[Federal Register Volume 89, Number 215 (Wednesday, November 6, 2024)]
[Notices]
[Pages 88030-88032]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-25753]


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DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE; Calendar Year (CY) 2025; TRICARE Prime and TRICARE 
Select Out-of-Pocket Expenses

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Notice of calendar year (CY) 2025 TRICARE Prime and TRICARE 
Select out-of-pocket expenses.

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SUMMARY: This notice provides the Calendar Year (CY) 2025 TRICARE Prime 
and TRICARE Select out-of-pocket expenses.

DATES: The CY 2025 rates contained in this notice are effective January 
1, 2025.

ADDRESSES: Defense Health Agency (DHA), TRICARE Health Plan, 7700 
Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.

FOR FURTHER INFORMATION CONTACT: Debra Fisher, 703-275-6224, 
dha.ncr.healthcare-ops.mbx.thp-policy-and-programs-branch@health.mil.

SUPPLEMENTARY INFORMATION: The National Defense Authorization Acts for 
Fiscal Years 2012 and 2017, and subsequent implementing regulations 
(e.g., Sec.  199.17 of title 32 of the Code of Federal Regulations), 
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 2025 retiree COLA increase is 2.5%.
    The DHA has updated the CY 2025 out-of-pocket expenses as shown 
below:

  Calendar Year 2025 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses--Active Duty Family Members (ADFM)
                                                    Category
                                                  [Page 1 of 1]
----------------------------------------------------------------------------------------------------------------
                                                                                            Prime *     Prime *
        Out of pocket expense             Select Group A CY25      Select Group B CY25      Group A     Group B
                                                                                             CY25        CY25
----------------------------------------------------------------------------------------------------------------
Annual enrollment fee:
    Individual.......................  $0......................  $0.....................          $0          $0
    Family...........................  $0......................  $0.....................           0           0
Annual deductible:
    E1-E4, individual................  $50.....................  $64....................           0           0
    E1-E4, family....................  $100....................  $128...................           0           0
    E5 & above, individual...........  $150....................  $193...................           0           0
    E5 & above, family...............  $300....................  $386...................           0           0
Annual catastrophic cap..............  $1,000..................  $1,288.................       1,000       1,288

[[Page 88031]]

 
Preventive visit.....................  $0......................  $0.....................           0           0
Primary care.........................  $27 (IN); 20% (OON).....  $19 (IN); 20% (OON)....           0           0
Specialty care.......................  $38 (IN); 20% (OON).....  $32 (IN); 20% (OON)....           0           0
ER visit.............................  $105 (IN); 20% (OON)....  $51 (IN); 20% (OON)....           0           0
Urgent care center visit.............  $27 (IN); 20% (OON).....  $25 (IN); 20% (OON)....           0           0
Ambulatory surgery...................  $25 (IN or OON).........  $32 (IN); 20% (OON)....           0           0
Ambulance, outpatient ground.........  $86 (IN); 20% (OON).....  $19 (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..................  $23.45 per day; $25 min.  $77 per adm. (IN); 20%            0           0
                                        per admission.            (OON).
Inpatient SNF/rehab facility.........  $23.45 per day; $25 min.  $32 per day (IN); $64             0           0
                                        per admission.            per day (OON).
----------------------------------------------------------------------------------------------------------------
* 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.


    Calendar Year 2025 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses--Retiree Beneficiary Category
                                                  [Page 1 of 2]
----------------------------------------------------------------------------------------------------------------
                                                                                            Prime *     Prime *
        Out of pocket expense             Select Group A CY25      Select Group B CY25      Group A     Group B
                                                                                             CY25        CY25
----------------------------------------------------------------------------------------------------------------
Annual enrollment fee:
    Individual.......................  $181.92.................  $579...................        $372        $450
    Family...........................  $364.92.................  $1,158.96..............         744      900.96
Annual deductible:
    Individual.......................  $150....................  $193 (IN); $386 (OON)..           0           0
    Family...........................  $300....................  $386 (IN); $772 (OON)..           0           0
Annual catastrophic cap..............  $4,261..................  $4,509.................       3,000       4,509
Preventive visit.....................  $0......................  $0.....................           0           0
Primary care.........................  $37 (IN); 25% (OON).....  $32 (IN); 25% (OON)....          25          25
Specialty care.......................  $51 (IN); 25% (OON).....  $51 (IN); 25% (OON)....          38          38
ER visit.............................  $140 (IN); 25% (OON)....  $103 (IN); 25% (OON)...          77          77
Urgent care center visit.............  $37 (IN); 25% (OON).....  $51 (IN); 25% (OON)....          38          38
Ambulatory surgery...................  20% (IN); 25% (OON).....  $122 (IN); 25% (OON)...          77          77
Ambulance, outpatient ground.........  $115 (IN); 25% (OON)....  $77 (IN); 25% (OON)....          51          51
Ambulance, outpatient air............  25%; (IN or OON)........  25%; (IN or OON).......          20          20
----------------------------------------------------------------------------------------------------------------
Note: The calendar year catastrophic cap for TRICARE Select Group A retirees who are survivors of active duty
  deceased sponsors or medically retired Uniformed Service members and their dependents is $3,000.


    Calendar Year 2025 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses--Retiree Beneficiary Category
                                                  [Page 2 of 2]
----------------------------------------------------------------------------------------------------------------
                                 Select Group A    Select Group B
     Out of pocket expense            CY25              CY25         Prime * Group A CY25   Prime * Group B CY25
----------------------------------------------------------------------------------------------------------------
Durable medical equipment.....  20% (IN); 25%     20% (IN); 25%     20%..................  20%.
                                 (OON).            (OON).
Inpatient admission:
    In-network................  $250/day up to    $225 per adm....  $193 per adm.........  $193 per adm.
                                 25% of hospital
                                 charges, plus
                                 20% of sep.
                                 billed services.
    Out of network............  [Dagger] $1,221/  25%.............  $193 per adm.........  $193 per adm.
                                 day up to 25%
                                 of hosp.
                                 charges, plus
                                 25% of sep.
                                 billed services.
Inpatient SNF/rehab facility..  $250/day up to    $64 per day       $38 per day..........  $38 per day.
                                 25% of hospital   (IN); lesser of
                                 charges, plus     $386 per day or
                                 20% of sep.       20% (OON).
                                 billed services
                                 (IN); 25% (OON).
----------------------------------------------------------------------------------------------------------------
[Dagger] This is the CY24 rate. The CY25 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.


[[Page 88032]]

    The CY 2025 rates contained in this notice are effective January 1, 
2025.

    Dated: October 31, 2024.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2024-25753 Filed 11-5-24; 8:45 am]
BILLING CODE 6001-FR-P


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