DoD Wants More Predictable TRICARE Fees: Predictably Higher

October 19, 2017

It's hard to distinguish fact from fiction these days. But one thing military personnel, their families, retirees who've served a career, and all other eligible TRICARE beneficiaries know is, their earned health care benefit is under siege. 

The simple facts as we know them: First, DoD's health care costs have remained the same - or even declined -  for decades and take up no more of the budget than they have in years past. And second, DoD has been relentless in its attempts to have beneficiaries pay disproportional amounts for something they earned with their service and sacrifice.

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What Is Happening Right Now:

DoD is making an end run late in the budgetary game. This is a manipulative attempt to get more of your money to fund its readiness accounts and other, unspecified programs. As directed in last year's National Defense Authorization Act (NDAA), which grandfathered current beneficiaries from increased fees, DoD used its authority as an agency to publish new rules pertaining to upcoming TRICARE program changes, set to take effect on Jan. 1. 

But, surprisingly, they took this as an opportunity to change the cost shares, as MOAA detailed in a recent article effectively bypassing the legislated grandfathering. 

TRICARE officials have said the motivation behind these cost share changes in the new TRICARE Select option is to make costs more predictable for beneficiaries. They plan to accomplish this by changing the percent cost share applied to TRICARE in the beneficiary's bill (usually 15 percent for active duty families and 25 percent for retirees) to a fixed amount - hence, the claimed predictability. (The head of the Defense Health Agency also will have discretion to change these fees on an annual basis, among other program authorities.)

While the exact methodology DoD used is not apparent, MOAA understands the new fixed costs were derived from an average of what beneficiaries actually spend in a variety of outpatient settings. 

MOAA assessed the impact these new TRICARE fees will have on beneficiaries, using basic assumptions and very conservative health care utilization patterns for an E5 family of four. 

These tables do not include ancillary services, like lab tests, radiology, or diagnostic testing. The results (show in the tables below) are hardly surprising: The costs to the beneficiary went up. 

TRICARE table oct 19 2017

Click here to view TRICARE's new fee schedule

MOAA is concerned the introduction of this new fee structure:

  • raises fees above COLA across most categories of beneficiaries, to support department readiness costs;
  • takes control of setting and then adjusting these fees on an annual basis without regard to an index or other supporting data; and
  • ignores the 2017 NDAA's grandfathering of beneficiaries, as evidenced in the way DoD has set up the fee structure between active duty and retired service families.  

Contact your elected officials today with a MOAA-suggested message opposing these fee hikes.


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