171,000 Military Retirees To Lose Tricare :Prime

[krome2ez]

171,000 Retirees Likely To Lose Tricare Prime

Tom Philpott | November 08, 2012

171,000 Retirees Likely To Lose TRICARE Prime Option

With the presidential election over, Defense officials are expected to announce soon that military retirees and their dependents living more than 40 miles from a military treatment facility or base closure site will lose access to TRICARE Prime, the military's managed care option.

These beneficiaries would be expected to shift to TRICARE Standard, their fee-for-service insurance option, which would mean an increase in out-of-pocket costs for beneficiaries who are frequent users of health services.

A total of 171,000 retirees and dependents are expected to have to shift coverage when remote Prime networks go away. Tentative plans are for this to occur April 1 in the West Region, which would coincide with UnitedHealth Military and Veterans Services taking over the region's support contract from TriWest Healthcare Alliance after 16 years.

[Let your elected officials know how you feel about this issue.]

The North and South TRICARE regions are expected to close down Prime service areas beyond 40-mile catchment areas of bases or base closure sites by Oct. 1, 2013, the date when current Prime enrollment periods expire for most beneficiaries.

Active duty members and their families generally would not be impacted. Drilling National Guard members and reservists living far from military bases could see small increases to health costs. This would occur if they have been taking advantage of modest discounts available under TRICARE Reserve Select when network providers are used. Such discounts would end in areas far from bases if the Prime option goes away.

Under TRICARE Prime, beneficiaries get managed care through providers in the network. They pay an annual enrollment fee of $269.28 for individual coverage or $538.56 for family coverage. Retirees and family members also are charged co-pays of $12 for each doctor visit.

Under TRICARE Standard, beneficiaries can choose their own physicians and pay no annual enrollment fee. But when they need care, retirees must cover 25 percent of allowable charges. Retirees also have an annual deductible of $150 for the individual or $300 per family. Total out-of-pocket costs, however, are capped at $3000 per family.

In most Prime service areas, about half of eligible retirees already choose to use Standard rather than enroll in the network.

The end of Prime outside of 40-mile "catchment" areas of military treatment facilities has been anticipated since 2007, when Defense officials drafted the third generation of TRICARE support contracts. It called for returning the managed care option to its original concept of being a backup network to military clinics and hospitals when they can't provide managed care to all beneficiaries living nearby or in areas where bases have been closed and military health facilities shuttered.

Through the first two TRICARE contracts, on the assumption that managed care saved money for the government, contractors had financial incentive to establish networks beyond 40-mile catchment areas. In the South Region, for example, the contractor has offered Prime everywhere. But experience has shown that providing Prime far from bases can add costs to the system, TRICARE officials concluded.

Though they wrote the new generation of support contracts to constrict Prime service areas, health officials wanted the shift to occur across all regions simultaneously. That hasn't been possible until now because of delays in finalizing contract awards, the result of multiple protests and even a few reversals of original contract awards.

Contracts for every region are now settled. Health Net Federal Services has been running the North Region under the new contract since April 2011. Humana Military Healthcare Services has operated the South Region under the new contract since April this year. But all Prime service areas have been maintained with contract modifications, awaiting final word from Defense that Prime area restrictions are to be implemented.

The new contracts were drafted during the Bush administration and are intended to be more comprehensive and efficient. But sensitive to how a change in Prime eligibility might be used by politicians this fall, Defense officials ordered plans to end Prime for retirees living outside catchment areas, including draft notification letters, shelved until after the election.

Plans for implementation have not changed, congressional and health sources said. But they also have not been announced officially yet.

"The Department is considering whether to maintain the same number of PSAs (Prime service areas) as it has now," said Cynthia O. Smith, a spokeswoman for the Department of Defense. Until a decision is final on reducing PSAs, the department won't confirm the number of beneficiaries potentially impacted or the likely dates for executing the changes.

Some members of Congress already are concerned. Sen. Dean Heller (R-Nev.) told Dr. Jonathan Woodson, assistant secretary of defense for health affairs, in recent letter he was "dismayed" by news reports that Prime "will be cut for many of the military families and constituents I represent, not only in Reno but also throughout the northern part of the state."

Heller said the plan would cause "more out-of-pocket expenses and longer drive times…I am very troubled by these changes and am concerned that these alterations are not being made in a transparent manner. If changes are made, I hope you will notify those affected immediately."

