[HEALTH.MIL] Webinar Explaining TRICARE and Affordable Care Act & DoD Budget Proposes TRICARE Consolidation, New Fees and Reduced Commissary Hours\Days

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  • Date: Tue, 3 Feb 2015 12:00:38 -0600

Webinar to Explain TRICARE and the Affordable Care Act 



TRICARE and Military OneSource are co-hosting a webinar to educate TRICARE
beneficiaries about tax reporting and the Patient Protection and Affordable Care
Act. The webinar will take place on Monday, February 9, 2015, from Noon - 1:00
p.m. EST. 

Go to  <https://attendee.gotowebinar.com/register/8226953182319863297>
https://attendee.gotowebinar.com/register/8226953182319863297 to sign up.
Registration is on a first-come, first-served basis and is limited due to system
capacity. Participants must avoid sharing personal health information when
asking a question.

All Americans, unless exempted, must have minimum essential coverage (MEC) or
pay a monthly "individual shared responsibility" tax penalty via federal tax
returns. TRICARE fulfills the MEC requirements of the ACA under certain

The speaker for this event is Mr. Mark Ellis who is a senior health program
analyst with the TRICARE Health Plans Division of the Defense Health Agency.  He
manages the Continued Health Care Benefit and TRICARE Young Adult programs which
offer premium based health care coverage to former service members and their
family members when they are no longer eligible for TRICARE benefits.  He has 35
years of DoD health care experience.

This webinar will cover the options available to TRICARE beneficiaries once they
are no longer eligible for any TRICARE health plan coverage and what they need
to do to meet requirements of the Patient Protection and Affordable Care Act.
You may submit your questions to Mark Ellis before the webinar by sending an
email to MOSWebinars@xxxxxxxxxxxxxxxxxxxxx
<mailto:MOSWebinars@xxxxxxxxxxxxxxxxxxxxx> .

NOTE:  Archived copies of previous Military OneSource webinars are available at

SOURCE:  TRICARE News Release at http://www.tricare.mil/TRICAREandACAWebinar



Tricare consolidation, new fees on DoD wish list

By Patricia Kime, Staff writer 5:19 p.m. EST February 2, 2015

(Photo: MC1 James Stenberg/Navy)

The Pentagon's 2016 budget request revisits a proposal pitched last year -
unsuccessfully - to consolidate Tricare into a single system, while also
suggesting new fees designed to steer families away from using emergency rooms
for routine care.

The $47.8 billion health budget request would do away with Tricare's current
structure and replace it with a single system designed to encourage
beneficiaries to seek care from military facilities or network providers - or
pay more.

Like the plan introduced last year, the latest proposal calls for consolidating
Tricare Prime, Tricare Standard and Tricare Extra into one Tricare program.

But unlike the plan floated last year, the new version would not increase
co-payments or cost-shares for active-duty families seen at military hospitals
and clinics or in the network.

But they would pay between $10 and $20, depending on sponsor's rank, for care
they seek without a referral to a network physician - similar to the Tricare
Extra option offered now, which gives a discount to family members who are not
enrolled in Prime but choose to see a network physician.

Also under the new plan, cost-shares for visits to out-of-network providers for
family members would rise to 20 percent of the Tricare allowable charge, up from
the current 15 percent.

But they also would pay new fees for using emergency rooms at military treatment
facilities or civilian hospitals for non-emergent care, ranging from $30 to $70
depending on the rank of the sponsor.

When military families cannot get an appointment at their primary care physician
for urgent care - either because appointments are full or they need care outside
office hours - they often turn to military or civilian emergency rooms for
primary care visits.

According to the budget documents, planners felt that the new fee structure
provides options for active-duty families to get care at no cost when
appointments are not available at their military treatment facility or through
their primary care physician, minimizing the need for non-emergency visits to
the ER.

For other beneficiaries, the fiscal 2016 budget proposal is strikingly similar
to the plan floated in the 2015 budget, which made very little headway in
Congress last year.

Retirees below age 65 and their family members would pay annual "participation
fees," (currently called enrollment fees). Starting in 2017, annual fees would
rise to $289 for an individual, up from $277.92, and to $578 for a family, up
from $555.84.

Retirees also would begin making co-payments for services at military treatment
facilities, ranging from $10 for a primary care visit to between $20 and $50 for
specialty care, urgent care, emergency room services and ambulatory surgery.

Visits to a network provider for retirees and family members would range from a
$20 co-payment for primary care to $100 for a network ambulatory surgery visit.

For all out-of-network care, retiree cost-shares would remain at 25 percent of
the Tricare allowable amount.

Future beneficiaries using Tricare For Life also would begin paying an
enrollment fee for the program based on a percentage of gross retired pay - 0.5
percent in 2016 - and capped at $150 a year for a family and $200 for retired
flag and general officers.

