Posted on 06/16/2008 5:42:48 AM PDT by jb111o
What would you say if tomorrow Medicare changed it's rules and told you that they would only pay 20% of your doctor's bills? You would be responsible to pay the doctor the remaining 80% of the bill. And what if Medicare also said that you must pay a co-pay of 25% of the 20% that Medicare will pay? And all of this was being done without the express consent of Congress.
You would be rightly angry and probably would immediately call your Senators and Congressman or Congresswoman to insist they take action to stop this injustice.
Well, this is exactly what maybe happening to U.S. Military services members' dependents, U.S. Military retirees and their dependents living outside of the United States. Tricare covers them for their health care, (Tricare is a Department of Defense Health Insurance Program developed and authorized by Congress). Military member’s dependents, retirees and their dependents living in foreign countries that are covered under the Tricare Standard Program will soon have a new "country specific index" applied to all medical claims they submit to Tricare. This new index is a product of the World Bank's survey of the average cost of goods and services in a specific country and resulted in the development of a percentage factor that reflects what amount of goods and services $1.00 would buy in the foreign currency.
Unfortunately, this survey was taken in 2005, prior to the decline of the U.S. dollar overseas and does not accurately reflect the cost of those goods and services in today’s dollar. Worst yet, since this survey results are an average of the cost of goods and services, it mixes private health care cost with the foreign government health care cost, (which are normally provided free or at a nominal fee, much like Medicaid). In addition, many authorities feel it is impossible to use these indexes to compare the cost of medical care between countries.
The program is due to take effect in August 2008 and will be phased in using a higher allowed percentage for the first year and then the World Bank's percentage or a slightly modified percentage starting on 1 March 2009. The implementation of this program is being done under the DOD's rule making authority; however, it is actually attempting to skirt the U.S. Congress' directions which established a 25% co-pay for Tricare Standard beneficiaries. Congress did not authorize a higher co-pay, and although DOD has requested higher co-pays for the past several years, Congress has rebuffed all attempts to increase the co-pay and deductibles of the Tricare program.
So how can the DOD get away with this increase in co-pay? As I said above, the DOD is going to use data from the World Bank. Data that even the World Bank states, in it's handbook on this survey, must take into consideration the foreign exchange rate, (and presumably the inflation rate), for a specific country at the time of making use of their data. The DOD has ignored that part of the study handbook, and is going to ignore the vast difference in health care cost in rural vs. urban settings and private vs. government health care.
The program is scheduled to start in the Philippine and Panama first with the intent to later make it the standard for all foreign countries where Tricare has beneficiaries residing.
An example of how this program can affect the pocket books of our service member's dependents, retirees and their dependents is;
A beneficiary is admitted to a hospital in Manila, Philippines for a coronary bypass and is hospitalized for 10 days. The hospitals' legitimate charges, (the charges that the same procedure would cost a Philippine citizen), is $11,200. Tricare will only allow $6971 for this procedure based on the country specific index. This means that the beneficiary must pay the hospital the $4,229 that Tricare will not pay. On top of this, Tricare will only reimburse the beneficiary 75% of the allowed amount. The beneficiary is mandated by Federal statute to pay 25% of what ever Tricare pays, so the beneficiary will only get $5,228.25. The beneficiary will pay the outstanding hospital bill of $4,229 plus the co-pay of $1,742.75 for a total of $5,971.75 (or 53.32% of the total hospital bill).
Other examples for outpatient ancillary care have shown a beneficiary cost of 60 to 80 percent of the total amount of the bill. Which is the beneficiaries out of pocket cost after the Tricare reimbursement and will apply even at the higher percentage taking effect now.
And then comes the kicker, in most third world countries, such as the Philippines, the patient must pay the hospital bill and doctors/laboratory bills in full prior to discharge from the hospital or prior to receiving medical care. Some hospitals require a deposit of 110% of the estimated hospital bill prior to admission. In the Philippines, unlike the United States, a hospital is not required to admit a patient or treat a patient without being paid for the medical care given.
How many of you can come up with $11,200 within a day in order to be treated for a life threatening medical condition?
DOD has refused to use a prevailing rate system for the Philippines, even though this is the manner in which they determine allowable charges in the U.S. (The U.S. rates are even adjusted by zip codes and localities to account for the differences in health care cost in different parts of the U.S.).
Why are active duty military member's dependents, retirees and their dependents going to be forced to shoulder a higher percentage of their health care cost overseas than is required of their counterparts in the U.S.?
I suspect that DOD just does not think anyone will notice. Maybe they need to find funds to help with the Iraq war cost. They know, due to all the newspaper articles concerning poor treatment of active duty and retired military in U.S., that they could not extract the savings from U.S. military health system in the U.S. But the service members and retirees overseas don't normally make the news, so why not get the dollars from them. All they have to do is misuse data from the World Bank and ignore the exchange rate, inflation rate and take an average cost analysis to derive a reduction in benefits to active duty military member's dependents, retirees and their dependents overseas.
Is this how we Americans treat are active and retired military members who risked their lives for their country? I hope not. If you feel this is wrong, contact your Senators and Congressman/Congresswoman and tell them to stop DOD from eroding our active duty and retiree members' benefits that they risk their lives to earn.
Welcome to Free Republic.
Why should I pay for health care in a foreign country? Here in the United States, we pay for everybody, whether they belong or not. Shouldn’t other countries reciprocate?
What am I missing?
Do you have a link to this info?
Advantage of Tricare Standard over Prime is there are more medical facilities (Civilian) to choose from. Of course you need to pay for that “advantage”.
Your post is misleading.
I agree that it’s probably impossible to do this correctly, and if you can’t, you shouldn’t do it.
However, on principle I agree that they should, if possible, adjust the plans so that all servicepeople and their families are treated equally regardless of what country they are in. There is no reason people in one country should get a better deal than people in a neighboring country, ESPECIALLY if they don’t get to choose which country they are in.
What would you say if tomorrow Medicare changed it's rules and told you that they would only pay 20% of your doctor's bills?
This is not paying health care FOR another country. This is paying the health care for military retirees and eligible military family members when they happen to be IN other countries.
In other words, the US has the obligation to pay the health care of these people as part of the contract for that person’s retirement or their current employment. The government has given that responsibility to a “health care group” called “Tricare.” Tricare wants NOT to pay (all) if you happen to be visiting Mexico and get sick or injured and hospitalized.
I remember many families getting health care in Germany in German hospitals....especially for child birth. That was because most small communities did NOT have US military hospitals or clinics with that capability.
The solution is simple. The US government should live up to its obligations to retirees and current military members. It was part of the deal they made. If you give your word, then you follow through. There really should be no debate at all.
Several years ago the courts ruled that the "implied" coverage for life was not in written form an thus the coverage could be abrogated at any time. It was not a real contract and the military members could be screwed at any time.
Active duty families and retirees get the health benefit at the whim of the DoD and Congress.
I’m a USAF retiree over 65 covered under Tricare for life. I pay for Medicare part B, about $100 per month. The arrangement between Medicare and DOD effectively gives me 100% coverage. This is for health care in the US. Coverage while overseas, including in military hospitals, is not authorized. I’m writing this without researching Medicare again, but it has been my understanding they do not cover American citizens living or visiting in foreign countries. In the overall picture, I do not think there are a significant number of retired military families living overseas to make this a major issue. Those who do are world-wise people who certainly consider these factors in deciding to live there. Living in a foreign country is based mainly on economics and attractiveness of an area.
In personally considering such move I included cost and availablity of local health care. This is a major part of the decision since we retirees are older and need more medical care.
Living in an foreign paradise is currently on my back-burner because I’m living in Las Vegas. I’m not sure I can find a better paradise that I could handle. As an OLD rooster who has had assignments in Europe, the far east and the middle east, I know America is the best place to be.
Good luck to all you military retirees who find your paradise anywhere. You earned it.
You are correct that Tricare does not cover retired in foreign countries. My wife and I just came back from a Caribbean cruise. I contacted Tricare about coverage at sea and in the countries we would visit. I was told that Tricare would provide coverage in the US Virgin Islands but nowhere else, either in another country or at sea. Consequently, we purchased travel insurance that, amongst other things, provided health coverage through out our trip.
“The solution is simple. The US government should live up to its obligations to retirees and current military members. It was part of the deal they made. If you give your word, then you follow through. There really should be no debate at all.”
You’re right, but that would, literally, take an act of Congress, and they don’t want to play. If they did, they would have already done so. They’ve only had 34 years to do so since I was promised free medical care for myself and family, and I enlisted near the end of the war in Vietnam. We have darned few Congress-critters with military experience left, these days.
“Several years ago the courts ruled that the “implied” coverage for life was not in written form an thus the coverage could be abrogated at any time. It was not a real contract and the military members could be screwed at any time.”
Implied. I like that phrasing. NOT! Technical Sergeant Clifton T. Angel, Jr., where are you? I want to talk to you in a dark alley, somewhere...and I hope you have civilian medical care paid for.
The sad thing in this, OS, is that it generally is not congress that’s the problem...it’s the Department of Defense. They absolutely love bean counters, and bean counters absolutely love to screw anyone just to save a few bucks for some cherished project/program.
Health care isn’t R&D.
I have to disagree here. (Not that bean counters aren't a problem, also.) Congress has the authority to tell DOD what to do, and does. They have never told DOD NOT to do stuff like this. Col. Bud Day sued (in a class-action suit, representing all retirees) DOD over the implied medical care promise several years ago, and went all the way to the supreme court, which is who said DOD isn't required to pay for medical care for retirees, and that only Congress can rectify the situation. Congress is responsible, not DOD. Fact, not opinion.
Retirees and their dependents living overseas are not entitled to Prime
We have a web page that we are still developing.
https://sites.google.com/site/militaryretireesoverseas/
You can also go to TRICARE’s web site and read Section 34 and 35 of Chapter 1 to the TRICARE Reimbursement Manual 6010.55-M http://manuals.tricare.osd.mil/
Of course you were misinformed. TRICARE does provide coverage worldwide. The problem now is they want to change the formula so that only 20% or so is covered. Of course they say we still have the same coverage but they never compared their changes to actual costs overseas.
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