Getting out, military health issues - Air Force Times

Health care

The military’s Tricare health care system uses a combination of military hospitals, clinics and civilian professionals to treat service members, reservists, retirees and their families.

Active-duty members have priority, which may limit access for military families and retirees and force many to go to civilian hospitals and health providers. Those eligible for Tricare include family members of active-duty personnel; retirees and their families; some former military spouses; certain survivors; and Medal of Honor recipients and their immediate families.

All drilling members of the National Guard and reserve and their families are eligible for a relatively new program called Tricare Reserve Select. The program has a complicated three-tier eligibility structure and gives the lowest monthly premium rates to those who have demobilized after serving in support of a contingency operation for more than 30 days.

Survivors of members killed on active duty can use Tricare Standard, at rates charged to active-duty families, for three years after the member’s death.

To access Defense Department health services, members must be registered in the Defense Enrollment Eligibility Reporting System, or DEERS.

Three basic health care plans are available under Tricare: Tricare Prime, Tricare Standard and Tricare Extra. An individual can pay less by using a restricted network of military and civilian doctors under Prime or Extra, or pay more for a wider choice of providers under Standard.

The three plans are available in the U.S., but not in every U.S. location. All three have a cap on how much a family pays out of pocket each fiscal year, depending on the sponsor’s duty status and the type of Tricare program used.

For a map of the Tricare regions and a wide variety of fact sheets and information on the program, see www.tricare.osd.mil.

Through Tricare for Life, Tricare medical benefits extend to military retirees over age 65 who are eligible for Medicare Part A, provided they buy Medicare Part B outpatient insurance.

Active-duty dependents and retirees also can use the Uniformed Services Family Health Plan through former Public Health Service hospitals. Some also may be eligible for care through the Department of Veterans Affairs.

Service members who leave the military before retirement can enroll in the Continued Health Care Benefit Program to bridge the gap between separation from service and obtaining health insurance through a civilian employer.

Outpatient care at military facilities is free, with minimal charges for inpatient care. Treatment in civilian facilities generally means more out-of-pocket expenses. An exception is for active-duty dependents in Prime; they do not have to pay for civilian care if they get it through the Prime program.

For the second consecutive year, the Defense Department has proposed to significantly increase Tricare fees and deductibles for so-called “working age” retirees — those under 65 who presumably have access to other health insurance through their post-service civilian employers — as part of its fiscal 2008 budget plan.

Defense officials argue that Tricare fees have not changed since 1995, while costs have continued to soar. They say the Defense Department’s ever-increasing share of health care costs, now approaching $40 billion per year, threatens the viability of the Tricare benefit for everyone who is eligible.

Congress rejected the Pentagon proposal when it was first floated in 2006, and the early indications are that lawmakers are no more amenable to it the second time around.