Notice2022-25439
TRICARE; Calendar Year (CY) 2023; TRICARE Prime and TRICARE Select Out-of-Pocket Expenses
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
November 22, 2022
Effective
January 1, 2023
Issuing agencies
Defense Department
Abstract
This notice provides the CY 2023 TRICARE Prime and TRICARE Select out-of-pocket expenses.
Full Text
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<title>Federal Register, Volume 87 Issue 224 (Tuesday, November 22, 2022)</title>
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[Federal Register Volume 87, Number 224 (Tuesday, November 22, 2022)]
[Notices]
[Pages 71313-71314]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-25439]
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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.
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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:
Calendar Year 2023 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses: Active Duty Family Members (ADFM)
Category
[Page 1 of 1]
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Prime * Group Prime * Group
Out of pocket expense Select Group A CY23 Select Group B CY23 A CY23 B CY23
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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 $73 per adm. (IN); 0 0
min. per admission. 20% (OON).
Inpatient SNF/rehab facility...... $21.30 per day; $25 $30 per day (IN); $60 0 0
min. per admission. per day (OON).
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* 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 2023 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses: Retiree Beneficiary Category
[Page 1 of 2]
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Prime * Group Prime * Group
Out of pocket expense Select Group A CY23 Select Group B CY23 A CY23 B CY23
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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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[[Page 71314]]
Calendar Year 2023 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses: Retiree Beneficiary Category
[Page 2 of 2]
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Select Group A Select Group B Prime * Group A Prime * Group B
Out of pocket expense CY23 CY23 CY23 CY23
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Durable medical equipment...... 20% (IN) 25% (OON) 20% (IN) 25% (OON) 20%................ 20%.
Inpatient admission:
In-network................. $250/day up to 25% $213 per adm...... $182 per adm....... $182 per adm.
of hospital
charges, plus 20%
of sep. billed
services.
Out of network............. [Dagger] $1,053/ 25%............... $182 per adm....... $182 per adm.
day up to 25% of
hosp. charges,
plus 25% of sep.
billed services.
Inpatient SNF/rehab facility... $250/day up to 25% $60 per day (IN); $36 per day........ $36 per day.
of hospital lesser of $365
charges, plus 20% per day or 20%
of sep. billed (OON).
services (IN);
25% (OON).
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[Dagger] 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
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</html>Indexed from Federal Register on November 22, 2022.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.