Tricare Coverage Changes for the National Guard and Military Reserve

Tricare Coverage Changes for the National Guard and Military Reserve

Tricare Coverage Changes for the National Guard and Military Reserve


Contributed by Kris Baydalla-Galasso

TRICARE, the health care program for uniformed service members, retirees, and their families in the U.S. and around the world, has been expanded for Reserve Component members in transition. Active duty servicemembers and their families receive TRICARE coverage without any annual or monthly fee, but that’s not the case for National Guard and Reserve personnel.

Prior to now, traditional Guardsmen and Reservists coming off more than 30 days of active duty were limited to 180 days of fee-free TRICARE coverage only if they were activated in support of war or overseas efforts. While this was helpful in times of conflict or contingency operations, it didn’t help Reservists and Guardsmen assigned to stateside efforts such as hurricane relief. When not activated, Guardsmen and reservists qualify for Tricare Reserve Select, a purchased care option which carries a monthly premium, deductibles, and out-of-pocket costs.

Congress signed the 2018 National Defense Authorization Act into law in 2017, but the changes went into effect just last month. Now, Guardsmen and Reservists can enjoy 180 days of TRICARE coverage after any 30-day activation.

Not addressed by this legislation was the problem specific to dual-service technicians in the National Guard. As federal civilian employees, they are ineligible for TRICARE benefits. Legislative alterations to this rule have been tabled in the past due to cost factors.

Tricare Could Costs Thousands for Troops to Keep


Tricare Could Cost Thousands for Troops to Keep

By Debbie Gregory

As of January 1, 2018, Health Net Federal Services took over the TRICARE contract from United Healthcare for beneficiaries in the West region and former North region..

For those who had previously made TRICARE enrollment payments via an automated method of either electronic funds transfers (EFT) or recurring credit card (RCC) with United Healthcare, the arrangement did not transfer over to Health Net, requiring a new registration.

Beneficiaries who missed paying their monthly Tricare premium payments due to the swap must not only make up the months of missed payments, but they also have to pay one or two months in advance to reinstate coverage. Fixing the issue could cost them thousands of dollars out of pocket all at once.

Tricare officials said all beneficiaries using those plans should check to make sure their payment information is up to date, including those who updated it by late December as instructed in the November notices.

That’s because a separate Tricare system freeze over December caused an unknown number of updates made before the due date to be lost, officials said last month.

Officials with military support organizations that represent Tricare beneficiaries said the system needs to work to make sure no one is dropped.

That’s why they are trying to get the word out: if payment is not received before the last paid-through date, which in many cases was January 1st, coverage will be canceled within 150 days. That means thousands of Tricare users will be dropped from the coverage books by the end of May if the information is not updated.

The TRICARE West Region includes the states of Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except the Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (areas of Western Texas only), Utah, Washington, and Wyoming.



2018 Defense Bill Addresses Troop Size, Benefits, Sexual Assault

2018 budget

By Debbie Gregory.

Congress’ annual defense authorization bill addresses some of the yearly basics, such as pay benefits and insurance coverage, but also spells out the rules regarding the topical subject of sexual assault and harassment.

In the benefits department, there is a proposed 2.4 percent pay raise for active duty troops. The raise will be needed to cover the increased cost of Tricare prescription costs.

Military spouses who get a new professional license or certification after a PCS will be reimbursed up to $500.

To address problems with sexual harassment and assault in the military and at the U.S. Merchant Marine Academy, military sexual trauma counseling and treatment will be broadened to be more inclusive. Special victims counsel will receive training to better assist victims of sexual assault, with an emphasis on the male victims, thought to be much more common than assaults on females, but much less reported..

In addition to the military’s Sexual Assault Prevention and Response Program, a new article to the Uniform Code of Military Justice regarding “wrongful broadcast or distribution of intimate visual images” allows anyone charged to be brought before a court-martial.

This comes on the heels of the scandal involving active-duty Marines who shared nude pictures of female colleagues on a series of military-themed web sites. More than 40 Marines received some form of punishment for their involvement.