A spokesman for Heller said Woodson had not yet answered the letter. Given the nation's debt crisis and the budget cuts looming for defense programs, Congress is not expected to block this long-standing plan to tighten access to Prime if the intent is to hold down costs. Doing so likely would require lawmakers to find equivalent budget savings elsewhere.

http://www.military.com/features/0,15240,251962,00.html#.UJwifbusPkI.facebook

[Elixirbaby]

171,000 Retirees Likely To Lose Tricare Prime

Tom Philpott | November 08, 2012

171,000 Retirees Likely To Lose TRICARE Prime Option

With the presidential election over, Defense officials are expected to announce soon that military retirees and their dependents living more than 40 miles from a military treatment facility or base closure site will lose access to TRICARE Prime, the military's managed care option.

These beneficiaries would be expected to shift to TRICARE Standard, their fee-for-service insurance option, which would mean an increase in out-of-pocket costs for beneficiaries who are frequent users of health services.

A total of 171,000 retirees and dependents are expected to have to shift coverage when remote Prime networks go away. Tentative plans are for this to occur April 1 in the West Region, which would coincide with UnitedHealth Military and Veterans Services taking over the region's support contract from TriWest Healthcare Alliance after 16 years.

[Let your elected officials know how you feel about this issue.]

The North and South TRICARE regions are expected to close down Prime service areas beyond 40-mile catchment areas of bases or base closure sites by Oct. 1, 2013, the date when current Prime enrollment periods expire for most beneficiaries.

Active duty members and their families generally would not be impacted. Drilling National Guard members and reservists living far from military bases could see small increases to health costs. This would occur if they have been taking advantage of modest discounts available under TRICARE Reserve Select when network providers are used. Such discounts would end in areas far from bases if the Prime option goes away.

Under TRICARE Prime, beneficiaries get managed care through providers in the network. They pay an annual enrollment fee of $269.28 for individual coverage or $538.56 for family coverage. Retirees and family members also are charged co-pays of $12 for each doctor visit.

Under TRICARE Standard, beneficiaries can choose their own physicians and pay no annual enrollment fee. But when they need care, retirees must cover 25 percent of allowable charges. Retirees also have an annual deductible of $150 for the individual or $300 per family. Total out-of-pocket costs, however, are capped at $3000 per family.

In most Prime service areas, about half of eligible retirees already choose to use Standard rather than enroll in the network.

The end of Prime outside of 40-mile "catchment" areas of military treatment facilities has been anticipated since 2007, when Defense officials drafted the third generation of TRICARE support contracts. It called for returning the managed care option to its original concept of being a backup network to military clinics and hospitals when they can't provide managed care to all beneficiaries living nearby or in areas where bases have been closed and military health facilities shuttered.

Through the first two TRICARE contracts, on the assumption that managed care saved money for the government, contractors had financial incentive to establish networks beyond 40-mile catchment areas. In the South Region, for example, the contractor has offered Prime everywhere. But experience has shown that providing Prime far from bases can add costs to the system, TRICARE officials concluded.

Though they wrote the new generation of support contracts to constrict Prime service areas, health officials wanted the shift to occur across all regions simultaneously. That hasn't been possible until now because of delays in finalizing contract awards, the result of multiple protests and even a few reversals of original contract awards.

Contracts for every region are now settled. Health Net Federal Services has been running the North Region under the new contract since April 2011. Humana Military Healthcare Services has operated the South Region under the new contract since April this year. But all Prime service areas have been maintained with contract modifications, awaiting final word from Defense that Prime area restrictions are to be implemented.

The new contracts were drafted during the Bush administration and are intended to be more comprehensive and efficient. But sensitive to how a change in Prime eligibility might be used by politicians this fall, Defense officials ordered plans to end Prime for retirees living outside catchment areas, including draft notification letters, shelved until after the election.

Plans for implementation have not changed, congressional and health sources said. But they also have not been announced officially yet.

"The Department is considering whether to maintain the same number of PSAs (Prime service areas) as it has now," said Cynthia O. Smith, a spokeswoman for the Department of Defense. Until a decision is final on reducing PSAs, the department won't confirm the number of beneficiaries potentially impacted or the likely dates for executing the changes.

Some members of Congress already are concerned. Sen. Dean Heller (R-Nev.) told Dr. Jonathan Woodson, assistant secretary of defense for health affairs, in recent letter he was "dismayed" by news reports that Prime "will be cut for many of the military families and constituents I represent, not only in Reno but also throughout the northern part of the state."

Heller said the plan would cause "more out-of-pocket expenses and longer drive times…I am very troubled by these changes and am concerned that these alterations are not being made in a transparent manner. If changes are made, I hope you will notify those affected immediately."

