New law molds Tricare into a true benefit

  • Tom Philpott / Military Update
  • Sunday, November 5, 2000 9:00pm
  • Local News

President Clinton signed into law Oct. 30 a health care initiative for current and future Medicare-eligible military beneficiaries that has a vastly expanded prescription drug benefit and turns Tricare into a true cradle-to-grave benefit.

Clinton said he was pleased the law supports "individuals who dedicated so much to the service of our country." But he also said he was "concerned that the Congress fails to deal fully with the high, long-term cost of this new benefit."

P. J. Crowley, spokesman for Clinton’s national security staff, said he was referring to the fact that the Defense Department will have to cover first-year costs of Tricare for Life, estimated at $2.5 billion. Because the benefit is an "entitlement," it will be funded, regardless. But after fiscal 2002, an accounting maneuver in the law kicks in and Tricare for Life becomes an unfunded liability of the U.S. Treasury, not a Defense Department expense.

Clinton also remarked on the new drug benefit for military seniors to underscore what Congress did not approve: his administration’s proposal to provide a prescription drug benefit for all Medicare retirees, paid for through the Medicare program.

Clinton’s final defense budget request, sent to Congress last February, had no health care initiatives for service elderly, despite the joint chiefs’ stand during budget negotiations that promises had been broken and, with help from the budget surplus, should be kept. In the end, the Republican-led Congress came to the rescue, spurred on by military associations and an unusual and intense grass-roots lobbying campaign by retirees.

In meeting with reporters Oct. 26, Dr. H. James Sears, executive director of the Tricare Management Activity, sounded a bit stunned himself at the richness of the benefit older retirees and their spouses have gained.

"I can’t think of a better health plan, or a more comprehensive health plan, and way beyond what I would have dreamt would have occurred this year," said Sears.

Effective Oct. 1, 2001, any Medicare-eligible military beneficiary who has enrolled in Medicare Part B will have Tricare as second payer to their Medicare benefits.

This means Tricare will pay out-of-pocket costs for any services covered under Medicare, including 20 percent co-payments on doctor care and deductibles for hospital stays. In addition, beneficiaries will be eligible for all Tricare benefits not covered by Medicare. Tricare plans an elaborate effort to inform individual beneficiaries on details.

The Tricare Senior Pharmacy Program, its official name, will begin April 1, 2001, six months sooner than Tricare for Life. A Tricare official said an easy way to explain it is it’s "the exact same benefit" provided to under-65 retirees and spouses. That includes:

  • Continued access to cost-free medications at base pharmacies.

  • Access to the military’s National Mail Order Pharmacy Program where a 90-day supply of most medicines costs $8.

  • Access to the Tricare retail pharmacy benefit which requires a 20 percent co-payment for patients.

  • Access to any non-network pharmacy but the patient will face a 25 percent co-payment after a deductible of $150 per individual or $300 per family.

    Legislative language on the pharmacy plan delivered a surprise to Tricare officials that will delight some beneficiaries. Anyone 65 or older before April 1, 2001, will be able to use the senior pharmacy benefit without enrolling in Medicare Part B. Those who turn 65 on or after April 1 next year must enroll in Part B to use the full drug benefit.

    What should Medicare-eligible beneficiaries do now?

    Tricare officials suggest three actions:

  • Update your record in the Defense Enrollment Eligibility Reporting System (DEERS) with your correct address and any change in family status such as marriage, divorce, birth or adoption. Your address in DEERS is important because Tricare will use it to send you more details on these benefits when available. DEERS toll free phone number for Washington residents is 800-538-9552. You also can write: DEERS Support Office, Attn: COA, 400 Gigling Road, Seaside, CA 93955-6771.

  • Update your DEERS record to reflect your Medicare Part B enrollment status.

  • Enroll in Medicare Part B if you haven’t already. You can’t qualify for Tricare for Life without it.

    Seniors should not yet cancel their Medigap insurance coverage. Those who do so prematurely will face a gap in secondary coverage until Tricare for Life begins next year.

    Tricare has a Web site for the latest official information on these and other health care issues: www.tricare.osd.mil.

    A smiling Sears tried still another way to put the "biggest platter of benefit changes" in more than 30 years in perspective.

    "We’re talking about a military health system that is going in exactly the opposite direction than the rest of the world," Sears said. "We’re continuing to add benefits, to lower out-of-pocket costs, or, essentially, to eliminate costs in many instances."

    At the same time, Tricare officials are working hard to end system "irritants," Sears said, like delays in claim processing and reimbursements. But the top three factors in choosing a health plan, he said, are quality of care, range of benefits and affordability.

    "When you look at Tricare," said Sears, "those are all slam dunks."

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