Also addressed in the bill are: Special Survivor Indemnity Allowance payments, which were due to end this year, but now are permanent for surviving military spouses; troop strength being increased by 20,000, with about ¾ of the number devoted to active duty troops, and the other ¼ devoted to the Reserves; mental health assessments as a part of the separation physical.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Merger of VA and DoD Health Systems Being Considered


By Debbie Gregory.

The Department of Veterans Affairs (VA) provides healthcare to veterans through medical centers and clinics owned and run by the federal government, although veterans can also see private doctors through the Choice if VA wait times are too long. The Department of Defense provides healthcare to current servicemembers, retirees and their families through TRICARE,  insurance that is paid for by the government and uses private doctors and hospitals.  But soon, the two may be one and the same.

The VA generally serves older, sicker veterans, while TRICARE’s patients are generally healthier.

VA Secretary David Shulkin has been exploring the option of integrating VA and Pentagon health care. This follows the VA’s planned adoption of utilizing a similar electronic health record (EHR) platform as the Defense Department’s MHS GENESIS.

“VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems,” said Shulkin.

Since an overhaul of VA’s EHR won’t be completed for another seven to eight years, a TRICARE merger would more than likely take at least as long.

News of the plan is worrying various veterans groups. The American Legion, Veterans of Foreign Wars, AMVETS and Disabled American Veterans have expressed that a TRICARE merger is likely to be a “non-starter” if the goal is to transform VA care into an insurance plan.

Louis Celli, director of veterans’ affairs and rehabilitation for The American Legion, said outsourcing services away from the current VA system via its medical centers and clinics would be financially unsustainable.

Bob Wallace, the executive director of VFW’s Washington office  said that his organization  would oppose any effort to reduce the VA’s role of providing care for veterans.

What do you think?

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Pharmacist Who Swindled Millions From TRICARE May Lose Mansion ‘The Rock’ Called Home

the rock

By Debbie Gregory.

A South Florida pharmacist accused of defrauding a U.S. military health insurance program may lose a Southwest Ranches mansion once owned by movie star Dwayne “The Rock” Johnson.

Charges have been brought against Serge Francois, 51, the owner of  Pompano Beach’s Atlantic Pharmacy, who is accused of trying to defraud TRICARE, as well as another federal coverage network for government employees, of $37 million.

Assistant U.S. Attorney Dan Bernstein alleges that Francois amassed his fortune by lying, cheating, and paying millions of dollars in kickbacks to several marketing companies and doctors in exchange for a steady supply of TRICARE patients’ prescriptions.

The trial, which is expected to last for approximately one month, could cost Francois not only his freedom, but also all of his ill-begotten luxuries, including the mansion and his exotic car collection.

Deemed a flight risk, Francois, who pleaded not guilty, has been detained without bond in a tiny jail cell in downtown Miami since November, 2016. Francois’ right-hand man in the alleged scheme, Patrick Tonge, has also pleaded not guilty. Deemed a flight risk as well, Tonge has been held in the same detention center as his former boss.

According to the indictment, between 2010 and 2015 the pharmacy submitted fraudulent claims for compounded medications that were not necessary, not properly prescribed, not ordered or refills that were unwanted. When the medications were returned to the pharmacy, they were re-labeled and re-sold.

“Serge Francois never paid a bribe to anyone,” alleges Francois’ defense attorney, Sean Ellsworth. He told the jurors that the pharmacy owner was completely unaware of the alleged scheme to bilk the federal government.

Most of the 13 other defendants indicted in the case, including four South Florida doctors, have pleaded guilty.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Meeting the Healthcare Needs of Those Who Have Served


By Debbie Gregory.

Ever an advocate for our nation’s veterans, U.S. Rep. Julia Brownley (CA-26) has issued a statement about a provision of the House Republican’s healthcare bill that could hurt veterans and their families:

“We have known for months that the GOP healthcare bill could strip roughly 7 million veterans of eligibility for healthcare tax credit assistance.  Despite warnings from our veterans service organizations, and pleas from veterans across the country, President Trump and Speaker Ryan have recklessly forged ahead despite the consequences,” stated Brownley.  “While I am deeply concerned about many aspects of this bill, the rush to put politics ahead of people, and the impact it could have on our veterans as a consequence, is simply shameful.”

