2022 AFBA Financial Planning Guide

3-12. TRICARE COST TABLE

TRICARE beneficiaries fall into one of two groups: Group A or Group B Group A — Military sponsor’s initial enlistment or appointment began before 1 January 2018 Group B — Military sponsor’s initial enlistment or appointment began on or after 1 January 2018

PRIME GROUP A

PRIME GROUP B

SELECT GROUP A

SELECT GROUP B

TOPIC

ACTIVE DUTY FAMILY MEMBERS

Annual Enrollment Fee

None

None

None

None

E4 and below: $56/ individual; $112/family E5 and above: $168/ individual; $336/family

E4 and below: $50/ individual; $100/family E5 and above: $150/ individual; $300/family

Annual Deductible

None

None

$1,120

$1,120

Catastrophic Cap

$1,000

$1,000

Point of Service Deductible Primary Care Outpatient Visit

$300 per individual; $600 per family

N/A

N/A

Network: $24 Out of Network: 20% Network: $99 Out of Network: 20% $20.75 per day or $25 per admission, (whichever is more) Network and Out of Network

Network: $16 Out of Network: 20% Network: $44 Out of Network: 20% Network: $67 per admission Out of Network: 20%

None

None

Emergency Room Visit

None

None

Inpatient Admission (Hospitalization )

None

None

RETIREES AND THEIR FAMILY MEMBERS

$323/individual $647/family

$392/individual $784/family

$158/individual $317/family

$504/individual $1,008/family Network: $168/individual $336/family Out of Network: $336/individual $672/family

Annual Enrollment Fee

$150/individual $300/family

Annual Deductible

None

None

$3,921

$3,706

$3,921

Catastrophic Cap

$3,000

Point of Service Deductible Primary Care Outpatient Visit

$300 per individual; $600 per family

N/A

N/A

Network: $32 Out of Network: 25% Network: $133 Out of Network: 25% Network: $250 per day up to 25% of hospital charge plus 20% of separate charges

Network: $28 Out of Network: 25% Network: $89 Out of Network: 25% Network: $196 per admission Out of Network: 25%

$22

$22

$67

$67

Emergency Room Visit

Inpatient Admission (Hospitalization)

$168 per admission $168 per admission

1) Costs and deductibles are on an annual basis (1 January - 31 December) 2) Rates and other information are subject to change. Beneficiaries should contact their regional contractor for the most recent information.

CHAPTER 3: TRICARE

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