INSIGHTi
TRICARE Cost-Sharing Changes in 2023
Updated November 14, 2022
The Department of Defense (DOD) administers a statutory health entitlement (under Title 10, Chapter 55,
of the 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 million beneficiaries that include
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. Periodically, 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,
2023. These changes may generate constituent inquiries during the next TRICARE open enrollment
season.
What TRICARE health plans and benefit programs are
scheduled to have modified cost shares in 2023?
For calendar year (CY) 2023, DHA is increasing certain beneficiary cost-sharing amounts for the
following TRICARE health plans and benefit programs:
TRICARE Prime,
TRICARE Select,
TRICARE Reserve Select,
TRICARE Retired Reserve,
TRICARE Young Adult,
Continued Health Care Benefit Program, and the
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TRICARE Pharmacy Program.
There are no scheduled changes to the cost-sharing amounts for the TRICARE dental plan, or TRICARE
for Life. A detailed listing of cost sharing amounts by health plan or benefit program is available on the
CY2022 Costs and Fees Sheet, DHA’s preview of CY2023 TRICARE Health Plan Costs, or by using the
TRICARE compare cost tool.
How does DHA determine the change in cost-sharing
amounts?
DHA generally 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
Amounts specified in statute and statutory formula
10 U.S.C. §1075a
TRICARE Select
Amounts specified in statute and statutory formula
10 U.S.C. §1075
Enrollment fee: actuarial adjustment
TRICARE Reserve Select
10 U.S.C. §1076d
Other cost-sharing amounts: mirrors TRICARE Select
Enrollment fee: actuarial adjustment
TRICARE Retired Reserve
10 U.S.C. §1076e
Other cost-sharing amounts: mirrors TRICARE Select
Enrollment fee: actuarial adjustment
TRICARE Young Adult (Prime or Select) Other cost-sharing amounts: mirrors TRICARE Prime 10 U.S.C. §1110b
or TRICARE Select
Enrollment fee: actuarial adjustment
Continued Health Care Benefit Program
10 U.S.C. §1078a
Other cost-sharing amounts: mirrors TRICARE Select
TRICARE Pharmacy
Amounts specified in statute and statutory formula
10 U.S.C. §1074g
DHA-administered dental benefit: actuarial adjustment
10 U.S.C. §1076a
TRICARE Dental
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 enrollment-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 annually. Certain DOD beneficiaries (i.e., military retirees and their family members) are eligible for
dental benefits through FEDVIP, which annually 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 open enrollment season for calendar year 2023 is to
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begin on November 14, 2022, and end on December 13, 2022. Beneficiaries who opt to remain in their
current health plan or benefit program are not required to re-enroll. Beneficiaries who 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
Permanent change of station/moving
Marriage
Initial military commissioning or enlistment
Divorce
Reserve Component member activation/deactivation
Having a baby or adopting a child
Injured on active duty
Children going to college
Separating from active duty
Children becoming adults
Retiring
Becoming Medicare-eligible
Military-directed change of primary care manager
Moving
Change in overseas command-sponsorship
Death in family
Loss or gain of other health insurance
Source: 32 C.F.R. §199.17(o) and TRICARE, “Qualifying Life Events,” accessed November 9, 2022,
https://www.tricare.mil/LifeEvents.
Author Information
Bryce H. P. Mendez
Analyst in Defense Health Care Policy
Disclaimer
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