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Know your costs before making a choice during TRICARE Open Season

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TRICARE Health Program

TRICARE Open Season is underway. If you want to enroll in or change between TRICARE Prime and TRICARE Select health plans, you have until Dec. 10.

Active duty service members (ADSMs) are required to have TRICARE PrimeA managed care option available in Prime Service Areas in the United States; you have an assigned primary care manager who provides most of your care.TRICARE Prime health coverage. Active duty family members (ADFMs), retirees, and eligible retiree family members can choose to have either TRICARE Prime or TRICARE SelectStarting on January 1, 2018, TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider.  Enrollment is required to participate. TRICARE Select coverage.

For many people, cost is a major factor in picking a health care plan. Before you choose a plan, make sure you know what’s covered and what it costs. To help you understand your potential health care costs, here are a few key TRICARE terms you should know.

  • TRICARE beneficiaries fall into one of two groups: Group A or Group B. Each group has different enrollment fees, deductibles, and out-of-pocket costs. You’re in Group A if your initial enlistment or appointment or that of your uniformed services sponsor began before Jan. 1, 2018. You’re in Group B if your initial enlistment or appointment or that of your uniformed services sponsor began on or after Jan. 1, 2018. When enrolled in TRICARE Reserve SelectA premium-based plan for qualified Selected Reserve members and their families.TRICARE Reserve Select, TRICARE Retired ReserveA preimum-based plan for qualified Retired Reserve members and their families.TRICARE Retired Reserve, TRICARE Young AdultA premium-based plan for qualified adult children.TRICARE Young Adult, or Continued Health Care Benefit Program follow Group B deductibles, copayments, cost-shares, and catastrophic caps regardless of when the uniformed services sponsor enlisted or was appointed.
  • An enrollment fee is the yearly amount you pay to enroll in TRICARE Prime or TRICARE Select. ADSMs and ADFMs don’t have an enrollment fee with TRICARE Prime. However, TRICARE Prime retirees, their families, and some others pay yearly enrollment fees. With TRICARE Select, ADFMs don’t pay enrollment fees, and neither do Group A retirees, their families, and others with TRICARE Select. However, Group B retirees, their families, and others pay yearly enrollment fees. Visit Health Plan Costs for more information.
  • A deductible is a fixed amount you pay for covered services each calendar year before TRICARE pays anything. You may have a deductible if you have TRICARE Select or if you have TRICARE Prime but see a provider without a referral.
  • A cost-share is a percentage of the total cost of a covered health care service that you pay after you pay your deductible.
  • A copayment is the fixed amount those with TRICARE Prime (who aren’t active duty) and TRICARE Select (for certain services) pay for a covered health care service or drug.
  • The catastrophic cap is the most you or your family will pay out of pocket for covered health care services each calendar year. When met, TRICARE pays your copayment or cost-share for covered health care services for the rest of the calendar year.
  • Point-of-service is an option under TRICARE Prime where you pay extra when getting nonemergency care from any TRICARE-authorized provider. The point-of-service option isn’t available to ADSMs.
  • The TRICARE-allowable charge is the maximum amount a participating TRICARE provider can be paid for a covered service. Learn more about TRICARE provider types.

Health care costs can differ based on who you are and your health plan option. For specific plan costs and dollar amounts, use the TRICARE Compare Cost Tool. Also, download the 2019 TRICARE Costs and Fees Sheet. If you want to enroll in or change your TRICARE health plan during TRICARE Open Season, take command of your health benefit by understanding your health care costs.

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2019 Monthly Premium Rates for TRS, TRR, and TYA

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Policy Memorandum to Establish 2019 Monthly Premium Rates for TRICARE Reserve Select, TRICARE Retired Reserve, and TRICARE Young Adult

Interim Final Rule: Establishment of TRICARE Select and Other TRICARE Reforms

Policy

This interim final rule implements the primary features of section 701 and partially implements several other sections of the National Defense Authorization Act for Fiscal Year 2017 (NDAA-17). The law makes significant changes to the TRICARE program, especially to the health maintenance organization (HMO)-like health plan, known as TRICARE Prime; to the preferred provider organization (PPO) health plan, previously called TRICARE Extra which is to be replaced.

Policy Memorandum to Establish 2018 Monthly Premium Rates for TRICARE Reserve Select and TRICARE Retired Reserve

Policy

This policy memorandum establishes the 2018 monthly premium rates for TRICARE Reserve Select and TRICARE Retired Reserve.

