Of all days to learn of this intent by our elected leaders, it would be Veterans Day.
Defense officials are expected to soon announce that military retirees and their dependents that live more than 40 miles from a military treatment facility or BRAC (base closure) site will lose access to TRICARE Prime as early as next April.
This move could force as many as 171,000 retirees to shift to TRICARE Standard, which would mean an increase in out-of-pocket costs – especially those with special needs dependents or other chronic health issues.
It is important to note that active duty members and their families won’t be impacted. However, military retirees and their families are not the only ones to be hit by the move. Some drilling Guard and reserve members enrolled in TRICARE Reserve could also see increases in health costs.
It is being reported that “Congress is not expected to block this long-standing plan to tighten access to Prime if the intent is to hold down costs. Doing so likely would require lawmakers to find equivalent budget savings elsewhere.”
Many may find it disturbing that Defense officials delayed announcing this TRICARE change until after the election out of concern that it could be used by politicians.
The first round of Prime service changes is “tentatively” planned to go into effect in the TRICARE West region on April 1. The North and South regions will see the plan implemented by October 1, 2013.
First of all, the healthcare rates for military retirees and their families have gone up for the insurance they receive and is expected to continue to climb. In addition, the Catastrophic Cap for military retirees has dropped from $7500 to $3000.
Secondly, there are significant disadvantages to TRICARE Standard coverage. Here is a list of those disadvantages:
No Primary Care Manager
Patient pays Deductible and Co-payment
Patient pays balance if bill exceeds allowable charge and provider is a non-participant (up to 15% additional)
Nonavailability statement may be required for civilian inpatient care for areas surrounding Military Treatment Facilities
Beneficiaries may have to do their own paperwork and file their own claims
The Point of Service annual deductible and cost-share amounts do not count toward your enrollment-year maximum out-ofpocket expense, but instead are credited to your fiscal year maximum. There is no limit to the amount of a patients responsibility under the Point of Service option.
This is based on an article written by Tom Philpott. Here is a link to the article.
About Tom Philpott
Tom Philpott has been breaking news for and about military people since 1977. After service in the Coast Guard, and 17 years as a reporter and senior editor with Army Times Publishing Company, Tom launched "Military Update," his syndicated weekly news column, in 1994. "Military Update" features timely news and analysis on issues affecting active duty members, reservists, retirees and their families. Tom also edits a reader reaction column, "Military Forum." The online "home" for both features is Military.com.
Tom's freelance articles have appeared in numerous magazines including The New Yorker, Reader's Digest and Washingtonian.