[HEALTH.MIL] Tricare Choice: What's in it for you?

  • From: HEALTH.MIL@xxxxxxxxxxxxx
  • To: "Milton Bell" <Milton.Bell@xxxxxxxxxxx>
  • Date: Mon, 16 Mar 2015 12:17:04 -0500

Tricare Choice: What's in it for you?

By Patricia Kime, Staff writer 10 a.m. EDT March 16, 2015

Washington policymakers will soon begin consideration of the biggest overhaul of
the military health care system since Tricare replaced CHAMPUS in the early
1990s - changes that would shift millions of beneficiaries to commercial,
private-sector health plans.

The Military Compensation and Retirement Modernization Commission, which
proposed the radical changes in its recently issued final report, says the move
would save the Pentagon billions of dollars while greatly enhancing health
services for nearly 9.2 million active-duty family members, retirees and their

The Pentagon has not yet weighed in on the plan. In their fiscal 2016 budget
request, defense officials have floated other proposals that would increase
health care costs for retirees and their family members while providing
incentives for beneficiaries to get care at military hospitals and clinics.

But Congress, which ultimately would decide how Tricare reform proceeds, is
looking closely at the commission's recommendations, with lawmakers on both
sides of the aisle generally agreeing that something must change to rein in the
Defense Department's $49 billion annual health budget and provide more choice
for military families.

"This idea of opening it up to provide more options is ... very interesting and
necessary, especially in some places," said Rep. Tulsi Gabbard, D-Hawaii,
speaking for her island constituents. "Our access really is an issue."

"We've got to do something with the current system because it's just
unsustainable," said Sen. Lindsay Graham, R-S.C. "We've been wrestling this
alligator for five years. I just sort of lose faith that we can take the current
construct, the single-payer system ... [and] make it as efficient as the
competitive model."

Providing more choice

The blue-ribbon compensation commission was created by Congress to review
military pay, retirement and quality-of-life programs and recommend
improvements. Its final report, released in January, contained three health care

The one that would have the biggest impact on currently serving troops and
retirees under age 65 would be Recommendation 6: "Increase access, choice and
value of health care for active-duty family members, reserve component members
and retirees by allowing beneficiaries to choose from a selection of commercial
insurance plans offered through a Department of Defense health benefit program."

Under that proposal, beneficiaries would choose a health plan from a menu of
programs compiled by the federal Office of Personnel Management, similar to the
health plans offered to federal employees.

Available selections would include traditional fee-for-service plans; those
offered by health maintenance organizations; and preferred provider network
options from some of the biggest names in the industry, including Blue
Cross/Blue Shield, United Healthcare, Kaiser Foundation and more.

Participants would have to provide the same services now covered by Tricare,
including inpatient and outpatient services, medical and surgical care, mental
health and substance abuse treatment, maternity care and pediatrics, preventive
care and more.

But some plans could offer benefits that the current Tricare program doesn't -
chiropractic care, fertility treatments, acupuncture and more - at various

The commission, whose members included six retired military officers, a Navy
reservist and a Medal of Honor recipient, all with legislative and professional
expertise in military pay-and-benefits issues, says the program, called Tricare
Choice, would give families more choice of doctors, better access and improved

Shoring up networks

Citing results of a survey conducted as part of the commission's fact-finding
process, the panel said patients who use Tricare have trouble getting
appointments with their primary or specialty care doctors if they're on Tricare
Prime and have issues finding doctors who take Tricare if they use Standard.

Many doctors, commission members said, will not take Tricare because its
reimbursement rates are often lower than those of Medicare.

For example, in Fayetteville, North Carolina, near the Army's Fort Bragg, there
are 114 OB/GYN physicians who take Blue Cross/Blue Shield, but only 43 providers
are in the Government Employees Health Association plan and just 36 take
Tricare, said commission member Steve Buyer, a former congressman from Indiana.

"If you are a doctor, you look at your practice and say 'OK, I can only take so
much Medicare, so much Medicaid.' You also may [decide to take Tricare because
you] are a veteran or will do this because of the flag - a patriot. But you can
only do that for so long," Buyer said.

The commission argues that because civilian insurers offer doctors appealing
rates and can adjust reimbursement rates in response to supply and demand -
using them as incentive for doctors to provide treatment - those civilian
insurers are better able to attract physicians to their networks and control

The commission's proposed Tricare overhaul also would provide beneficiaries with
choices of type of plan, level of health care and costs, according to the

"There are clear benefits to having alternatives among plans. When beneficiaries
are able to pick their ideal plan from a selection of many offerings, they are
empowered," the members wrote in their 280-page report.

