[TFL] Affordable Care Act: No Impact On TRICARE, But Some Coverage Isn't Equal
- From: TFL@xxxxxxxxxxxxx
- To: <HEALTH.MIL@xxxxxxxxxxxxx>, <TFL@xxxxxxxxxxxxx>
- Date: Sun, 20 Oct 2013 20:10:13 -0500
Affordable Care Act: No impact on Tricare, but some coverage isn't equal
By Patricia Kime
MilitaryTimes Staff writer
Sep. 26, 2013 - 04:42PM
Tricare beneficiaries should see little impact from implementation of the
Affordable Care Act because the military health care system was excluded from
the law and Congress later passed legislation defining Tricare as meeting the
act's insurance coverage requirements.
But as seen immediately after the law's passage, the omission of Tricare left
military families out of at least one benefit - a provision that extended
parents' health care coverage to unmarried children up to age 26 - and there may
be more, including the much-anticipated changes to mental health treatment and
weight management.
While Tricare largely is viewed as a comprehensive health care program, there
are disparities between the military plan and the ACA's requirements of private
insurers and state exchanges. Congress rectified the oversight of coverage for
unmarried children by approving the Tricare Young Adult program shortly after
the law passed, but additional changes may be needed, especially in the area of
mental health, to bring the military program into line with the law.
```````````````````
NOTE: Information about the Tricare Young Adult program is available at
http://www.tricare.mil/TYA.
- TRICARE Young Adult Fact Sheet
http://www.tricare.mil/~/media/Files/TRICARE/Publications/FactSheets/TYA_FS.pdf
- TRICARE Young Adult-Standard Option
http://www.tricare.mil/Welcome/Plans/TYA/StandardOption.aspx
- TRICARE Young Adult-Prime Option
http://www.tricare.mil/Welcome/Plans/TYA/PrimeOption.aspx
-------------------
"Despite sustained effort to improve screening, assessment and treatment
capacity, the Defense Department and Veterans Affairs have a long way to go,"
noted National Alliance on Mental Illness officials in a 2012 report, "Parity
for Patriots."
For instance, the ACA expands previous legislation requiring insurers to cover
mental health and substance use treatment on par with care needed to treat
physical conditions.
The law states that mental health and substance use disorder coverage must be
provided as an essential benefit "comparable to general medical and surgical
coverage." It does not define what constitutes necessary care; many mental
health specialists interpret this to mean appropriate care recommended by a
physician.
But many insurers, including Tricare, place limits on mental health and
substance abuse treatment. For example, acute in-patient mental health treatment
is restricted to 30 or 45 days per fiscal year, depending on age, and
beneficiaries other than active duty troops who need more than eight outpatient
behavioral health care visits in a fiscal year must request authorization.
Some argue such limits do not meet the requirements for parity.
"More subtle forms of insurance discrimination, such as increased prior
authorization restrictions for specific mental health benefits, exclusion of
entire categories of services and more aggressive restrictive management of
benefits, have kept the law from achieving its full, intended potential,"
according to the NAMI report.
Another disparity lies in the field of weight loss. On one hand, Tricare covers
bariatric surgery for the morbidly obese - a benefit many insurers aren't
required to pay for - but it doesn't cover office visits for the treatment of
obesity, non-surgical procedures for weight loss, weight-loss medications, or
nutrition and diet counseling.
The ACA requires insurers to cover obesity screening, counseling and referrals.
And at the state exchanges, the obese are entitled to intensive behavioral
counseling and at least one prescription drug for obesity treatment.
Pregnant moms in Tricare may be dismayed to find that the ACA requires insurers
to pay the full cost of breast pumps, but Tricare does not. It pays only for
efficient electric breast pumps in hospitals and under certain circumstances for
premature infants.
"I'm just shocked," said Emily Cohen-Moreira, a New York City-based childbirth
educator and lactation consultant. "Pretty much all of my students - those with
private insurance and those on Medicaid - are covered now because of the
Affordable Care Act. But not my military client."
For a least one segment of the Tricare population - tobacco users - the military
program's exemption from the law is a boon to their wallets. Under the ACA,
smokers and users of smokeless tobacco can be charged up to 50 percent more in
premiums than non-smokers at the state-run health exchanges, and many insurance
companies already charge smokers higher premiums.
But in Tricare, enrollment fees, co-payments and cost-shares are not based on a
beneficiaries' habits or health care requirements.
It would take an act of Congress to charge Tricare patients who smoke or are
overweight higher health care enrollment fees, co-payments or a surcharge.
-------
SOURCE: MilitaryTimes Article at
http://www.militarytimes.com/article/20130926/BENEFITS06/309260025/Affordable-Ca
re-Act-No-impact-Tricare-some-coverage-isn-t-equal
NOTICE: Archived copies of this and other mailing list messages,
subscribe\unsubscribe
instructions and other useful information for active duty, retirees and
veterans, and
their families, are available on the LINKS FOR MIL\RET\VETS website at
www.hostmtb.org
Other related posts:
- » [TFL] Affordable Care Act: No Impact On TRICARE, But Some Coverage Isn't Equal - TFL
