With the presidential election over, Department of Defense officials are expected to soon announce 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, the military’s fee-for-service insurance option. This 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 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.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. When they need care, retirees must cover 25 percent of allowable charges. Retirees also have an annual deductible of $150 per individual or $300 per family. Total out-of-pocket costs are capped at $3,000 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 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, contractors had financial incentive to establish networks beyond 40-mile catchment areas.Though health officials wrote the new generation of support contracts to constrict Prime service areas, they 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. The new contracts were drafted during the Bush administration and are intended to be more comprehensive and efficient. 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 on reducing PSAs is final, the department won’t confirm the number of beneficiaries potentially impacted or the likely dates for executing the changes.Some members of Congress are already concerned. Sen. Dean Heller, R-Nev., told Dr. Jonathan Woodson, assistant secretary of defense for health affairs, in recent letter that 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,” he wrote. “If changes are made, I hope you will notify those affected immediately.”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 and hold down costs. To do so would require lawmakers to find equivalent budget savings elsewhere.To comment, send e-mail to milupdate@aol.com or write to Military Update, P.O. Box 231111, Centreville, VA, 20120-1111

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