After years of lobbying by the Pentagon, health insurance fees for working-age military retirees jumped Oct. 1.

But the debate over who should shoulder soaring health-care costs for the military is back in the Senate, which takes up a proposal this week from Sen. John McCain (R-Ariz) to raise the fees for the system known as Tricare higher still.

About 586,000 retirees of working age are paying annual family premiums of $520, up from $460, and individual premiums of $260, up from $230. Pharmacy co-pays also rose between $2 and $3.

The higher fees for the program’s popular HMO are part of a Defense Department effort to slash personnel costs by billions of dollars. Premiums had not been changed in 17 years.

The question now is how high the increases should climb in the future.The fiscal 2012 Defense Authorization bill under debate in the Senate this week includes language that would hold down costs by capping increases at the rate of the cost-of-living adjustment in military retired pay. In the past four years, that increase has ranged from zero to 5.8 percent, according to the Military Officers Association of America, an influential service group.

But McCain, the decorated war veteran and former prisoner of war, has proposed an amendment that would tie increases to the annual growth in health costs, estimated at 6 percent a year. The Pentagon agrees.

“As with other challenges we faced in this bill, we could have and should have done more,” McCain said on the Senate floor this month. “Military retirees and their families deserve the best possible care in return for a career of military service, and nothing less. But we cannot ignore the fact that health-care costs will undermine the combat capability and training and readiness of our military if we don’t begin to control the cost growth now.”

Not surprisingly, the amendment has drawn fire from MOAA and other service groups, who argue that inexpensive lifetime health care was part of a deal they made with the government for risking their lives on the battlefield.

“A few years ago when he was running for president, Senator McCain said he opposed any fee increases whatsoever,” said Steve Strobridge, director of government relations for MOAA. “We acknowledge times have changed, but military people should be the last people you’re going after.”