§1075 TRICARE Select

Summary

The Secretary of Defense must set up a new TRICARE option called TRICARE Select by January 1, 2018. TRICARE Select must be available everywhere and let eligible people choose their health care providers without restriction. People enroll under the usual enrollment rules. There are three enrollment groups: active‑duty family members, retired beneficiaries, and reserve and young adult beneficiaries. How much you pay depends on which group you are and on when the service member first enlisted. For people who first enlisted on or after January 1, 2018 (and their dependents), the law sets 2018 cost amounts that are adjusted each year by increases in retired pay. For 2018, active‑duty family members had no annual enrollment fee, deductibles of $50 per person/$100 per family for E4 and below and $150/$300 for E5 and above, and a $1,000 annual catastrophic cap. Retired beneficiaries had $450 per person/$900 per family enrollment, in‑network deductibles $150 per person/$300 per family (out‑of‑network $300/$600), and a $3,500 catastrophic cap. Sample 2018 in‑network copays were: primary care $15/$25 (active/retired), specialty $25/$40, ER $40/$80, urgent care $20/$40, ambulatory surgery $25/$95, ground ambulance $15/$60, DME 10%/20%, inpatient $60/$175, and skilled nursing $25/day/$50/day; out‑of‑network coinsurance was generally 20% (active) or 25% (retired). Reserve and young adult cost rules use the same amounts except they pay premiums set in their specific laws instead of the enrollment fee. People who first enlisted before January 1, 2018 have cost sharing calculated the same way TRICARE Extra or Standard would have. The Secretary may set a $150 individual/$300 family annual enrollment fee for some retired beneficiaries who enlisted before 2018, but cannot start that fee until 90 days after the GAO sends a review (due by February 1, 2020) about coverage changes, appointment access, percent of network providers taking new patients, and beneficiary satisfaction. TRICARE for Life and its cost rules stay available. Network providers must charge $0 for approved contraceptive services they provide. The Secretary may waive cost sharing for the first three outpatient mental‑health visits each year for active‑duty family members and certain other beneficiaries (this waiver ends five years after the NDAA for FY2024). The Secretary can create multiple provider networks and may require enrollees to join a specific network, making other providers out‑of‑network. Defined terms (one line each): active‑duty family member category (dependents of active duty members); retired category (retirees and their families as described in law); reserve and young adult category (those covered by the listed reserve/young adult statutes); network (civilian providers who contract to accept pre‑negotiated rates); out‑of‑network (TRICARE‑authorized civilian providers who have not contracted to accept those rates).