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» TRICARE Announces Updated Reimbursement Rates


TRICARE Announces Updated Reimbursement Rates

An updated list of the TRICARE reimbursement rates is now available to beneficiaries.  The changes for fiscal year 2007 include updated rates for inpatient mental health, residential treatment centers, partial hospitalization, hospice, and inpatient cost-shares for civilian hospitals.

“We take very seriously the President’s initiative toward transparency in health care costs,” said Army Major General Elder Granger, deputy director, TRICARE Management Activity.  “This is just one way we make the cost of medical services available to our beneficiaries.”

TRICARE reimbursement rates are aligned with Medicare rates as set by Congress. However, TRICARE does have some dispensations that may not be available to Medicare to ensure that beneficiaries continue to have health care available.

“It is important for our service members and their families to know that we will take care of them,” Granger said.

Medicare premiums also change annually and now the Medicare Part B premium is linked to income.  In 2007, individual incomes will trigger premium increases at $80,000, $100,000, $150,000 and $200,000.  For married couples the premium rises when the income is double those amounts.  However, this change will have no effect on TRICARE costs or benefits for those who are also Medicare beneficiaries.

The updated reimbursement rates are printed in the tables below, or they may be viewed on the TRICARE web site at www.tricare.osd.mil/tricarecost.cfm.

Tricare Costs

The charts, below, explain the cost shares for families using TRICARE programs: Prime is an HMO-type program; Standard is a fee-for-service plan; and Extra is a preferred provider option (when the Standard beneficiary sees an in-network provider, he/she is exercising the Extra option.).

For assistance in obtaining medical care or in understanding your benefits-plan choices, please contact a customer service representative at the regional contractor; visit a TRICARE Service Center to talk with a health benefits advisor; or talk with a Beneficiary Counseling and Assistance Coordinator (BCACs) at the military treatment facility (the hospital or clinic on base or on post).

For information about how costs are applied to a catastrophic cap, see the CAT CAP explanation-its message is particularly timely for any person who is a new-to-Prime enrollee, such as a service member who retires, changes status, and then must re-enroll in Prime.

For information about costs associated with TRICARE For Life (TFL), the program for Medicare-eligible beneficiaries (due to age, disability, or disease), please see the explanation of TFL and the detailed costs table.

 

Retirees, Their Family Members, and Others

  TRICARE Prime TRICARE Extra TRICARE Standard
Annual Deductible None $150/individual or
$300/family
$150/individual or
$300/family
Annual
Enrollment Fee
$230/individual $460/family None None
Civilian Cost Shares   20% of negotiated fee 25% of allowable
charges
for covered service
Outpatient
Emergency Care
Mental Health Visit
$12
$30
$25
$17 (group visit)
   
Civilian Inpatient
Cost Share
$11/day (minimum $25 charge per admission); no separate co-payment for separately billed professional charges. Lesser of $250/day or 25% of negotiated charges plus 20% of negotiated professional fees Lesser of $535/day or 25% of billed charges plus 25% of allowable professional fees
Civilian Inpatient Skilled Nursing
Facility Care
  $250 per diem cost share or 20% cost share of total charges, whichever is less, institutional services, plus 20% cost share of separately billed professional charges 25% cost share of allowable charges for institutional services, plus 25% cost share of allowable for separately billed professional charges.
Civilian Inpatient Behavioral Health $40 per day; no charge for separately billed professional    

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