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TRICARE in 2015: Historical Rates and Policy Changes

A historical guide to TRICARE in 2015, covering the introduction of ACA tax reporting (Form 1095-B), Autism Care changes, and maintenance drug mandates.

TRICARE in 2015: Historical Rates and Policy Changes

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## Quick answer The year 2015 was a pivotal transitional period for TRICARE, marked by the rollout of the Affordable Care Act (ACA) tax reporting requirements and the expansion of coverage for Applied Behavior Analysis (ABA). It was the final era before the major consolidation of TRICARE Standard and Extra into the modern "TRICARE Select" plan, which occurred in 2018.

In detail

While the TRICARE landscape of 2026 is dominated by the T-5 contract and TriWest Healthcare Alliance, the 2015 period established the foundational rules for how modern benefits are reported to the IRS and how developmental therapies are managed.

### 1. The Arrival of "Minimum Essential Coverage" (MEC) 2015 was the first year beneficiaries had to prove "Minimum Essential Coverage" to the IRS under the Affordable Care Act. * **IRS Form 1095-B:** Most TRICARE plans met MEC requirements. In 2015, the Defense Health Agency (DHA) began issuing the 1095-B form via myPay to verify coverage for tax purposes. * **The Penalty:** Beneficiaries without MEC in 2015 faced a tax penalty of $325 per adult or 2% of household income, whichever was higher.

### 2. The Comprehensive Autism Care Demonstration A major shift occurred in late 2014 and throughout 2015 regarding the treatment of Autism Spectrum Disorder (ASD). * **Consolidation:** TRICARE moved all ABA services under the "Autism Care Demonstration" (ACD). * **Access:** This move eliminated the requirement that sponsors be enrolled in the Exceptional Family Member Program (EFMP) to access certain ABA benefits. * **Rates:** 2015-era reimbursement rates for ABA providers were overhauled to ensure better network access.

### 3. Prescription Drug Rule Changes By mid-2015, TRICARE implemented "Maintenance Drug" rules that forced many beneficiaries to stop using local retail pharmacies for long-term medications. * **The Mandate:** Beneficiaries were required to switch maintenance medications (like blood pressure or cholesterol pills) to **Express Scripts Home Delivery** or a military pharmacy. * **The Penalty:** If a beneficiary continued using a retail pharmacy for maintenance drugs after two 30-day fills, they became responsible for the full cost of the medication.

### 2015 Cost Comparison (Historical Snapshot) *Note: These figures are provided for historical research. Current 2026 rates are significantly higher.*

| Feature | TRICARE Prime (2015) | TRICARE Standard (2015) | | :--- | :--- | :--- | | **Annual Enrollment Fee** | $277.92 (Individual) / $555.84 (Family) | $0 | | **Outpatient Copay** | $12 (Active Duty Family) | 20% of allowable charge | | **Ambulatory Surgery** | $25 | 20% of allowable charge | | **Catastrophic Cap** | $1,000 (ADFM) / $3,000 (Retiree) | $1,000 (ADFM) / $3,000 (Retiree) |

## Who this applies to * **Historical Researchers:** Those looking into the evolution of the Defense Health Agency and the merger of regional contracts. * **Legal/Claims Adjusters:** Individuals reviewing medical claims or disability cases that originated in the 2015 calendar year. * **Retirees:** Those who transitioned from active duty in 2015 and need to understand their "Group A" status (which is determined by whether the sponsor's initial enlistment was before Jan 1, 2018).

Common scenarios

**Scenario 1: The Maintenance Drug Shift (2015)** John, a retiree in 2015, filled his generic statin prescription three times at a local CVS. On the third fill, he was notified that because he didn't switch to **Express Scripts Home Delivery**, he would have to pay 100% of the cost ($85) instead of his usual $8 copay.

**Scenario 2: The First ACA Tax Filing** Sarah, an Army spouse, filed her 2015 taxes in early 2016. Because her husband was on active duty, she had to check a box on her 1040 form stating she had health coverage. She used the **Form 1095-B** downloaded from her myPay account to prove she had "Minimum Essential Coverage" for the entire year of 2015.

## Related terms * **IRS Form 1095-B:** The tax form used to verify TRICARE coverage under the Affordable Care Act. * **Maintenance Medications:** Long-term drugs taken for chronic conditions, which were moved away from retail pharmacies in 2015. * **Autism Care Demonstration (ACD):** The consolidated program for ABA therapy that took its modern shape in 2015. * **T-3 Contract:** The administrative contract period that governed TRICARE in 2015 (preceding the T-2017 and T-5 contracts). * **Catastrophic Cap:** The maximum out-of-pocket amount a family pays for covered services in a calendar year.

## Sources 1. **TRICARE.mil Archive:** Official 2015 Benefit Updates. 2. **Defense Health Agency (DHA):** Historical reports on the Autism Care Demonstration. 3. **IRS.gov:** Instructions for Form 1095-B regarding Government-sponsored health programs. 4. **Express Scripts:** Historical Pharmacy Benefit transition documents (2015).