INSIGHTi
TRICARE Cost-Sharing Changes in 2022
Updated December 6, 2021
The Department of Defense (DOD) administers a statutory health entitlement (under Chapter 55 of Title
10, U.S. Code) through the Military Health System (MHS). The MHS offers health care benefits and
services through its TRICARE program to approximately 9.6 mil ion beneficiaries composed of
servicemembers, military retirees, and family members. Health care services are available through DOD-
operated hospitals and clinics, collectively referred to as military treatment facilities (MTFs), or through
civilian health care providers participating in the TRICARE program. The Defense Health Agency (DHA)
manages the TRICARE program, in collaboration with the military departments.
With the exception of active duty servicemembers, beneficiaries are subject to certain cost-sharing
requirements based on beneficiary category, health plan or benefit program, and the sponsor’s initial
enlistment or appointment date. Beneficiary cost-sharing requirements include premiums (i.e., enrollment
fees), deductibles, co-payments, coinsurance, and a catastrophic cap. Periodical y, DHA reviews and
adjusts certain beneficiary cost-sharing amounts for the various TRICARE health plans and benefit
programs based on statutory requirements or changes to the cost of coverage. This Insight reviews
changes to TRICARE’s beneficiary cost-sharing amounts that are scheduled to take effect on January 1,
2022 and may generate constituent inquiries during the TRICARE open enrollment season.
What TRICARE health plans and benefit programs are
scheduled to have modified cost shares in 2022?
For calendar year (CY) 2022, DHA is increasing certain beneficiary cost-sharing amounts for the
following TRICARE health plans and benefit programs:
ï‚· TRICARE Prime,
ï‚· TRICARE Select,
ï‚· TRICARE Retired Reserve,
ï‚· TRICARE Young Adult, and
ï‚· TRICARE Pharmacy Program.
DHA is decreasing certain beneficiary cost-sharing amounts for TRICARE Reserve Select. There are no
scheduled changes to the cost-sharing amounts for the Continued Health Care Benefit Program,
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TRICARE dental plan, or TRICARE for Life. A detailed listing of cost sharing amounts by health plan or
benefit program is available on the CY2021 Costs and Fees Sheet, the CY2022 Costs and Fees Sheet, or
by using the TRICARE compare cost tool.
How does DHA determine the change in cost-sharing
amounts?
DHA general y adjusts the TRICARE beneficiary cost-sharing amounts based on (1) specified amounts
established in federal statutes; (2) statutory formulas; or (3) actuarial adjustments equal to the cost of
coverage. Table 1 specifies the method by which DHA determines periodic adjustments to beneficiary
cost-sharing amounts.
Table 1. Adjustment Methods used for TRICARE enrollee cost-sharing amounts
Health Plan or Benefit Program
Adjustment Method
Authority
TRICARE Prime
ï‚·
Amounts specified in statute and statutory formula
10 U.S.C. §1075a
TRICARE Select
ï‚·
Amounts specified in statute and statutory formula
10 U.S.C. §1075
ï‚·
Enrol ment fee: actuarial adjustment
TRICARE Reserve Select
10 U.S.C. §1076d
ï‚·
Other cost-sharing amounts: mirrors TRICARE Select
ï‚·
Enrol ment fee: actuarial adjustment
TRICARE Retired Reserve
10 U.S.C. §1076e
ï‚·
Other cost-sharing amounts: mirrors TRICARE Select
ï‚·
Enrol ment fee: actuarial adjustment
TRICARE Young Adult (Prime or Select)
ï‚·
Other cost-sharing amounts: mirrors TRICARE Prime
10 U.S.C. §1110b
or TRICARE Select
ï‚·
Enrol ment fee: actuarial adjustment
Continued Health Care Benefit Program
10 U.S.C. §1078a
ï‚·
Other cost-sharing amounts: mirrors TRICARE Select
TRICARE Pharmacy
ï‚·
Amounts specified in statute and statutory formula
10 U.S.C. §1074g
ï‚·
DHA-administered dental benefit: actuarial adjustment
10 U.S.C. §1076a
TRICARE Dental
ï‚·
Federal Employee Dental and Vision Insurance

Program (FEDVIP): actuarial adjustment
5 U.S.C. §8958
Source: See various statutes in Chapter 55 of Title 10 and Chapter 89A of Title 5, U.S. Code.
Notes: DHA makes actuarial adjustments based on enrol ment-weighted average annual costs of previous calendar years
and projected administrative and health care costs. See DHA’s methodology document for more on how actuarial
adjustments are made annual y. Certain DOD beneficiaries (i.e., military retirees and their family members) are eligible for
dental benefits through FEDVIP, which annual y adjusts its cost-sharing amounts in accordance with Chapter 89A of Title 5,
U.S. Code, Part 894 of Title 5, Code of Federal Regulations, and Office of Personnel Management policies.
What and when is the TRICARE Open Enrollment
Season?
The TRICARE open enrollment season is an annual period when beneficiaries may enroll in, terminate,
or change their health plan or benefit program. The calendar year 2021 open enrollment season for
calendar year 2022 began on November 8, 2021 and ends on December 13, 2021. Beneficiaries who opt
to remain in their current health plan or benefit program are not required to re-enroll. Beneficiaries who

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are newly eligible or would like to change their enrollment may do so by submitting an online
Beneficiary Web Enrollment request or contacting the appropriate TRICARE contractor.
Once the annual open enrollment season closes, beneficiaries may only make changes to their health plan
or benefit program within 90 days after a qualifying life event (QLE). Table 2 lists military or family-
related life changes that DHA deem a QLE.
Table 2. TRICARE Qualifying Life Events
Military Changes
Family Changes
ï‚·
Permanent change of station/moving
ï‚·
Marriage
ï‚·
Initial military commissioning or enlistment
ï‚·
Divorce
ï‚·
Reserve Component member activation/deactivation
ï‚·
Having a baby or adopting
ï‚·
Injured on active duty
ï‚·
Children going to col ege
ï‚·
Separating from active duty
ï‚·
Children becoming adults
ï‚·
Retiring
ï‚·
Becoming Medicare-eligible
ï‚·
Military-directed change of primary care manager
ï‚·
Moving
ï‚·
Change in overseas command-sponsorship
ï‚·
Death in Family
ï‚·
Loss or gain of other health insurance
Source: 32 C.F.R. §199.17(o) and TRICARE, “Qualifying Life Events,” accessed November 29, 2021,
https://www.tricare.mil/LifeEvents.


Author Information

Bryce H. P. Mendez

Analyst in Defense Health Care Policy




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