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Some TRICARE Enrollees Won’t Have to Pay Annual Fee Increases

The Pentagon is making an exception for two groups of Prime beneficiaries.

Some TRICARE beneficiaries and their dependents no longer have to worry about paying higher enrollment fees for their health care each year, according to a new policy announced on Tuesday.

The Pentagon has decided to freeze annual enrollment fees for two groups of Prime beneficiaries at the rate in effect at the time of their enrollment. The change affects survivors of active-duty deceased service members, and medically-retired uniformed services members and their dependents, both of whom are part of the retiree group under TRICARE rules. The new final rule, published in Tuesday’s Federal Register, is an exception to current policy, which stipulates that TRICARE Prime enrollment fees are the same for all retirees and their dependents.

The rule goes into effect on Oct. 30, 2014.

Beneficiaries in those two TRICARE categories who enrolled in Prime before Oct. 1, 2013, and those since that date, will have their annual enrollment fee frozen at the appropriate fiscal year rate. The enrollment fees for fiscal 2011 through fiscal 2014 are:

  • Fiscal 2011: $230 (Single); $460 (Family)
  • Fiscal 2012: $260 (Single); $520 (Family)
  • Fiscal 2013: $269.38 (Single); $538.56 (Family)
  • Fiscal 2014: $273.84 (Single); $547.68 (Family)

Future beneficiaries added to these categories will have their fee frozen at the rate in effect at the time they are classified in either category and enroll in TRICARE Prime or, if not enrolling, at the rate in effect at the time of enrollment. The fee stays frozen as long as one family member is enrolled in TRICARE Prime in one of the two categories, and there is not a break in coverage.

According to TRICARE’s website, the fiscal 2015 TRICARE Prime enrollment fee will be $277.92 (single) and $555.84 (family).

“The Prime beneficiaries in these categories have made significant sacrifices for our country and are entitled to special recognition and benefits for their sacrifices,” said the notice in the Federal Register explaining the decision.

Active-duty service members and their dependents do not pay for health care under TRICARE Prime.

The military’s massive health insurance program offers millions of service members, retirees and their dependents quality care at a relatively low cost. That’s what the government aimed for when it created the Civilian Health and Medical Program of the Uniformed Services in 1966, now known as TRICARE. But the price of that success has been high for Uncle Sam: The $53 billion program now consumes 10 percent of the Pentagon’s nonwar budget.

TRICARE premiums for beneficiaries have not kept up with inflation and the overall increase in health care costs during the past two decades. Congress agreed to raise TRICARE Prime annual enrollment fees for retirees in 2011 -- the first time the fees have gone up since 1995. Since the legislative change, the rate of increase has been indexed to the rate of inflation.

Retired TRICARE Prime beneficiaries now pay between $30 and $88 more in annual fees than they paid before the increase, which took effect in fiscal 2012.

The Obama administration has proposed more aggressive changes to TRICARE, including tying annual fees to retired recipients’ income and charging an enrollment fee for TRICARE for Life, the health care program Congress created in 2001 for military retirees age 65 and older. Congress so far has rejected both of those ideas.

The Pentagon currently is reviewing military pay and benefits -- including health care programs – through its Military Compensation and Retirement Modernization Commission. The panel is scheduled to issue a report in early 2015 with recommendations for reform.