TRICARE has released its fee structure for 2023, which includes increases for certain services and options beginning on 1 January in the new year.
Fee increases affect some TRICARE enrollees differently than others. You will need to know the increases for your specific demographic and/or selected TRICARE plan as they may be different from other plans you enrolled in previously.
What kind of differences?
- Active duty service members and their families enrolled in TRICARE Prime or the U.S. Family Health Plan are not required to pay an annual enrollment fee, annual deductible, or pay out-of-pocket costs for covered services. TRICARE Prime does feature a catastrophic cap (see below), which is the amount you must pay out of pocket before TRICARE begins paying.
- Compare the no-fee structure for Prime to the options offered to those enrolled in TRICARE Select; these families also have no annual fees, but there are co-payment increases coming in 2023. Some enrollees may find an increase in their annual deductible on 1 January.
There are two types of TRICARE groups–TRICARE Group A and TRICARE Group B. Which group you belong to determines your fee structure. Both groups may have fee increases scheduled for 2023.
Why Fee Increases Matter
TRICARE Open Season runs from November 14 to December 13. This is the one time you can make changes to your health insurance coverage without needing a Qualifying Life Event like birth, marriage, or death in the family to do so.
TRICARE Cost Increases: Enrollment
There are no enrollment fees for active-duty families. Those who are military retirees who are considered “working age” will experience fee increases based on whether they are in TRICARE Prime or TRICARE Select:
- TRICARE Prime Group A: Enrollment fees increase in 2023 to $351.96 per individual, and $703.92 per family. Compare those increases to the 2022 numbers; $323 per individual and $647 per family.
- TRICARE Prime Group B: In 2023 the individual enrollment fee is $426 up from $392 in 2022 and the enrollment fee for families is $852 for 2023 up from $884 in 2022.
- TRICARE Select Group A: $171.96 per individual in 2023, up from $158; and $345 per family, up from $317.
- TRICARE Select Group B: $547.92 for individuals in 2023 (up from the previous year’s $504 per individual), and $1,095.96 for families (up from $1,008 per family).
Annual Deductibles
Some TRICARE cost concerns don’t affect active-duty military members and their families. One example–there are no deductibles for Prime Group A or Prime Group B.
TRICARE Select for active duty family members in Group A, grades E-4 and below, features no change in 2023 from the previous year. These beneficiaries pay $50 per individual and $100 per family. Active duty Group A, grades E-5 and above, pay $150 per individual and $300 per family, the same as in 2022.
Group B members pay $60 per individual, up from $56 in 2022, and $121 per family, up from the 2022 fee of $112. Group B members E-5 and above pay $182 per individual, up from $168, and $365 per family, up from $336.
Working-age retirees in Group A pay $150 per individual and $300 per family (no change).
Out-of-Pocket Costs
Out-of-pocket copays with TRICARE Select may be higher in 2023 depending on the type of care needed. There are no costs for covered preventive care visits.
Primary care outpatient visit costs within the TRICARE Select network will increase for active duty families by one dollar only for those in Group A with a $2 cost increase for Group B. Working-age retirees may see a $2 cost increase.
TRICARE Prime urgent care center visits for working-age retirees will see a copay increase by $3.
TRICARE Catastrophic Cap
What’s a catastrophic cap? This is the largest dollar amount TRICARE beneficiaries must pay out of pocket (over a single year) before TRICARE begins to pay.
The catastrophic cap for active-duty family members and working-age retirees may, depending on the nature of their coverage, go up by approximately 8.7%.
Active duty family members in Group B of both TRICARE Prime and TRICARE Select will see a $97 increase in the cap. Increases in the cap for working-age retirees, their families, and others in Tricare Select go up by $322 in 2023.
TRICARE Premium-based plans
2023 sees higher costs for TRICARE premium-based plans:
- TRICARE Young Adult Prime sees an increase of 11% in the new year, going up to $570 each month in 2023.
- TRICARE Young Adult Select will see a 10% increase in 2023, going up to $291 a month.
- Tricare Reserve Select sees a 2023 increase of 4% to $48 a month for individuals and up to $240 for families.
- Tricare Retired Reserve gets a 9% increase for a total of $549 a month for individuals and up to $1,321 for families.
Some TRICARE Costs Are Not Going Up
There are a few exceptions to the 2023 cost increases. Outpatient care is one of them. The co-pay for outpatient care is actually going down in some cases. The co-pay goes down by one dollar in 2023 for Group A TRICARE Select members. Group B does not fare so well–the co-pay costs for Group B increase in 2023 by $2.
Get more information on your TRICARE costs and options in 2023 at the TRICARE official site.