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DoD silent on major changes to Tricare Prime

Aug. 2, 2013 - 06:00AM   |  
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More than 170,000 retired military personnel and their family members face significant changes to their medical care on Oct. 1, yet the Pentagon has been strangely silent on the coming changes, sending out just one notification letter earlier this year that contained scant details.

Starting Oct. 1, the Pentagon plans to reduce Tricare Prime service areas to within a 40-mile radius of active or former military installations, forcing 173,000 retirees and their family members to switch to Tricare Standard or seek a waiver if they live within 100 miles of an existing network.

The decision will affect retirees and their dependents in Prime, and those on Tricare Young Adult Prime. That totals 98,771 people in the Tricare South region; 37,404 in the North region; and 36,706 in the West region.

The Pentagon notified affected beneficiaries in April. But a second planned reminder letter, one that likely will contain more information on Tricare Standard, is more than a month late.

Defense Department officials repeatedly have deferred interview requests from Military Times to discuss the pending changes in more detail.

The Pentagon has said the cuts will save the government $45 million to $65 million a year, based on estimates that DoD pays about $600 more a year, on average, to provide Prime to a beneficiary compared to Standard.

But the cuts may come at a price for beneficiaries accustomed to using Tricare Prime, a program similar to a health maintenance organization.

Rebecca Brown, a 60-year-old school teacher in Jackson, Miss., is among those affected by the change. She described the lack of information coming from the Defense Department as “bewildering.”

For the past 35 years, Brown either has received her health care at a military hospital or has been enrolled in Tricare Prime.

Now she doesn’t know whether she’ll be allowed to see the same doctor or be required to pay up front and file all her own paperwork on claims.

“I called Tricare and couldn’t get any answers. I know I’ll be eligible for Tricare Standard, but I don’t even know what that means,” she said.

DoD has wanted to cut its Prime service areas since 2007, when it published requirements for the management contracts of the three Tricare regions. But the Pentagon has done little to publicize the changes.

In late 2011, it quietly began notifying physicians and health care providers of the cutbacks. Subsequent media reports prompted lawmakers in Oregon and Nevada — the first areas affected — to press for additional information.

The House version of the proposed 2014 defense authorization bill contains a provision that would require Tricare to grant affected beneficiaries a one-time “opt-in” to remain on Tricare Prime.

The Senate version of the bill contains no similar provision.

Active-duty members and their families would not be affected by the change. Those living outside the condensed Prime service areas may use Standard or Tricare Prime Remote, a program for those living in rural areas.

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