessary increase from $49 to $53.

The good news is prescriptions filled at military pharmacies will still be free.

The increases were mandated by the 2016 National Defense Authorization Act.