TRICARE Cost-Sharing Changes in 2025 (CRS Report for Congress)
| Release Date |
Revised Nov. 13, 2024 |
| Report Number |
IN11532 |
| Report Type |
Insight |
| Authors |
Bryce H. P. Mendez |
| Source Agency |
Congressional Research Service |
| Older Revisions |
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Premium Revised Nov. 13, 2023 (3 pages, $24.95)
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Premium Revised Nov. 14, 2022 (2 pages, $24.95)
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Premium Revised Dec. 6, 2021 (2 pages, $24.95)
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Summary:
The U.S. Department of Defense (DOD) administers a statutory health entitlement (under Title 10,
Chapter 55, of the U.S. Code) through the Military Health System (MHS). The MHS offers health care
benefits and services through its TRICARE program to approximately 9.5 million beneficiaries that
include servicemembers, military retirees, and family members. Health care services are available through
DOD-operated hospitals and clinics, collectively referred to as military treatment facilities (MTFs), or
through civilian health care providers participating in the TRICARE program. The Defense Health
Agency (DHA) manages the TRICARE program.
With the exception of active duty servicemembers, beneficiaries are subject to certain cost-sharing
requirements based on beneficiary category, health plan or benefit program, and the sponsor’s initial
enlistment or appointment date. Beneficiary cost-sharing requirements include premiums (i.e., enrollment
fees), deductibles, copayments, coinsurance, and a catastrophic cap. Periodically, DHA reviews and
adjusts certain beneficiary cost-sharing amounts for the various TRICARE health plans and benefit
programs based on statutory requirements or changes to coverage costs. This Insight reviews changes to
TRICARE’s beneficiary cost-sharing amounts that are scheduled to take effect on January 1, 2025. These
changes may generate constituent inquiries during the next TRICARE open enrollment season from
November 11, 2024, to December 10, 2024 (see below) or during the transition in TRICARE contracts.
