TRICARE.com

TRICARE Costs and Fees October 2019 Guide

Comprehensive guide to TRICARE costs and fees as of October 2019, including Group A/B distinctions, Prime enrollment fees, and pharmacy copays.

TRICARE Costs and Fees October 2019 Guide

*Disclaimer: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense or the official TRICARE program. For official policy and the most current data, visit TRICARE.mil.*

## Quick answer In October 2019, TRICARE costs were primarily determined by your beneficiary "Group" (A or B) and your specific plan. During this period, active duty members paid $0 out-of-pocket, while retirees and family members paid annual enrollment fees (for Prime) or annual deductibles and cost-shares (for Select).

## In detail Understanding 2019 costs requires looking back at the "Group" system implemented during the 2018 TRICARE overhaul, which remained the standard in late 2019.

### Group A vs. Group B * **Group A:** Your sponsor’s initial enlistment or appointment date was **before** January 1, 2018. * **Group B:** Your sponsor’s initial enlistment or appointment date was **on or after** January 1, 2018.

### TRICARE Prime Costs (2019) TRICARE Prime was the "managed care" option, similar to an HMO. * **Active Duty & Families:** No enrollment fees and $0 out-of-pocket for covered services (when referred). * **Retirees & Families (Group A):** * Annual Enrollment Fee: ~$297 for individuals / ~$594 for families. * Primary Care Copay: ~$20. * Specialty Care Copay: ~$30. * Urgent Care Copay: ~$30.

### TRICARE Select Costs (2019) TRICARE Select was the "preferred provider" option, similar to a PPO. It did not require enrollment fees for Group A retirees in 2019 (those fees were famously introduced later in 2021). * **Deductibles (Group A):** * Active Duty Family (E4 & below): $50 individual / $100 family. * Active Duty Family (E5 & above): $150 individual / $300 family. * Retirees: $150 individual / $300 family. * **Cost-Shares (Network):** Generally 15% of the negotiated rate for active duty families and 20% for retirees.

### Pharmacy Costs (Effective Oct 2019) Pharmacy rates were standardized across all plans except for Active Duty Service Members (who always pay $0). * **Military Pharmacy:** $0 for a 90-day supply. * **Home Delivery (Generic):** $7 (90-day supply). * **Home Delivery (Brand):** $24 (90-day supply). * **Retail Network (Generic):** $11 (30-day supply). * **Retail Network (Brand):** $28 (30-day supply).

## Who this applies to * **Active Duty Service Members:** Always have $0 out-of-pocket costs for covered medical care. * **Active Duty Families:** Affected by deductibles and cost-shares if using TRICARE Select. * **Retirees and their Families:** Responsible for annual enrollment fees (Prime) and cost-shares for most visits. * **TRICARE Reserve Select (TRS) Members:** Paid monthly premiums ($44.17 individual / $228.27 family in 2019) regardless of Group status.

Common scenarios

**Scenario 1: Retiree in Group A using TRICARE Prime (2019)** John is a retired Navy commander. In October 2019, he paid an annual enrollment fee of roughly $297. When he visited a network specialist for a knee injury, he paid a flat **$30 copayment** for the visit.

**Scenario 2: Active Duty Family (E-5) using TRICARE Select (2019)** Sarah is married to an active duty Sergeant. They use TRICARE Select. In 2019, they had to meet a **$300 family deductible**. Once met, Sarah paid a **15% cost-share** for her office visits at a civilian network doctor.

**Scenario 3: Using the Pharmacy Benefit** A retiree filling a 90-day prescription for a maintenance "Brand Name" medication via Express Scripts mail order in late 2019 would have paid **$24**, compared to $0 if they were able to get it at a Military Treatment Facility (MTF).

## Related terms * **Catastrophic Cap:** The maximum out-of-pocket amount a beneficiary pays per year before TRICARE covers 100% of additional costs. * **Cost-Share:** A percentage of the total cost of a covered health care service that you pay (typical of TRICARE Select). * **Copayment:** A fixed dollar amount you pay for a covered health care service (typical of TRICARE Prime). * **Enrollment Fee:** An annual fee paid by retirees and their families to participate in TRICARE Prime. * **Point-of-Service (POS) Option:** Higher out-of-pocket costs for Prime members who see a non-emergency provider without a referral.

## Sources * **TRICARE.mil:** official cost archives for 2019. * **Defense Health Agency (DHA):** Annual evaluation of the TRICARE Program. * **Federal Register:** Documentation of 2019 pharmacy co-pay adjustments.