Notice2024-25753
TRICARE; Calendar Year (CY) 2025; 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 6, 2024
Effective
January 1, 2025
Issuing agencies
Defense Department
Abstract
This notice provides the Calendar Year (CY) 2025 TRICARE Prime and TRICARE Select out-of-pocket expenses.
Full Text
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<title>Federal Register, Volume 89 Issue 215 (Wednesday, November 6, 2024)</title>
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[Federal Register Volume 89, Number 215 (Wednesday, November 6, 2024)]
[Notices]
[Pages 88030-88032]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[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,
<a href="/cdn-cgi/l/email-protection#b3d7dbd29dddd0c19ddbd6d2dfc7dbd0d2c1d69edcc3c09dded1cb9dc7dbc39ec3dcdfdad0ca9ed2ddd79ec3c1dcd4c1d2dec09ed1c1d2ddd0dbf3dbd6d2dfc7db9ddedadf">dha.ncr.healthcare-ops.mbx.thp-policy-and-programs-branch@health.mil</a>.
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]
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Prime * Prime *
Out of pocket expense Select Group A CY25 Select Group B CY25 Group A Group B
CY25 CY25
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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).
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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 2025 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses--Retiree Beneficiary Category
[Page 1 of 2]
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Prime * Prime *
Out of pocket expense Select Group A CY25 Select Group B CY25 Group A Group B
CY25 CY25
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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
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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]
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Select Group A Select Group B
Out of pocket expense CY25 CY25 Prime * Group A CY25 Prime * Group B CY25
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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).
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[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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</html>Indexed from Federal Register on November 6, 2024.
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