Tricare Costs and Benefits Remain Largely Unchanged in 2021

Tricare appointment
Yamoca Joseph, a medical support assistant at Kenner Army Health Clinic's Wilkerson Pediatric Clinic, checks the credentials of 14-year-old Jayden Rios prior to an appointment on July 29, 2019. Photo by Lesley Atkinson/Regional Health Command-Atlantic

Users will see little change in the costs and benefits of the popular insurance program Tricare next year.

Retirees using Tricare Select face a new enrollment fee for the upcoming year, but cost increases for both Tricare Prime and Tricare Select will be very small and affect only a handful of services. Most beneficiaries won't notice any change to their medical costs; in fact, any increases for 2021 will be less than $10 for most medical procedures.

Tricare Groups

Tricare has two groups of members: Group A consists of those who entered the service before Jan. 1, 2018, and Group B covers those who entered after that date. The groups have different costs for different services.

Tricare Prime

The biggest change Tricare Prime users will see in 2021 is their catastrophic cap limits. The catastrophic cap is your maximum out-of-pocket cost for all health care provided during any year. If you have a serious illness or injury, your out-of-pocket costs are limited to the catastrophic cap no matter how much you are charged for medical care.

While the catastrophic cap limits remain the same for active-duty family members and retirees in Group A, Group B beneficiaries will see the limit change from $1,044 to $1,058 for active-duty families and from $3,655 to $3,703 for retirees.

Enrollment fees will see very slight increases. Active-duty family members under both Group A and Group B pay no enrollment fees, while Group A retirees will pay an annual enrollment fee of $303 for a single member, up from $300; retired families will see their annual fee increase from $600 to $606.

Group B retirees and family members will see no increase.

The only other changes in cost for Tricare Prime in 2021 are $1 increases in primary care or emergency room visits, and those changes will affect only retirees in both Groups A and B. The cost for retiree’s primary care visits will go from $20 to $21, and an emergency room visit will rise from $62 to $63.

Check out the 2021 costs of common medical services under Tricare Prime.

Tricare Select

The biggest change Tricare Select members will see in 2021 is the addition of an enrollment fee for Group A retirees. This fee didn't exist prior to 2021. Group A Tricare Select users with single coverage will begin paying a $150 annual fee; those with family coverage will pay $300 annually. For retirees in Group B, the existing annual enrollment fee will increase from $471 to $474; those with family coverage will see their fee jump from $942 to $948.

The catastrophic cap will remain unchanged for Group A family members and increase from $1,044 to $1,058 for Group B active-duty family members. Retirees will see it go from $3,000 to $3,500 for Group A and from $3,655 to $3,703 for family coverage.

Co-pays for medical services will see slight increases in 2021. While primary care visits will cost the same as in 2020, the cost of seeing a specialist, visiting an urgent care facility or emergency room, ambulance rides and some mental health and maternity care services will see increases of less than $10 in the upcoming year.

Check out the 2021 costs of common medical services under Tricare Select.

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