washingtonscene TRICARE Select and TRICARE Retired
Reserve beneficiaries would continue their current premium levels and deductibles, and cost shares would be the same as those proposed for TRICARE Standard retirees.
Beyond A
Enrollment Fees What would you pay for a doctor visit?
mong the more complex changes of the budget plan are proposed cost shares for various
kinds of provider visits. TRICARE Prime enrollees would have some increases in fees for seeing civilian network providers. TRICARE Standard beneficiaries would pay flat fees rather than a percentage of the bill (and would not have a deductible) if they see civilian in- network providers. If they see out-of- network providers, they still would pay 25 percent of TRICARE- allowed charges but would see their cur- rent deductible dou- ble — from $150/$300 (individual/family) to $300/$600.
Services
Clinical Preventive Services
Primary Care Visits
Specialty-Care Visits (PT, OT, speech)
Urgent Care Center
Prime beneficia- ries who use out-of- network care without a referral would be subject to steep point- of-service fees: 50 percent of allowable charges after paying a $300/$600 deductible. In addition, the DoD plan proposes
Emergency Department/ Emergency Care
Ambulance (MTF or Network)
Durable Medical Equipment/Supplies
Ambulatory Surgery
charging all military retirees under age 65 an annual enrollment fee for partici- pating in either TRICARE Prime or Stan- dard. The Prime enrollment fee would rise to $350/$700 (individual/family) versus the current $283/$565. The new enrollment fee for Standard
would be even higher — $450/$900 (in- dividual/family) — plus the $300/$600 deductible for out-of-network care. Military retiree copayments and cost sharing also would apply to survivors (ex- cept those whose sponsors died on active duty) and TRICARE Young Adult benefi- ciaries with a retired sponsor. Care in military treatment facilities
(MTFs) would continue to be provided at no cost. Active duty family members would not see the same drastic increases, unless they use out-of-network providers, in which
DoD-Proposed TRICARE Outpatient Cost-Sharing for Retirees Under Age 65
In Network
TRICARE Prime ** $0
$0 MTF
$20 network referral $0 MTF
$30 network referral $0 MTF
$30 network referral $75 network
$20/trip $0 MTF
20% of MTF cost or
network negotiated fee $0 MTF
$100 network referral
TRICARE Standard $0
$0 MTF
$25 network referral $0 MTF
$35 network $0 MTF
$35 network $90 network
$25/trip $0 MTF
20% of MTF cost or
network negotiated fee $0 MTF
$100 network * Percentage of TRICARE maximum allowable charge after $300 individual/$600 family deductible is met.
** If TRICARE Prime beneficiary obtains care without a referral, point-of-service charges will apply: 50% of the allowed charge after the $300 individual/$600 family deductible is met.
*on the web: Inim voluptat elit utpating ex etuerci eu feum eum aliquating ese feugait APRIL 2016 MILITARY OFFICER 35 Out of Network $0
25%* 25%* 25%* 25%* 25%* 25%* 25%*
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