By 2019, TFL enrollees would pay a fee amounting to 2 percent of gross retired
pay, up to a maximum of $614. Flag officers would pay up to $818 by 2019.

The budget also proposes increases to catastrophic caps. Active-duty families
would see theirs rise to $1,500 for network or $2,500 for combined network and
non-network visits, while all others would see an increase to $3,000 for network
and $5,000 combined.

One proposal that would touch all Tricare users would be future hikes in co-pays
for generic prescriptions purchased through retail pharmacies and increases in
brand name drugs, both at retail pharmacies and by mail.

Prescriptions would continue to be filled free for everyone at military
treatment facilities and generic drugs also would be available at no charge
through Tricare's mail order system. Generics would cost $8 at a retail pharmacy
in 2016 and would remain at that level through fiscal 2018.

Brand names would rise to $28 per prescription, up from the current $17.
Medications not on the Tricare formulary now are tightly restricted. While they
cost $44 in 2014, they are available only on a limited basis now at retail

Costs for mail order prescriptions also would rise, to $28 from $16 for brand
name medications in 2016. Unlike retail pharmacy prescriptions, medications
filled by mail are for 90 days. Nonformulary medications would still be
available by mail, with co-pays rising to $54 from the current $46.

Medications would continue to be dispensed free of charge at military

While Congress approved a small increase to Tricare pharmacy fees in the fiscal
2015 defense budget, Pentagon officials said the additional measures are needed
to encourage more patients to use mail order and generic brands.

According to Pentagon estimates, the average active-duty family of three
averages $13,615 in medical costs per year, with the military bearing $13,448 of
the expense while the family picks up $166, or about 1.2 percent.

Under the new plan, families would bear 1.4 percent of the overall cost, which
would drop to $13,584, accounting for flat health care costs and savings under

A working-age retiree's family of three accrues $16,715 in medical costs per
year, according to DoD, and pays $1,337, or 8.2 percent of the cost. Under the
plan, they would pay $1,666, or 10.2 percent, of the estimated $16,302 cost.

Pentagon officials estimate that the initial changeover to a single Tricare plan
would cost the department money - $100 million in fiscal 2016. But it would save
$3.1 billion from 2017 through 2020, according to budget documents.

The fiscal 2016 defense health budget request is $108 million lower than the
fiscal 2015 budget enacted by Congress. But when funds to support medical care
for overseas contingency operations are included, the proposal represents an
increase of less than 1 percent increase over the 2015 budget.


SOURCE:  Military Times Article at





Budget plan would cut commissary days, hours

By Karen Jowers, Staff writer 4:30 p.m. EST February 2, 2015

(Photo: Defense Commissary Agency)

Defense officials want to reduce operating days and hours of most commissaries,
as part of an effort to sharply reduce the amount of taxpayer dollars going to
support the stores.

Supporting documents for DoD's fiscal 2016 budget request, released Monday,
indicate defense officials want to reduce the commissary subsidy by about $300
million, to about $1.15 billion.

Most commissaries would remain open at least five days a week, according to the
budget documents. But similar to a proposal floated last year, DoD has bigger
plans for reducing the commissary budget, and for raising prices, starting in
fiscal 2017.

Officials are asking for legislative changes that would allow them to expand the
types of items commissaries sell, and to allow "variable pricing" - i.e., price
markups. The surcharge money is used to build, repair, maintain and modernize
commissaries, and to pay for store equipment. Taxpayer dollars are used to cover
the costs of overhead and employee wages and benefits.

"This will allow goods to be priced above cost to increase revenues on certain
items, while providing more savings to a market basket of goods that affect
junior members with families the most," according to the budget documents.
Currently, all items in commissaries are sold at cost plus a 5 percent surcharge
added at the register.

With the help of those additional proposed cuts starting in fiscal 2017, DoD
would save a cumulative $4.4 billion from fiscal years 2016 to 2020, according
to the budget documents.

In their budget request last year, DoD officials proposed cutting $200 million
in Defense Commissary Agency funding, the first phase of a proposed three-year
plan to slash the DeCA budget by $1 billion. In the end, lawmakers restored that
$200 million to the budget.

It remains to be seen whether lawmakers will be receptive to the latest proposed
cuts. Recommendations released by the Military Compensation and Retirement
Modernization Commission on Jan. 29 proposed more modest cuts in the subsidy,
and also suggested consolidating the commissary and exchange systems into one
retail agency.

Defense officials said the commission's report has not been taken into account
in deliberations specifically on the 2016 budget request.

The proposals have raised alarms in some quarters. "If you cut hours, cut days
and cut savings, the benefit is no longer a benefit," said Joyce Raezer,
executive director of the National Military Family Association.

Draft documents obtained by Military Times note that proposed reductions in
operating hours would save more than $29 million in fiscal 2016, and cuts in
days of operation would save $58 million.

DeCA operates 241 stores around the world, including 178 domestic locations.


SOURCE:  Military Times Article at




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