Tricare can boost other insurance for seniors

  • Tom Philpott / Military Update
  • Sunday, November 19, 2000 9:00pm
  • Local News

Medicare-eligible military beneficiaries should view their new Tricare benefit as government-paid Medigap insurance, not as an opportunity to enroll in Tricare Prime, the managed-care plan open to active duty members, under-65 retirees and their families, said Dr. J. Jarrett Clinton, acting assistant secretary of defense for health affairs.

Clinton said that an Oct. 1, 2001, deadline for expanding Tricare to 1.4 million Medicare eligible beneficiaries requires Defense Department officials to "keep it simple." That means no plans for a large expansion of military hospital staffs or civilian provider networks run by Tricare support contracts.

Service elderly will gain access to Tricare Standard, which in stateside areas will become a "second payer" plan, or insurance supplement, to Medicare. Overseas, where Medicare is unavailable, 25,000 elderly beneficiaries will begin using Tricare Standard next October as their primary medical insurance.

But that "doesn’t mean," said Clinton, "that (elderly) have automatic access to an MTF (Military Treatment Facility) or to a program that’s a sub-component of Tricare" such as Tricare Prime.’

A concern, besides time, is cost. Opening Tricare to service elderly could add $3 billion to the fiscal 2002 defense health budget. A more robust pharmacy benefit for seniors, which begins April 1, will cost $400 million next year and $800 million in 2002.

One way to hold down Tricare costs is to keep beneficiaries 65 and older out of the military health care system so Medicare serves as their primary insurance and Tricare as second payer.

About 30,000 Medicare-eligible retirees and spouses already are enrolled in Tricare Senior Prime demonstrations at 10 sites, including military hospitals or medical centers near Tacoma, Colorado Springs, Colo., Biloxi, Miss., Lawton, Okla. and San Diego. Congress ordered the tests to continue through at least December 2001.

Defense officials are weighing the pros and cons of continuing Senior Prime in light of the new health benefits. It’s popular with enrollees and some geriatric care is important to keep medical staffs well trained. "The general sense among everyone," Clinton said, "is we would like to sustain that activity."

But he also noted that Senior Prime is much like civilian-run "Medicare Choice" programs, and 90 percent of them have gone out of business in the past two years. Plan managers can’t make the "financing part" work, he said. Defense officials will have to decide if Senior Prime "is worth the effort," he said. "In theory, it is."

Clinton, no relation to the president, was named acting health chief last July. He is a rear admiral in the U.S. Public Health Service and a board-certified physician in preventive medicine.

It’s unclear whether the Defense plan not to open Tricare Prime to the elderly complies with congressional intent. Congress referred to "enrollment" as though elderly Tricare users who live near military hospitals, such as younger beneficiaries, would be assigned to a primary care manager and have an equal shot with others to in-service care.

Clinton said Congress has given Defense "a lot of latitude" on the matter.

He doesn’t expect the current number of elderly enrolled in military managed care to grow. "We couldn’t let it grow," he said. But it won’t "go to zero" either, he said.

The elderly will find they can visit any civilian health care provider they choose, show them their Medicare card and a military identification card showing Medicare Part B enrollment status, and get their care. Physicians will send Medicare the bill and Tricare will be tapped automatically for most, if not all, of what Medicare won’t pay.

With the new pharmacy plan, Clinton said, it’s "a very rich benefit."

How rich, even Clinton can’t say. He would like to compare it with one of the 10 Medicare supplemental plans, A through J, allowed by law. But to his surprise, Clinton said, the Defense Department doesn’t have a detailed list of what Tricare Standard will and won’t cover.

"We’re going to have to get that sorted out in the next couple of months," he said, so that elderly will know what benefits they will have if they drop their Medigap insurance.

_

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Local News

Customers enter and exit the Costco on Dec. 2, 2022, in Lake Stevens. (Olivia Vanni / The Herald)
Costco stores could be impacted by looming truck driver strike threat

Truck drivers who deliver groceries and produce to Costco warehouses… Continue reading

Two Washington State ferries pass along the route between Mukilteo and Clinton as scuba divers swim near the shore Sunday, Oct. 22, 2023, in Mukilteo, Washington. (Ryan Berry / The Herald)
Ferry system increases ridership by a half million in 2024

Edmonds-Kingston route remains second-busiest route in the system.

A view of a homes in Edmonds, Washington on Friday, Sept. 8, 2023. (Olivia Vanni / The Herald)
Snohomish County to mail property tax statements this month

First half payments are due on April 30.

Ticket and ORCA card kiosks at the Lynnwood Light Rail station on Thursday, April 4, 2024 in Lynnwood, Washington. (Olivia Vanni / The Herald)
Beginning March 1, Community Transit to reduce some fares

Riders eligible for reduced fares will pay $1 for a single ORCA card tap and $36 for a monthly pass.

Robin Cain with 50 of her marathon medals hanging on a display board she made with her father on Thursday, Jan. 2, 2025 in Lake Stevens, Washington. (Olivia Vanni / The Herald)
Running a marathon is hard. She ran one in every state.

Robin Cain, of Lake Stevens, is one of only a few thousand people to ever achieve the feat.

People line up to grab food at the Everett Recovery Cafe on Wednesday, Dec. 4, 2024 in Everett, Washington. (Olivia Vanni / The Herald)
Coffee, meals and compassion are free at the Everett Recovery Cafe

The free, membership-based day center offers free coffee and meals and more importantly, camaraderie and recovery support.

Devani Padron, left, Daisy Ramos perform during dance class at Mari's Place Monday afternoon in Everett on July 13, 2016. (Kevin Clark / The Herald)
Mari’s Place helps children build confidence and design a better future

The Everett-based nonprofit offers free and low-cost classes in art, music, theater and dance for children ages 5 to 14.

The Everett Wastewater Treatment Plant along the Snohomish River on Thursday, June 16, 2022 in Everett, Washington. (Olivia Vanni / The Herald)
Everett water, sewer rates could jump 43% by 2028

The rate hikes would pay for improvements to the city’s sewer infrastructure.

The bond funded new track and field at Northshore Middle School on Thursday, Oct. 24, 2024 in Bothell, Washington. (Courtesy of Northshore School District)
Northshore School District bond improvements underway

The $425 million bond is funding new track and field complexes, playgrounds and phase one of two school replacements.

The amphitheater at Deception Pass during the 2021 concert series. (Photo provided by Deception Pass Park Foundation Facebook page.)
Deception Pass Foundation seeks Adopt-A-Trail volunteers

If you’re looking for a way to get outside and… Continue reading

A pedestrian is struck and killed by vehicle Wednesday in Everett

The pedestrian was a man in his 60s. The collision happened at 5:30 a.m. on Broadway.

Want coffee? Drink some with the Marysville mayor.

A casual question-and-answer session between mayor and constituents is planned for March 24.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.