More than two-thirds of the annual $49 billion defense health budget goes to
patient services and care, and a large portion of that money - $15.4 billion in
2012 - went to purchased care, treatment received by beneficiaries at
nonmilitary facilities.

The commission estimates that its proposal could save the Pentagon $26.5 billion
over four years, starting in 2016. The savings would stem from eliminating DoD's
large Tricare administrative costs and making most beneficiaries pay a larger
share of their health costs.

In their fiscal 2016 budget request, Pentagon officials propose their own
solutions to trim health costs, to include raising fees for nonmilitary care,
increasing costs paid by working-age retirees and luring more patients back to
military hospitals and clinics.

But commission members said this approach is unlikely to improve care for
patients or keep personnel at military hospitals and clinics trained in
cutting-edge medicine and trauma care - skills they need to ensure the wartime
medical readiness of the force.

"As commissioners, we share the unequivocal belief that a high-quality health
benefit is essential for all military constituencies and we find that the
current Tricare program falls short of this aspiration," commission chairman
Alphonso Maldon Jr. said.

Retired Adm. Edmund Giambastiani, another commission member, put it more
bluntly, saying the panel "believes that Tricare is in a death spiral."

The White House and Defense Department have until April 1 to weigh in on the
commission recommendations. Then it will fall to Congress to decide whether to
act. Already, lawmakers have held four hearings on the recommendations, with
more likely to come after the administration issues its views.

Advocates: mixed reaction

The Military Coalition, a group of military and veterans advocacy groups, has
not presented a unified response to the recommendations. Reaction from some
individual member groups has been mixed.

Representatives of the National Military Family Association and National Guard
Association of the United States told senators Feb. 26 that they support the
plan "in principle" but want more information on its proposals and a fuller
understanding of the potential beneficiary costs before endorsing it.

The Military Officers Association of America has taken an opposite tack,
maintaining that the current version of Tricare - and the military health system
as a whole - needs reform and could save money by being made more efficient.

"Despite its current challenges and shortcomings, MOAA believes Tricare is not
currently in a 'death spiral' as some have said, and it is not broken," said
retired Vice Adm. Norb Ryan, the group's president.

If Congress were to include the Tricare Choice recommendation in the fiscal 2016
defense policy bill, the plan could be in play within two years, commission
spokesman Jamie Graybeal said.

One thing seems clear: Tricare Choice would change health care services for 9.2
million military beneficiaries, including everyone now on Tricare Prime, Tricare
Standard and Extra, Tricare Reserve Select, Tricare Retired Reserve and Tricare
Young Adult.

Here's a look at how the plan would affect you.

Active-duty members

Q. Would I see any changes?

A. Not for your own health care. Active-duty personnel would continue receiving
medical care at unit facilities and through military hospitals and clinics. If
service members need specialty care that's unavailable in the military system,
they would be referred to the private sector, with the Defense Department
picking up the tab.

Q. What if I have a family?

A. See the active-duty family members section below.

Active-duty family members

Q. Who would provide my health care?

A. Active-duty family members would select a health plan from options compiled
by the federal Office of Personnel Management under the Tricare Choice program.

The number of plans and services offered would depend on what's available in a
given geographic region. But all plans would have to offer coverage that at
least matches what Tricare currently offers.

Q. What kinds of choices might I be offered?

A. Choices would include traditional fee-for-service plans, which would allow
family members to choose their own doctors and pay premiums and co-payments;
network-based plans that provide incentives to see doctors enrolled in that
network; and health maintenance organizations similar to Tricare Prime or Kaiser
Permanente, in which family members would see primary care physicians and
specialists who work for a single organization.

Q. What will be covered? 

A. Plans must offer benefits available in the commercial market, meeting or
exceeding baselines for health plan quality.

In the federal employee health system, all plans cover medical and surgical
care, mental health and substance abuse treatment, maternity care and
pediatrics, preventive care, hospitalization and outpatient care, diagnostic and
laboratory testing, physical, occupational and speech therapy, emergency and
ambulance service, and prescriptions drugs.

Some plans could offer partial dental and vision coverage as well, although the
compensation committee recommends retaining the Tricare Dental Program and
Tricare Retired Dental programs as options.

Q. How will my costs change, and how will I cover them?

A. Costs would rise - a 28-percent premium cost share and higher out-of-pocket
expenses - but the commission recommends that active-duty service members
receive a basic allowance for health care, or BAHC, to cover premiums,
cost-shares and co-payments incurred by their family members.

BAHC would be transferred directly to the insurance carrier to cover premiums,
with the remainder going to the service member to cover the out-of-pocket costs.