A spokesman for Heller said Woodson had not yet answered the letter. Given the nation's debt crisis and the budget cuts looming for defense programs, Congress is not expected to block this long-standing plan to tighten access to Prime if the intent is to hold down costs. Doing so likely would require lawmakers to find equivalent budget savings elsewhere.

http://www.military.com/features/0,15240,251962,00.html#.UJwifbusPkI.facebook

Edited November 10, 2012 by Elixirbaby

[TPSprayduster]

Thanks Elixir for highlighting this, people need to read stuff fully to ensure they are not misled.

[krome2ez]

Thanks Elixir for highlighting this, people need to read stuff fully to ensure they are not misled.

So, because it was "drafted" during the Bush administration,

which by the way had a Democratic majority in both the House and the Senate the last 2 years,

but not IMPLEMENTED till the Obama administration,

makes it Bush's fault.

Really??

Just because it was drafted during an administration,

does not mean that the President supported it.

Last year the House Republicans drafted several budgets,

yet not one was implemented by the Obama administration.

hmmmmmm......

Edited November 10, 2012 by krome2ez

[Luigi1]

Chris Mathews, MSNBC Hardball, was quick to blame Bush for the increases in ObamaCare & loss of Tricare.

Why don't they just name it BushCare instead of ObamaCare? Bush will be blamed anyhow for anything that backfires under Obama.

[PowerGeneration]

Tricare is not that good anyway as a disabled vet I dont use it.And my benefits are still the same

I lost nothing so Thank You Obama for not messing with my benefits.

keep looking for something to blame things on thou.

[TexasGranny]

Tricare is not that good anyway as a disabled vet I dont use it.And my benefits are still the same

I lost nothing so Thank You Obama for not messing with my benefits.

keep looking for something to blame things on thou.

So, since you don't use Tricare, its okay if the veterans that need it because of where they live are screwed.

Not everyone lives within driving distance of a VA facility. But that's okay, you got yours so the others can do without?

Then you surely agree with all of the below planned actions too. Just so you understand, these recommendations are

from the George Soros funded, Center for American Progress.

AirForceTimes

Think tank recommends big benefits cuts

By Rick Maze - Staff writer

Posted : Thursday Nov 1, 2012 11:36:21 EDT

A new report by a liberal-leaning think tank recommends a dramatic overhaul of military pay, retirement and health care benefits as part

of a $1 trillion cut in defense spending over 10 years.

The Center for American Progress calls for capping pay raises, eliminating military health benefits for many retirees who are covered by

an employer-provided plan, and reducing the value of military retired pay as well as making retirees wait until age 60 to start receiving it.

Recommendations are included in a report, Rebalancing Our National Security, released Oct. 31 by the progressive think tank and advocacy

group. The report opposes across-the-board cuts in defense spending that could occur beginning in January under sequestration but still

calls for major reductions in defense spending.

Capping pay raises, the report says, could save $16.5 billion over the next five years. Reducing retiree health care benefits, through a

combination of restricting care and raising fees, could save $15 billion a year. Reforming military retired pay could save, in the short term,

up to $13 billion a year, and over time could save up to $70 billion a year off the current plan.

In addition to cutting compensation and benefits, the report also recommends cutting the number of active-duty troops permanently

based in Europe and Asia, saving $10 billion a year. It recommends withdrawing 33,000 troops from Europe and about 17,000 from Asia.

In calling for less spending on military pay raises, the report basically endorses a plan proposed, but not yet executed, by the Defense

Department. Under the Pentagon plan, pay raises beginning in 2015 would be capped at less than the average increase in private sector

pay, a move that responds to a belief that military members are being paid more than civilians with comparable jobs and experience.

This happened because Congress, over Pentagon objections, has regularly provided the military with raises that were slightly larger

than the average private-sector raise to eliminate what had been perceived as a pay gap. The end result, says the report, is that the

average service member is receiving $5,400 more in annual compensation than a comparable civilian.

The Defense Department plan calls for a 0.5 percent raise in 2015, a 1 percent raise in 2016 and a 1.5 percent raise in 2017 to bring

pay levels back in line, which the CAP report endorses.

“To its credit, the Department of Defense has attempted to tackle this problem in its FY 2013 budget request, outlining a plan that would

gradually bring military pay back in line with the Employment Cost Index without cutting any service member’s pay,” the report says.

“Congress should demonstrate political courage and allow the Department of Defense to execute this long-term plan.”

Similarly, the report endorses many of the Defense Department’s proposals for cutting health care costs by raising fees, mostly on

retirees and their families. But the report goes a step further: “To truly restore the Tricare program to stable financial footing, the Defense

Department should enact measures to reduce the overutilization of medical services and limit double coverage of working-age military

retirees,” the report says.

