"Working age" military retirees -- those under age 65 -- who use Tricare Select for their health care will start paying enrollment fees beginning next year, Defense Department officials announced Tuesday.
For the first time since the creation of Tricare Standard, now known as Tricare Select, retired beneficiaries who joined the military before 2018 will pay a monthly fee for their health care: $12.50 for an individual or $25 for a family.
The enrollment fees do not apply to active-duty family members on Tricare Select or Medicare- eligible retirees on Tricare For Life.
Defense health officials said these retirees can expect to hear from their regional contractors -- either Health Net Federal Services for Tricare West or Humana Military for Tricare East -- in the coming months instructing them on how to set up payments, either by allotment from their retired pay, electronic funds transfer, debit or credit card.
Dr. Danita Hunter, director of Tricare at the Defense Health Agency, said the DHA decided to issue a news release now to give beneficiaries time to prepare and factor the fees into their decisions on health care.
"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," Hunter said in the release.
In the fiscal 2017 National Defense Authorization Act, Congress approved a request from the DoD to implement enrollment fees for what was then known as Tricare Standard.
At the time, the DoD argued that the change would entice more retirees to use Tricare Prime at military hospitals and clinics, where they would pay an annual enrollment fee but not make any copayments.
The switch would curb the government's cost of providing health care to these beneficiaries, since private care was determined to be more expensive to provide than military health care.
But in the past three years, the DoD has done an about-face on providing health services to the 3.2 million retirees and their family members under the age of 65 who are eligible for Tricare, forcing many from military hospitals as soon as they retire and embarking on a restructuring geared to reserving military treatment facilities to treat active-duty personnel only.
By law, the DoD was required to wait to implement the Tricare Select enrollment fees until at least 90 days after the Government Accountability Office provided a report to Congress reviewing Tricare patients' access to medical care, the percent of network providers that accept new patients, the satisfaction of beneficiaries in Tricare Select and any changes to the Tricare system since 2017.
In response, the GAO issued several reports this year indicating that, overall, patients saw very little change to their health care or access to care when Tricare Standard became Tricare Select.
Patient satisfaction also remained relatively unchanged during the first year of care, although some did report issues finding providers, according to the GAO.
In another report released in late May, GAO analysts warned that DoD's assessment of whether there are enough network providers to accept an influx of new patients once seen at military treatment facilities is built on "incomplete and inaccurate information."
Without a robust network able to accept patients from military facilities that are being realigned to serve active-duty troops, some may experience problems finding care, the GAO said.
With the announcement of the new enrollment fees, all military retirees under age 65 will be paying a baseline for participating in Tricare.
Retirees using Tricare Prime, a health-maintenance style program offered at military treatment facilities and through specialty programs and networks near military bases, pay $300 a year for an individual and $600 a year for a family. Copayments per visit to a network provider run from $20 for primary care and $31 for specialty care or urgent care. These retirees make no copays if they are seen at a military treatment facility.
Retirees using Tricare Select currently pay no enrollment fees. But with the new change, they will pay $150 per year for an individual and $300 per year for a family. They also are obligated to meet deductibles of $150 for an individual and $300 for a family. And they must pay a $30 copay for a primary care visit or urgent care at a network physician, or 25% of the cost for non-network care, as well as $45 or 25% at a network or non-network specialty care provider, respectively.
If retirees on Tricare Select do not pay the enrollment fees, they could lose their health care for nearly a year, since they would have to wait for Tricare open season to re-enroll.
That potential loss has some military advocacy organizations worried.
“The stakes are high,” Karen Ruedisueli, director for Health Affairs at the Military Officers Association of America, said.
"We are very concerned about the new Tricare Select enrollment fee for Group A retirees [retirees who joined the military before Jan. 1, 2018]. For the past couple of years, the open enrollment message has been 'if you are happy with your plan, you don't have to take action.' I think that has created an uphill battle for effectively communicating about this enrollment fee," Ruedisueli said.
Eileen Huck, deputy director of health care at the National Military Family Association, called it "unfortunate" that the enrollment fee is being imposed on retirees.
However, she added, "We're glad the Defense Health Agency is being proactive and putting out the information. That will make it easier for families to plan and budget for this change."
Tricare Open Season, the period during which Tricare beneficiaries can switch health plans, is scheduled for Nov. 9 through Dec. 14 this year.