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.
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