Language in the bill could deny tax credits to any individual who is “eligible” for other healthcare programs, like VA healthcare or TRICARE.  This provision potentially denies 7 million veterans access to healthcare, because though they are technically eligible, they are not currently enrolled in VA healthcare.

Furthermore, on April 25th, Rep. Brownley, along with Rep. Glenn ‘GT’ Thompson (PA-05) introduced H.R. 2123, the Veterans E-Health and Telemedicine Support (VETS) Act of 2017.

Under current law, VA doctors can provide treatment via the phone or internet chat services for many routine appointments.  But the rules prohibit physicians from providing those services across state lines, unless both the veteran and the doctor are in federal facilities. The VETS Act of 2017 removes these barriers and allows the VA to provide treatment through physicians free of this restriction.

“As Ranking Member of the House Veterans’ Affairs Subcommittee on Health, I believe that we need to meet veterans where they are. The rapid growth of technology offers new possibilities for providing timely, quality healthcare that best suits veterans’ needs,” Brownley said.

Veterans would no longer be required to travel to a VA facility, but rather could receive telemedicine treatment from anywhere, including their home or a community center.

Changes to DOD’s Pharmacy Program Likely to Save More than $1 Billion


By Debbie Gregory.

Thanks to higher beneficiary co-pays, tighter point-of-service rules and recent streamlining of prescription drug processes across the military, the Department of Defense pharmacy program may be able to reduce the cost of prescriptions by more than $1 billion in the five year period between 2014 and 2019.

Policy changes have forced or enticed beneficiaries to skip retail outlets and use mail order for refills on maintenance drugs used for chronic conditions. Additionally, base pharmacies, where drugs are still dispensed at no charge, have expanded the drugs they stock to better meet beneficiaries’ medication needs.

Despite a couple of co-pay increases the past five years to encourage beneficiaries to use generic medicines and more cost-efficient drug outlets, the average annual out-of-pocket cost per beneficiary has ranged from $553 to $603.

Beneficiaries who want brand name maintenance drugs can do so via home delivery or on base. But if they opt for a retail pharmacy, they have to pay the full cost.

Express Scripts, the TRICARE contracted mail order pharmacy, has been a major component in the success of the program.

Of 9.4 million beneficiaries eligible to the use the pharmacy benefit, 82 percent did so in fiscal 2016. That was up from 66 percent in 2002, before the TRICARE mail order program began. A total of 7.7 million beneficiaries got at least one prescription filled in 2016, two million more than in 2002. Prescriptions filled across all three points of service totaled 127 million in 2016 versus 82 million in 2002, a 55 percent jump.

Almost 60 percent of beneficiaries are retirees or their family members: 3.1 million (33.2 percent) are retirees 65 and older and their dependents; 2.2 million (23.7 percent) are younger retirees and their family members. About 1.5 million beneficiaries (16.4 percent) are active duty and two million (21.4 percent) are family members of active duty.

The remaining half million “other” beneficiaries are mostly Reserve, Guard and their family members who qualify for the drug benefit.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Easier Medical Care Access for Mil Families Expected

tricare 12 29

By Debbie Gregory.

Thanks to changes in the annual defense department bill, passed by both the House and Senate, military families will have easier access to urgent care and primary care.

Awaiting President Obama’s signature before becoming law, the bill ensures out-of-pocket costs won’t change for most Tricare users who are already enrolled in the system.

Unfortunately for future service members and their families, plans call for fees and co-payments to be collected from those entering service and/or enrolling in health plans beginning in 2018. Retirees and family members now enrolled in Tricare Standard will have to pay an annual enrollment fee of $150 for singles and $300 for families starting in 2020.

Among the improvements are urgent care referrals will no longer be required, allowing greater access to care.