"BAHC should be set at levels that sufficiently offset or completely cover costs
or even afford families a surplus each month after costs are paid," the
commission said in its report.

Q. Can I still go to my military hospital or clinic?

A. The commission recommends that companies in Tricare Choice be required to
include on-base military hospitals and clinics in their networks, so family
members who want to get care at a military treatment facility may be able to do
so as their plan allows.

Q. What if something catastrophic happens - a major accident, injury or chronic

A. All plans would have "catastrophic caps," but the commission also recommends
that DoD establish a program to help family members or troops who are severely
injured or fall seriously ill to pay related out-of-pocket expenses or help with
other health-related costs.

Q. What if I choose a plan and I hate it? What if I move?

A. Beneficiaries would be allowed to change plans during annual open season or
at a milestone such as a permanent change-of-station move or retirement.

Q. What happens if my sponsor is assigned overseas?

A. Plans would be available overseas.

Q. How will I figure out what plan might be best for me?

A. The commission recommends that DoD build an education program to help troops
and families understand the impact of all its recommendations, especially health

"To ensure affected service members and beneficiaries can navigate the new
insurance program with ease, DoD should institute a program of education and
benefits counseling," the commission report states.

Q. What happens to dependent children over age 21 who are using Tricare Young

A. TYA would simply vanish. Those adult dependent children would simply be
covered under their parents' Tricare Choice plan until age 26.

In fact, unlike the current TYA program, those dependent children could be
covered under Tricare Choice even if they are married, not living with their
parents, attending school, financially independent or eligible to enroll in
their own employer's health care plan.

Reserve components

Q. How would this work for me?

A. All reserve component members would be able to purchase a plan from Tricare

The commission recommends making Selected Reserve members eligible for plans
with a reduced cost share to encourage them to purchase one, ensuring continuity
in care and medical readiness when they're mobilized.

Other reserve component members would pay cost shares corresponding to their
category of service.

When called to active duty for more than 30 days, reservists and their family
members would get the same level of care as their fulltime active-duty

Q. Who would pay for it?

A. Reserve component members would pay premiums for a Tricare Choice plan, but
when mobilized would get free care through the military health system. Those
with families would receive the proposed Basic Allowance for Health Care while

If a reservist had not previously picked a Tricare Choice plan, that allowance
could be used to pay the premiums and cost-shares of their civilian plans.

Retirees and their family members

Q. How would I get health care?

A. Retirees and their families would select from the same list of health plans
offered to active-duty family members under Tricare Choice. A variety of plans,
with a variety costs and benefits, would be available in all geographic areas.

Q. How much would it cost?

A. All working-age retirees and families who want health coverage would be
required to pay an annual enrollment fee, similar to Tricare Prime fees,
currently $277.92 for an individual and $555.84 for a sponsor with family

Under the new plan, premiums would rise slightly the first year, by 1 percent,
and would rise by the same amount for 15 years, reaching roughly $1,769 by 2030.
Depending on the plan selected, co-payments, cost-shares and deductibles also
may be required. The commission believes that retirees with families would see
their average total out-of-pocket costs increase from about $2,000 a year to
$3,500, according to panel estimates.

Q. What about retirees' dependent children over age 21 using Tricare Young

A. Their situation would be the same as for active-duty family members using

That program would go away, and those adult dependent children could use their
parents' Tricare Choice plan until age 26, regardless of their life

Q. Would anything change for "gray area" retirees?

A. Not really. The current Tricare Retired Reserve program that serves reserve
component retirees under age 60 would disappear and be replaced by Tricare

As with the current TRR program, the government would not subsidize their health
care costs.

Q. What happens to Tricare for Life beneficiaries?

A. Nothing. For retirees over 65, TFL would remain in place and operate as
before, normally with Medicare as first payer and TFL acting as second payer if

A third-party administrator contracted by the Defense Department would pay and
coordinate patient claims with Medicare as necessary.

Overseas, where Medicare does not operate, TFL would remain the primary payer,
and DoD would have authority to contract with a third-party administrator to
handle claims.

Q. Why is all this happening now? Is it related in any way to the Affordable
Care Act?

A. No. Congress created the commission in 2013 to respond to growing concerns
that military personnel costs - especially for retirement and health care - are
escalating at a rate that threatens military training, readiness and operations.

While the commission was not tasked specifically with finding cost-savings in
their proposals, the panel sought to adapt the current health benefit to
preserve the medical readiness of the force and propose what they believe would
be improvements to the military health care benefit that would continue to
attract and retain quality recruits.


SOURCE:  Military Times article (via Early Bird Brief) at





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