20 Sep 2021 | Military.com | By Patricia Kime
Military families and retirees who use retail pharmacies or the Tricare mail-order delivery system for their medications will see an increase in copayments in 2022, according to a notice to be published Tuesday in the Federal Register.
Likewise, military retirees still considered to be working age — those under age 65 who are not old enough for Medicare and Tricare for Life — can expect to pay more in health care enrollment fees, although the exact amount of the bump has yet to be determined.
Prescriptions for all Tricare beneficiaries at retail pharmacies will cost $14 for a 30-day supply for a generic drug, up from $11; $38 for a brand-name medication, up from $33; and $68 for a non-formulary drug not listed in Tricare’s list of covered medications, up from $60.
Eligible patients can save money by using military pharmacies, which charge no copayments, or they can trim costs of regularly prescribed medications by using Tricare’s mail-order pharmacy, managed by Express Scripts.
Copayments for the mail-order pharmacy also will see an increase. The cost of a generic prescription will rise from $10 to $12 for a 90-day supply, and from $29 to $34 for a brand-name drug for a 90-day script. Non-formulary drugs will cost $68.
Annual enrollment fees for Tricare Prime and Select also are expected to rise for career retired service members and their families, but the amount of the increase has yet to be determined because it is based on the calculated cost-of-living adjustment for retired military pay, which is usually published in mid-October.
The enrollment fee increase is expected to be significant this year as military retirees could see the largest jump in their retirement pay in nearly 40 years. As of June, the projected cost-of-living, or COLA, increase was 5.1%, meaning that both retirement pay and Tricare Prime enrollment fees could rise by that percent as well, give or take a few tenths.
Currently, military personnel who retired before Jan. 1, 2018, known as Group A retirees, pay $303 per year for an individual and $606 per year for a family.
Those designated as Group B retirees entered service on or after Jan. 1, 2018, and have left military service, mainly medical retirees and their family members. This group currently pays annual enrollment fees for Tricare Prime of $366 per individual and $732 per family.
Retirees in Group A who use Tricare Select began paying annual enrollment fees this year, $150 for an individual and $300 for a family, while Group B retirees’ enrollment fees for Select are $471 for an individual or $942 for a family.
Both groups are subject to the COLA adjustment and will see increases to their fees.
Surviving family members of sponsors who died on active duty or service members who medically retired before Jan. 1, 2018, and their families who are enrolled in Tricare Prime are exempt from the increases as long as they remain in that health program.
Tricare for Life beneficiaries don’t pay anything for that program, which acts as a secondary payer to Medicare. But they are likely to see increased cost in their health care as well, since they are required to have Medicare Part B, which carries monthly premiums based on income. Medicare Part B premiums are expected to increase based on the COLA.
In addition to pharmacy copay increases and enrollment fee hikes, some specialty populations within the Tricare system also will pay more, including reservists, young adults and transitioning service members.
Open Season this year is scheduled to begin Nov. 8 and end Dec. 13. During this period, eligible beneficiaries can enroll in Tricare Prime or Select if they have other insurance or change plans. If they are satisfied with their current Tricare health plan, they can do nothing and remain enrolled.
If they don’t make a change during Open Season, beneficiaries must wait until a “qualifying life event,” such as losing health insurance provided by another insurer, retiring, getting married or divorced, having a baby or adopting, moving or aging out of Tricare.
More than 4.7 million beneficiaries are enrolled in Tricare Prime, and nearly 1.7 million patients use Tricare Select. An additional 2.1 million beneficiaries use Tricare for Life.