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Retirees pushed off Tricare Prime may be allowed back in

Dec. 10, 2013 - 06:00AM   |  
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More than 171,000 military retirees and family members booted from Tricare Prime on Oct. 1 when the Defense Department cut coverage areas for its managed health program could get their old health plans back under the compromise 2014 defense bill under consideration in the House and Senate.

The bill contains a “one-time election to continue enrollment in Tricare Prime” for affected beneficiaries — a proposal floated in May by Reps. Mac Thornberry, R-Texas, and John Kline, R-Minn., after constituents in their districts learned they would lose the option to stay in Prime.

The $632.8 billion compromise bill, which still requires approval in the House and Senate before it becomes law, would allow beneficiaries a one-time chance to stay in Prime as long as they continue living in the same ZIP code where they opted into Prime.

The Pentagon reduced the availability of the Tricare Prime managed-care program to locations within 40 miles of an active or former military base on Oct 1, forcing 171,000 retirees and family members to switch to Tricare Standard, a traditional fee-for-service health care program with higher out-of-pocket costs than Prime.

The Pentagon said shrinking Prime will save the government $45 million to $65 million a year, based on estimates that DoD pays an average of $600 more per year to provide Prime to a beneficiary than Standard.

But affected beneficiaries felt abandoned by the system, given that the Pentagon began planning in 2007 to reduce its Prime service areas but did not publicize the change.

Media reports in October 2012 alerted both affected beneficiaries and lawmakers to the pending reduction.

In a summary of the compromise bill released Monday, Rep. Buck McKeon, R-Calif., chairman of the House Armed Service Committee, said committee members believe health care for retired service members is “a benefit earned through prior service to our nation.”

“Promises made should be promises kept, and the Pentagon should not break faith with our nation’s heroes,” Kline said earlier this year after proposing the legislation.

The compromise defense bill, which authorizes $32.9 billion for the defense health program, includes no significant increases in health care fees for military retirees and their families.

Lawmakers rejected White House efforts to raise fees markedly for retirees on Tricare Prime and create new fees for working-age retirees on Tricare Standard as well as for Medicare-eligible retirees and their families on Tricare for Life.

According to a House Armed Services Committee release, lawmakers believe that recent reforms, such as allowing Tricare Prime fees and pharmacy costs to be raised yearly in proportion to the annual cost of living increase, place Tricare on a “sustainable path” and new fees are unnecessary.

“The [Defense Department’s] record of incorrectly calculating Tricare costs and their repeated requests to transfer billions in unused funds out of the program to cover other underfunded defense priorities raises questions about repeated claims by the Defense Department that the defense health program is unsustainable,” the release states.

Other provisions in the bill include requirements for:

■The Defense and Veterans Affairs departments to develop and implement policies on treating and helping service members who have sustained severe injuries to their reproductive and urinary tract systems.

■DoD to carry out a pilot program for clinical trials of investigational treatments of brain injury and PTSD at non-military facilities.

■DoD and VA to establish and deploy an integrated electronic health record system by Dec. 31, 2016.

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