Policy Memorandum to Establish Calendar Year 2018 Premium Rates for the TRICARE Young Adult Program

Policy

This memo establishes the 2018 premium rates for the TRICARE Young Adult (TYA) Program. TYA premium rates are established annually on a calendar year basis in accordance with Title 10, United States Code, Section 11 lOb and Title 32, Code of Federal Regulations, Part 199.26.

Memorandum to Establish 2017 TRICARE Reserve Select and TRICARE Retired Reserve Rates

Policy

Calendar Year 2017 premium rates are established for TRICARE Reserve Select and TRICARE Retired Reserve as specified in the attachment. Please provide widest dissemination. This information can be found at www.tricare.mil/trs and www.tricare.mil/trr.

Memorandum to Establish 2017 Premium Rates for the TRICARE Young Adult Program

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This memo establishes the CY2017 Premium Rates for TRICARE Young Adult

Memorandum to Establish 2016 Rates for TRICARE Young Adult Premiums

Policy

TRICARE Young Adult (TYA) premium rates are established annually on a calendar year (CY) basis in accordance with Title 10, United States Code, Section 1110b and Title 32, Code of Federal Regulations, Part 199.26.

DoD Directive 6010.04: Healthcare for Uniformed Services Members and Beneficiaries

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This directive reissues DoD Directive (DoDD) 6010.04 (Reference (a)) to update established policy and assigned responsibilities for administering Title 10, United States Code (Reference (b)). It serves as the joint document for administration of healthcare benefits required pursuant to Reference (b), and is issued by the Departments of Defense, Homeland Security, and Health and Human Services

ASD HA Memorandum 14-022 Policy Memorandum to Establish 2015 Premium Rates for the TRICARE Young Adult Program

Policy

TRICARE Young Adult (TYA) premium rates are established annually on a calendar year (CY) basis in accordance with Title 10, United States Code, Section 111Ob and Title 32, Code of Federal Regulations, Part 199.26. TYA monthly premiums for CY 2015 shall be the rates listed in this document.

Establishing TRICARE Reserve Select and TRICARE Retired Reserve Rates for 2015 Calendar Year

Policy

ASD (HA) Memorandum 14-015 - Establishing TRICARE Reserve Select and TRICARE Retired Reserve Rates for 2015 Calendar Year. This memorandum establishes the Calendar Year 2015 premium rates for TRICARE Reserve Select and TRICARE Retired Reserve as specified in the attachment. This information can be found at www.TRICARE.mil/trs and www.TRICARE.mil/trr.

Procedures on Responsibility of Dispensing Prescriptions at MTF Pharmacies 14-004

Policy

This memorandum clarifies procedures relating to Health Affairs Policy 04-032, "TRICARE Pharmacy Benefit Program Formulary Management," dated December 22, 2004, which remains in effect. Specifically, this memorandum is addressed to all military treatment facility (MTF) providers and pharmacies. It revalidates the requirement for MTFs to provide medications prescribed by MTF providers and restates procedures for obtaining 3rd tier (Nonformulary) and compounded medications for patients treated at MTFs.

Policy Memorandum to Establish 2014 Premium Rates for TRICARE Reserve Select and TRICARE Retired Reserve 13-009

Policy

TRICARE Reserve Select (TRS) premium rates are established annually on a calendar year (CY) basis in accordance with Title 10, United States Code (U.S.C.), Section (Sec.) 1076d and Title 32, Code of Federal Regulations (CFR), Part 199.24. The TRS monthly premiums for CY 2014 shall be the rates listed in the table inside this document.

Policy Memorandum to Establish 2014 Premium Rates for the Continued Health Care Benefit Program 13-008

Policy

Continued Health Care Benefit Program (CHCBP) premium rates are established annually on a fiscal year (FY) basis in accordance with Title 10, United States Code, Section 1078a and Title 32, Code of Federal Regulations, Part 199.20. CHCBP quarterly premiums for FY 2014 shall be the rates listed in the table in this document

Policy Memorandum to Establish 2014 Premium Rates for the TRICARE Young Adult Program 13-007

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TRICARE Young Adult premium rates are established annually on a calendar year (CY) basis in accordance with Title 10, United States Code, Section IIIOb and Title 32, Code of Federal Regulations, Part 199.26. TYA monthly premiums for CY 2014 shall be the rates listed in the table in this document.

Guidelines for Suspension and Reinstatement of TRICARE Reserve Select Coverage 12-009

Policy

This memorandum clarifies the procedures under title 32 of the Code of Federal Regulations, section 199.24(d)(3) for suspending TRICARE Reserve Select (TRS) coverage for up to 12 months and, upon request from a TRS member/survivor request, lifting the suspension, which will reinstate coverage with no break.

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