Some military medical treatment facilities will keep urgent care services open until 11 p.m. daily. Defense department officials would determine the locations where these extra hours would be needed, and they’d have 365 days from the bill’s signing to get the plan in place.

Hours at primary care clinic military medical treatment facilities (MTF) would also expand, if needed. Again, the Defense Department would determine the appropriate hours for primary care clinics at MTFs based on the ability to meet access standards and patients’ patterns of using primary care. This would be implemented within six months after the bill is signed into law.

The legislation would retire the Tricare Standard and Tricare Extra programs as of the end of next year. The new program, Tricare Select, would take effect January, 2018. Current Standard/Extra users would enroll in either the new Select program or Tricare Prime.

Tricare Select will come with higher out-of-pocket costs for beneficiaries of anyone entering service after Jan. 1, 2018.

Tricare Prime will remain free for all active-duty families — no enrollment fees, deductibles or out-of-pocket co-payments.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Tricare Policy Update Expands Hearing Assistance


By Debbie Gregory.

Up until recently, Tricare did not cover hearing aids for retirees, Tricare for Life and Tricare Reserve Select users. But a recent policy change reclassifies a certain type of bone-implanted hearing aid — Auditory Osseointegrated Implant (AOI) Devices — as a “prosthetic,” opening up coverage of the implant to all Tricare beneficiaries.

With AOI implant devices, a tiny titanium vibrator is inserted in the skull behind the ear. A microphone and hearing aid components form the rest of the package. Incoming sounds cause the implanted portion to vibrate. These vibrations are transmitted to the inner ear via bone conduction and produce sound sensations.

The decision to expand coverage was made as part of a routine policy review and is retroactive to June 30, 2016.

The implants are used to treat conductive and mixed hearing loss or singled-sided deafness, according to the association. Cochlear implants, another implantable type of aid, are used to treat those with non-functioning cochlea or those who have bilateral severe to profound sensorineural hearing loss. Cochlear implants are currently covered by Tricare for all types of beneficiaries.

The change for AOI devices impacts all Tricare users, including Tricare for Life users.

The new policy does create parameters for what kind of hearing loss qualifies for coverage.

“AOI devices … are covered as a prosthetic device when necessary due to significant conditions resulting from trauma, congenital anomalies, or disease,” it states.

That means that retirees whose hearing loss can be blamed on other causes that are not trauma, disease or a birth defect don’t qualify for coverage.

Non-implantable devices, such as the BAHA Softband, which gives hearing help to children who are too young for the AOI implant, are still excluded from coverage, according to the policy.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Mil Families Await Action on Tricare Autism Coverage


By Debbie Gregory.

Now that the 2016 presidential election is in the books, Congress needs to finish work on a fiscal 2017 defense authorization bill that is already overdue.

This unfinished business is of the utmost importance for military families who have children with autism.

Language in both the House and Senate versions of the defense bill orders the Department of Defense to restore TRICARE reimbursement rates for applied behavior analysis (ABA) therapy for children with autism spectrum disorder to the higher levels paid until last April.

Rate cuts to the benefit have spurred many ABA providers to discontinue their care for some 13,000 military children. The low fees make it impossible for these providers to run their businesses.

ABA therapists work with children, often in their homes, to increase or decrease targeted behaviors and to help them acquire language, daily living or play skills. It also can involve intensive behavioral interventions.

The managers of TRICARE autism care recently held their third “roundtable discussion” this year with ABA providers and regional contractors to discuss current operations and changes ahead.

TRICARE fees typically are set to match those paid by Medicare.  Because Medicare has no rates for ABA therapy, TRICARE decided to use local Medicaid rates plus 28 percent, which is the average difference between Medicaid and Medicare rates for other common mental health therapies.

Tricare had been reimbursing for ABA therapy at $125 an hour for providers with doctorate or master’s degrees, $75 for those with bachelor’s degrees and $50 for technicians with high school diplomas and ABA training.

The reduced reimbursement rate was cut to $114 for doctorates, $107 for master’s degrees, $67 for bachelor degrees and $40 per hour for technicians.

Let’s hope that this issue receives top priority.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.