AFSA Alerts

FY 2013 Budget Released; Higher TRICARE fees Sought

As AFSA has been warning for many months, the Administration would soon call on Congress to raise TRICARE premiums and fees (yes, again). That day came yesterday when President Obama presented his FY 2013 budget to Congress. The plan calls for higher fees across a broad spectrum of TRICARE programs, here is what we know.

TRICARE PRIME: Under the President’s proposal, annual TRICARE Prime enrollment fees for retired families would rise as high as $820 beginning October 1 of this year and climb to as much as $2,048 within five years. The actual figures will be determined by the amount of retired pay the individual receives. Single coverage remains at half the family rate but these too will be tied to the level of military retired pay. DoD officials told AFSA on Monday that the department will “ramp-up” rates through FY 2017 but after that time, premiums will be indexed to medical inflation (National Health Expenditures or “NHE”).

TRICARE STANDARD/EXTRA: If Congress approves the Administration’s plan, beginning this fall, TRICARE Standard and Extra beneficiaries will be required to pay a new, $140 annual family enrollment fee and subject to higher deductibles (Individuals will pay half the family rate). Enrollment fees and deductibles for families would rise to $250 and $580, respectively within 5 years and these amounts are not, repeat not, and based on income. In FY 2018 and beyond, rates would be tied to NHE.

TRICARE for Life: The Administration is proposing to implement an annual enrollment fee for TFL coverage ranging from $35 to $115 using the same tiering & indexing as TRICARE Prime. Rates will apply to each individual in the program and may climb to as high as much as $475 per year within 5 years, BOTTOM LINE FOR THOSE ON MEDICARE B: You will be paying this new additional fee even though you are currently paying the Medicare B fees based on your income. For those not yet on the Medicare B program, this new tiered fee will be your enrollment fee.

PHARMACY: Pharmacy copays for brand-name medications obtained through retail and mail-order would more than double under the Presidents plan, from $12 to $26 beginning October 1. Copays for non-formulary medications that currently cost $25 would more than double, to $51, and their availability would be mostly restricted to the mail-order venue. Provisions for limited retail access will be made for medications deemed “medically necessary.” Fees for brand name and non-formulary copays will rise to $34 and $66, respectively, within 5 years.

CATASTROPHIC CAP: The annual Catastrophic Cap of $3,000 will be indexed to the NHE though it is unclear if this change will occur October 1 of this year, or sometime thereafter.

Survivors of military members who died on active duty and medically retired personnel are exempted from any fee increases. When asked, DoD officials told us they believe many of the remaining survivors will fall into the lowest tier.

There you have it; TRICARE is “officially on the table.” Click on this link for a chart in the Presidents proposal outlining all of the fees/changes. This latest challenge in the area of health care will require the active intervention of every AFSA member. In the days and weeks ahead our efforts will center on protecting your healthcare benefits. Members must tell Congress that in order to gain the support of the military electorate; they must oppose this effort to shift the cost of earned military healthcare onto the backs of retirees. A sample letter to help shape your thoughts will be soon be posted on our webpage. In the interim, call them. Don’t delay—the future of your benefits is in your hands.