Is TRICARE Fee Restructuring a Good Thing?


By Debbie Gregory.

The three region TRICARE system will soon be history as TRICARE divides into two regions: Tricare East and West, with East being managed by Humana Military and West falling under Health Net Federal Service. But there are other, bigger changes in store for the new year.

The Defense Health Agency (DHA) has announced a fee restructuring in 2018 that will impact all plans except Tricare for Life, the military’s supplemental insurance to Medicare for those over 65 or disabled retirees.

TRICARE Standard, the fee-for-service insurance option, and TRICARE Extra, the preferred provider option, are being replaced with TRICARE Select. Select is supposed to combine features of both. Meanwhile, the managed care option, TRICARE Prime, will not change.

The size of the new fixed fees unveiled for TRICARE Select did come as a bit of a surprise, as they are higher than appointment fees planned for new enrollees.

Last year when the DHA proposed new TRICARE copayments, Congress voted to insert a grandfather provision for existing TRICARE participants, and a separate fee schedule for new entrants in 2018 and after. Defense health officials urged the repeal of the grandfather provision so that TRICARE wouldn’t have two sets of fees, as well as an inequity in the cost. Further complicating the situation, the new method of calculating appointment fees has resulted in the copayments for the grandfathered group coming in higher than for the non-grandfathered group.

This means that many new entrants who join after Jan. 1, 2018, will be paying less than current beneficiaries, who should be paying less. For example, a grandfathered active duty family member’s cost for an in-network primary care physician visit will be $27, and a specialist visit will cost $34, while a new entrant family member will pay $15 for the primary care visit, and $25 for the specialist.

Since this is having the opposite affect than was intended, it seems as though someone needs to go back over the plan and make adjustment so that those who are already relying on their health benefits aren’t penalized.

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Military Connection: Tricare Changes Coming


tricareBy Debbie Gregory.

Historically, health care for military personnel and their dependents was provided in military medical facilities or through a referral system, by civilian medical personnel where military physicians were not available. After the second World War and Korea, access to care in military facilities became increasingly unavailable, due to growing demands on the system. To address this problem, Congress passed the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966. The civilian health care program became known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). Tricare replaced CHAMPUS in the early 1990s.

Now, in the biggest overhaul of the military health system in over 20 years, the Military Compensation and Retirement Modernization Commission is proposing changes that will shift millions of beneficiaries to commercial, private-sector health plans.

It’s possible that the move could save the government billions of dollars. But more importantly, the changes could greatly enhance current healthcare services for nearly 9.2 million active-duty family members, retirees and their dependents.

It will fall to Congress to ultimately decide how Tricare reform proceeds, taking in to consideration the commission’s recommendations. The one thing that most all agree upon is that the Defense Department’s $49 billion annual health budget is out of control.

“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 commission released its final report in January, 2015, and it contained a number of healthcare recommendations.

The biggest impact on current troops and retirees under age 65 would be the recommendation to increase access, choice and value of health care for themselves and their family members, by allowing a choice of commercial insurance plans offered through a Department of Defense health benefit program, similar to the health plans offered to federal employees.

This would include HMO and PPO choices from companies like Blue Cross/Blue Shield, United Healthcare, Kaiser Foundation and more.Some plans could offer benefits that the current Tricare program doesn’t offer, such as acupuncture, chiropractic care and fertility treatments.

The composition of the commission included six retired military officers, a Navy reservist, and a Medal of Honor recipient.

The changes will affect everyone currently on Tricare Prime, Tricare Standard and Extra, Tricare Reserve Select, Tricare Retired Reserve and Tricare Young Adult.

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Military Connection: Tricare Changes Coming: By Debbie Gregory