Military health care beneficiaries will be mailed information packets this year explaining benefits under Tricare, the triple-option health plan.
The mass mailing is unprecedented. It will mark the first time since Tricare began in 1993 that the system has reached out to all who are eligible — including more than 2 million users of Tricare Standard, the military’s fee-for-service health insurance.
More steps to support standard users will follow, approved by Congress in last year’s defense bill. They include a nationwide survey of civilian health care providers to measure reluctance to accept standard patients; a U.S. comptroller general review of Defense Department procedures to ensure access to standard benefits; and a communication plan between Tricare administrators, beneficiaries and providers.
For all the activity swirling around oft-neglected standard users, it isn’t clear yet how far the government will go to help them find doctors.
Beneficiary advocates have testified that fewer physicians are willing to accept Tricare patients and, of those who do, more are refusing to accept the fees. Finding rates inadequate, doctors are adding up to 15 percent, as the law allows, which patients must pay.
Standard users don’t enroll in Tricare Prime, the managed care network, and aren’t old enough for Tricare for Life, the golden supplement to Medicare. Many turn to standard, with its higher costs, to be able to choose their own physicians. Others only use standard benefits because they live in rural areas away from a Tricare Prime physician network.
The cost difference can be steep. A married retiree enrolled in prime pays $460 a year for family coverage and modest co-pays for doctor visits. The same retiree under standard pays a $300 annual deductible, plus 25 percent of the Tricare maximum allowance charge.
Sue Schwartz, a health benefits expert for the Military Officers Association of American, views the congressional initiatives as positive and the outreach effort for standard users with cautious optimism. She is "bullish" on a provider directory for standard users that recently was added to the Tricare Web site, www.tricare.osd.mil/ProviderDirectory/.
David McIntyre, president of TriWest Healthcare Alliance Corp. of Phoenix, Ariz., which will manage the Western region, noted that Medicare, like Tricare Standard, is a fee-for-service plan. Congress, he said, wouldn’t consider approving a costly system to track down doctors for Medicare patients. Also, he suggested, most Tricare Standard patients have a ready alternative: access to a managed care physician network.
"My obligation is to do whatever the Department of Defense thinks needs to be done to service this population most effectively," McIntyre said. But he added, "Someone needs to ask … ‘Where’s the problem?’ That’s up to association folks and Congress to decide."
Comments are welcomed. Write to Military Update, P.O. Box 231111, Centreville, VA. 20120-1111, e-mail milupdate@aol.com or go to www.militaryupdate.com.
Talk to us
> Give us your news tips.
> