Posted on 10/24/2012 6:57:32 PM PDT by Marie
The Pentagon is moving ahead with plans to slash its network of Tricare Prime providers, starting by eliminating the Prime option in three states and two cities in the Tricare West region.
As of April 1, as many as 30,000 Prime beneficiaries — retirees, Active Guard and Reserve troops, and family members — in Iowa; Minnesota; Oregon; Reno, Nev.; and Springfield, Mo., will have to switch to Tricare Standard, a traditional fee-for-service health plan, according to a source with knowledge of the reorganization.
Pentagon officials would not confirm that the five areas will lose Prime in April.
The areas lie outside Prime service areas covered under new Tricare regional contracts awarded by the Pentagon.
Under those contracts, Tricare will offer Prime networks only within “catchment areas,” defined as a 40-mile radius around military treatment facilities and in areas affected by the 2005 base closure and realignment process.
However, there are provisions to allow Prime beneficiaries who see a physician outside the 40-mile service area to stay in Prime if they live within 100 miles of an available primary care manager and sign an access waiver.
New enrollments also would be allowed for those outside Prime service areas if there is network capacity and the primary care manager is less than 100 miles from the beneficiary’s residence.
Spokeswoman Cynthia Smith said the intent is to bolster health care support for the core active-duty populations near military treatment facilities that have been left short-handed “due to the deployment requirements of military medical providers.”
But the move would save big money for the Pentagon because it cuts contract administration overhead in these Prime areas and shifts more of the costs of care to beneficiaries.
What it means for beneficiaries
Active-duty family members in Prime pay no enrollment fees or co-pays. Military retirees pay annual enrollment fees of $269.26 for an individual and $538.56 for families, and their co-pays for outpatient care are just $12. Prime requires no deductibles.
Under the changes that will start April 1, as many as 170,000 Prime enrollees across all three regions eventually may have to drive longer distances to see a Prime provider or switch to Tricare Standard, which has no enrollment fees but carries greater out-of-pocket costs:
• Cost shares are 20 percent for active-duty family members and 25 percent for retirees and other eligible beneficiaries.
• Annual deductibles for outpatient care are $50 for an individual and $100 for a family for active-duty members in paygrades E-4 and below, and $150 for an individual and $300 for a family for all others.
• The annual catastrophic cap — the maximum health care costs a beneficiary must pay in any one fiscal year — is $1,000 for active-duty families and $3,000 for retirees.
The move to eliminate Prime service areas away from military installations has been in the works since 2007, when the Defense Department released a draft of its new Tricare contract proposal. But a series of contract disputes delayed the launch of the new initiative.
“The can got kicked down the road” because of the contract protests, said retired Air Force Col. Steve Strobridge, director of government relations for the Military Officers Association of America. “Beneficiaries are going to have to change what they are used to. With something as basic as health care, this always raises a certain level of angst.”
With the contract disputes now resolved, the changes in the initial five areas could be just the beginning.
Under the old contracts, the entire Tricare South region was designated a Prime service area. In the West and North regions, the companies that managed the contracts also expanded Prime into areas not located near military bases, populated mainly by retirees, Active Guard and Reserve troops and their families.
“We’re worried mostly about the South” because Humana Military Health Services, the contractor for that region, “now provides Prime everywhere,” said Barbara Cohoon, deputy government relations director for the National Military Family Association.
Beneficiaries in the South “already are hearing from their providers” that they will not remain in Prime, Cohoon said.
Health Net Federal Services manages the North region contract. Beginning April 1, UnitedHealth Federal Services takes over the West region from TriWest Healthcare Alliance.
Officials with all three regional contractors declined to comment and referred all questions to the Defense Department.
Dismantling Prime networks outside the immediate vicinity of military treatment facilities also will eliminate Tricare Extra in these places; that option allowed non-Prime users to lower their costs by seeing Prime network providers.
“All beneficiaries can choose to use Tricare Standard, which gives the beneficiary the most flexibility and greatest choice of any of the Tricare products,” Smith said.
According to the Pentagon, those in Tricare Prime Remote — a program for active-duty troops and their families living in rural areas — as well as those on or near an installation with a hospital or clinic will see no change to their health benefits.
“This will not affect active-duty military and their families,” Smith said. “This change also will not impact areas where there is a military treatment facility.”
Thanks JJ ....grateful for the ping ...
Stay safe !
The other problem comes with the disabled vets who’re living off of disability and/or retirement only.
For them the $3000 catastrophic cap can be a real killer.
I remember at one time if you were getting out and had a problem on your separation physical that you would be placed on med hold. Now they are putting soldiers with broken bodies out on the streets with no support at all.
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