One idea would be to modify Tricare for Life benefits for Medicare-eligible retirees so that the program would not cover the first $500 of

costs per year and would cover only 50 percent of the next $5,000.

Another idea would be to mandate that working-age retirees could only have Tricare benefits if they or their spouses do not have

access to employer-provided health benefits. The report suggests this would be an income-based restriction but does not say what

the cutoff should be.

The report also recommends modifying military retirement benefits. For anyone currently in the military with fewer than 10 years of

service, benefits could be cut: Instead of receiving 50 percent of basic pay after 20 years of service, with immediate benefits, the report

says the benefits would be 40 percent of base pay with payments not beginning until age 60. For people not yet in the military, there

would be no fixed retired pay in the future, only a pre-tax retirement savings plan based on contributions from the service member.

*********************************************************

You do know that many military families live on such small incomes that they qualify for food stamps.

[securityguy]

Well, I guess that's OK....as long as the "average civilian" goes into the **** with all guns blazing like or GI's do when they are called. What a bunch of crap!!!

[PowerGeneration]

Well TG rayzur pulled up some good info for vets and if they are veterans the department of veteran affairs

will give them assistance and none of my rates or theres will be increased.There are lots of VA's in every state

and if they cant drive there they WILL provide transportation for them.I can tell YOU never used tricare because if you did

you would know its like getting a gold card and they dont provide descent heathcare or have very good doctors.

Rayzur can help just ask her she is awesome and helped me out.I dam sure care about our VETs thats why I went against romney he wanted state run healthcare with no regulations by our government just let each state charge what they want

Unregulated which would you want for them?I know your gunning to boot me granny just because I voted for Obama

so just get it over with and do it.I am only a half of a man put 12 years in and when I got out under bushes admin

I only got 632.00 a month is that fair too?Thats why I will never vote republican again EVER.

I am proud I served this country but this country sure wasnt proud to serve me.Tricare doesnt have specialist

that cant handle loss of limbs eys lungs legs ETC.The VA does have specialist for folks like me.

Your picking on the wrong man unless you like to kick a vet when he's down.I dont post anything in your threads

TG or say anything bad about you so leave me alone! Your a head strong repub and all can see that.You made your point

so that makes me a bad man there are you happy now? I should of died in the field of battle so your man could win.

I know this country is in a bad way and no president is going to save it not even Obama.

Kick me some more I deserve it!

[krome2ez]

Well TG rayzur pulled up some good info for vets and if they are veterans the department of veteran affairs

will give them assistance and none of my rates or theres will be increased.There are lots of VA's in every state

and if they cant drive there they WILL provide transportation for them.I can tell YOU never used tricare because if you did

you would know its like getting a gold card and they dont provide descent heathcare or have very good doctors.

Rayzur can help just ask her she is awesome and helped me out.I dam sure care about our VETs thats why I went against romney he wanted state run healthcare with no regulations by our government just let each state charge what they want

Unregulated which would you want for them?I know your gunning to boot me granny just because I voted for Obama

so just get it over with and do it.I am only a half of a man put 12 years in and when I got out under bushes admin

I only got 632.00 a month is that fair too?Thats why I will never vote republican again EVER.

I am proud I served this country but this country sure wasnt proud to serve me.Tricare doesnt have specialist

that cant handle loss of limbs eys lungs legs ETC.The VA does have specialist for folks like me.

Your picking on the wrong man unless you like to kick a vet when he's down.I dont post anything in your threads

TG or say anything bad about you so leave me alone! Your a head strong repub and all can see that.You made your point

so that makes me a bad man there are you happy now? I should of died in the field of battle so your man could win.

I know this country is in a bad way and no president is going to save it not even Obama.

Kick me some more I deserve it!

Obviously you've never used Tricare.

My family and I have used nothing but Tricare Prime

since I retired over 10 years ago, and have not had 1 problem with it.

There are plenty of doctors and providers in network.

So, I have no idea what your talking about.

[witewolf]

Obviously you've never used Tricare.

My family and I have used nothing but Tricare Prime

since I retired over 10 years ago, and have not had 1 problem with it.

There are plenty of doctors and providers in network.

So, I have no idea what your talking about.

No kidding. No idea at all. After spinal fusions on two lower discs, with 6 screws and 4 cages placed, and a 118k hospital bill statement of which I had to pay nothing out of pocket aside from my neurosurgeon office visit co-pays I have absolutely nothing to complain about!