TRICARE Cost-Sharing Changes in 2024
INSIGHTi
TRICARE Cost-Sharing Changes in 2024
Updated November 13, 2023
The U.S. 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.
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, copayments, 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 coverage costs. This Insight reviews changes to
TRICARE’s beneficiary cost-sharing amounts that are scheduled to take effect on January 1, 2024. These
changes may generate constituent inquiries during the next TRICARE open enrollment season from
November 13, 2023, to December 12, 2023 (see below).
What TRICARE health plans and benefit programs are
scheduled to have modified cost shares in 2024?
For calendar year (CY) 2024, DHA announced increases in 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
CY2023 Costs and Fees Sheet, DHA’s preview of CY2024 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
•
Enrol ment fee: actuarial adjustment
TRICARE Reserve Select
10 U.S.C. §1076d
•
Other cost-sharing amounts: mirrors TRICARE Select
•
Enrol ment fee: actuarial adjustment
TRICARE Retired Reserve
10 U.S.C. §1076e
•
Other cost-sharing amounts: mirrors TRICARE Select
•
Enrol ment fee: actuarial adjustment
TRICARE Young Adult (Prime or Select) • Other cost-sharing amounts: mirrors TRICARE Prime 10 U.S.C. §1110b
or TRICARE Select
•
Enrol ment 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 enrol ment-weighted average annual costs of previous calendar years
and projected administrative and health care costs. For more on how actuarial adjustments are made annually, see DHA’s
methodology document. 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 2024 is to
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begin on November 13, 2023, and end on December 12, 2023. 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 the DHA-designated
military or family-related life changes deemed as a QLE.
Table 2. TRICARE Qualifying Life Events
Military Changes
Family Changes
•
Permanent change of station/moving
•
Marriage
•
Initial military commissioning or enlistment
•
Divorce or annulment
•
Reserve Component member activation/deactivation
•
Having a baby or adopting a child
•
Injured on active duty
•
Children going to col ege
•
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 8, 2023, at
https://www.tricare.mil/LifeEvents.
Author Information
Bryce H. P. Mendez
Specialist in Defense Health Care Policy
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