87 FR 224 pgs. 71313-71314 - TRICARE; Calendar Year (CY) 2023; TRICARE Prime and TRICARE Select Out-of-Pocket Expenses
Type: NOTICEVolume: 87Number: 224Pages: 71313 - 71314
Pages: 71313, 71314FR document: [FR Doc. 2022-25439 Filed 11-21-22; 8:45 am]
Agency: Defense Department
Official PDF Version: PDF Version
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DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE; Calendar Year (CY) 2023; TRICARE Prime and TRICARE Select Out-of-Pocket Expenses
AGENCY:
Office of the Secretary, Department of Defense.
ACTION:
Notice of CY 2023 TRICARE Prime and TRICARE Select out-of-pocket expenses.
SUMMARY:
This notice provides the CY 2023 TRICARE Prime and TRICARE Select out-of-pocket expenses.
DATES:
The CY 2023 rates contained in this notice are effective January 1, 2023.
ADDRESSES:
Defense Health Agency (DHA), TRICARE Health Plan, 7700 Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.
FOR FURTHER INFORMATION CONTACT:
Debra Fisher, telephone (703) 275-6224.
SUPPLEMENTARY INFORMATION:
The National Defense Authorization Acts for Fiscal Years 2012 and 2017 established rates for TRICARE beneficiary out-of-pocket expenses and how they may be increased by the annual cost of living adjustment (COLA) percentage used to increase military retired pay or via budget neutrality rules. The CY 2023 retiree COLA increase is 8.7%.
The DHA has updated the CY 2023 out-of-pocket expenses as follows:
| Out of pocket expense | Select Group A CY23 | Select Group B CY23 | Prime?* Group A CY23 | Prime?* Group B CY23 |
|---|---|---|---|---|
| Annual enrollment fee: | ||||
| Individual | $0 | $0 | $0 | $0 |
| Family | $0 | $0 | 0 | 0 |
| Annual deductible: | ||||
| E1-E4, individual | $50 | $60 | 0 | 0 |
| E1-E4, family | $100 | $121 | 0 | 0 |
| E5 & above, individual | $150 | $182 | 0 | 0 |
| E5 & above, family | $300 | $365 | 0 | 0 |
| Annual catastrophic cap | $1,000 | $1,217 | 1,000 | 1,217 |
| Preventive visit | $0 | $0 | 0 | 0 |
| Primary care | $25 (IN) 20% (OON) | $18 (IN) 20% (OON) | 0 | 0 |
| Specialty care | $37 (IN) 20% (OON) | $30 (IN) 20% (OON) | 0 | 0 |
| ER visit | $103 (IN) 20% (OON) | $48 (IN) 20% (OON) | 0 | 0 |
| Urgent care center visit | $25 (IN) 20% (OON) | $24 (IN) 20% (OON) | 0 | 0 |
| Ambulatory surgery | $25 (IN or OON) | $30 (IN) 20% (OON) | 0 | 0 |
| Ambulance, outpatient ground | $75 (IN) 20% (OON) | $18 (IN) 20% (OON) | 0 | 0 |
| Ambulance, outpatient air | 20% (IN or OON) | 20% (IN or OON) | 0 | 0 |
| Durable medical equipment | 15% (IN) 20% (OON) | 10% (IN) 20% (OON) | 0 | 0 |
| Inpatient admission | $21.30 per day; $25 min. per admission | $73 per adm. (IN); 20% (OON) | 0 | 0 |
| Inpatient SNF/rehab facility | $21.30 per day; $25 min. per admission | $30 per day (IN); $60 per day (OON) | 0 | 0 |
| *?When TRICARE Prime enrollees other than active duty service members self-refer to specialty or non-emergent inpatient care without a referral from a network provider and/or authorization from the regional contractor, the TRICARE Point of Service deductible and copayment applies in lieu of TRICARE Prime copayments. | ||||
| Out of pocket expense | Select Group A CY23 | Select Group B CY23 | Prime?* Group A CY23 | Prime?* Group B CY23 |
|---|---|---|---|---|
| Annual enrollment fee: | ||||
| Individual | $171.96 | $547.92 | $351.96 | $426 |
| Family | $345 | $1,095.96 | 703.92 | 852 |
| Annual deductible: | ||||
| E1-E4, individual | $150 | $182 (IN); $365 (OON) | 0 | 0 |
| Family | $300 | $365 (IN); $730 (OON) | 0 | 0 |
| Annual catastrophic cap | $4,028 | $4,262 | 3,000 | 4,262 |
| Preventive visit | $0 | $0 | 0 | 0 |
| Primary care | $34 (IN) 25% (OON) | $30 (IN) 25% (OON) | 24 | 24 |
| Specialty care | $49 (IN) 25% (OON) | $48 (IN) 25% (OON) | 36 | 36 |
| ER visit | $138 (IN) 25% (OON) | $97 (IN) 25% (OON) | 73 | 73 |
| Urgent care center visit | $34 (IN) 25% (OON) | $48 (IN) 25% (OON) | 36 | 36 |
| Ambulatory surgery | 20% (IN) 25% (OON) | $115 (IN) 25% (OON) | 73 | 73 |
| Ambulance, outpatient ground | $100 (IN) 25% (OON) | $73 (IN) 25% (OON) | 48 | 48 |
| Ambulance, outpatient air | 25% (IN or OON) | 25% (IN or OON) | 20 | 20 |
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| Out of pocket expense | Select Group A CY23 | Select Group B CY23 | Prime?* Group A CY23 | Prime?* Group B CY23 |
|---|---|---|---|---|
| Durable medical equipment | 20% (IN) 25% (OON) | 20% (IN) 25% (OON) | 20% | 20%. |
| Inpatient admission: | ||||
| In-network | $250/day up to 25% of hospital charges, plus 20% of sep. billed services | $213 per adm | $182 per adm | $182 per adm. |
| Out of network | ‡?$1,053/day up to 25% of hosp. charges, plus 25% of sep. billed services | 25% | $182 per adm | $182 per adm. |
| Inpatient SNF/rehab facility | $250/day up to 25% of hospital charges, plus 20% of sep. billed services (IN); 25% (OON) | $60 per day (IN); lesser of $365 per day or 20% (OON) | $36 per day | $36 per day. |
| ‡?This is the CY22 rate. The CY23 out of pocket expense will be available mid-December once the DRG payment rates are calculated. | ||||
| *?When TRICARE Prime enrollees other than active duty service members self-refer to specialty or non-emergent inpatient care without a referral from a network provider and/or authorization from the regional contractor, the TRICARE Point of Service deductible and copayment applies in lieu of TRICARE Prime copayments. | ||||
The CY 2023 rates contained in this notice are effective January 1, 2023.
Dated: November 17, 2022.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2022-25439 Filed 11-21-22; 8:45 am]
BILLING CODE 5001-06-P