The proposed 2015 military budget contains a few major changes that would replace the current TRICARE system with a consolidated system. The plan would basically eliminate the three current TRICARE programs (Prime, Extra, and Standard), and replace them with a single TRICARE plan that closely resembles TRICARE Standard. If passed, this new consolidated plan would include higher enrollment fees and more out of pocket expenses for many TRICARE beneficiaries. The government says these changes would also offer TRICARE recipients more choices regarding where they can receive their health care.
Here is an overview of the proposed changes:
- Active duty: No change to benefits. Active duty members would continue to receive priority access to health care without any cost sharing. Active duty members would still require approval for off-base or civilian health care.
- New Enrollment Fees (now called Participation Fees): Retirees, their families, and survivors or retirees would have a new participation fee of $286 for an individual, or $572 for a family. Electing not to pay the enrollment fee would result in forfeiting coverage for the plan year. Service members who are medically retired, and survivors of those who died while serving on active duty would be exempt from the participation fees, and would have reduced cost sharing.
- Increased Catastrophic Caps: The enrollment fee would no longer count toward the catastrophic cap, and the cap for a family would be increased to $3,000 per person, or $5,000 per family.
- New Cost Sharing: Cost shares will depend on several factors, including category of beneficiary (active, retired, medically retired, etc.), and where the beneficiary receives care. Costs will be lowest at military treatment facilities, higher in-network, and highest out-of-network.
- Open Season Enrollment: Participants must choose to enroll for a 1-year benefits period or lose the opportunity for coverage.
- Increased Co-pays for Prescriptions: Co-pays for brand-name prescription medications will cost $26 in 2015, and increase annually. They are expected to reach $45 by 2014. Generic medications would cost $14 by 2024. There would be no change for active duty members.
- TRICARE for Life Enrollment Fees: TRICARE for Life participants would see enrollment fees based on their gross military retired pay. The fees would work out to 1% of base retirement pay in 2016; capped out at $300 per year, and $400 for Generals officers. By 2018 the enrollment fee would increase to 2% of retirement pay, capped at $600 and $800, respectively. Further increases will be based on inflation. Current TFL recipients would be grandfathered into the current system and will not pay enrollment fees.
Will TRICARE be Consolidated?
So far this is only a section of the 2015 budget proposal. But there is a good possibility some, or all of these proposals could be accepted. The bottom line is that the Department of Defense is faced with many tough decisions regarding the budget due to the Sequestration and pressure from Congress. Changes need to happen and they are looking at every possible avenue, including cutting weapons systems, reducing new weapon system acquisitions, Reductions In Force measures, cutting retirement benefits, and more.
Right now the best thing we can do is contact our lobbying groups and Congressional representatives to let them know how we feel about these proposals.