[Federal Register Volume 87, Number 224 (Tuesday, November 22, 2022)]
[Notices]
[Pages 71313-71314]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[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]
----------------------------------------------------------------------------------------------------------------
                                                                                  Prime *  Group  Prime *  Group
       Out of pocket expense        Select  Group A  CY23  Select  Group B  CY23      A  CY23         B  CY23
----------------------------------------------------------------------------------------------------------------
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]
----------------------------------------------------------------------------------------------------------------
                                                                                  Prime *  Group  Prime *  Group
       Out of pocket expense        Select  Group A  CY23  Select  Group B  CY23      A  CY23         B  CY23
----------------------------------------------------------------------------------------------------------------
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]
----------------------------------------------------------------------------------------------------------------
                                   Select  Group A     Select  Group B     Prime *  Group A    Prime *  Group B
     Out of pocket expense              CY23                CY23                 CY23                CY23
----------------------------------------------------------------------------------------------------------------
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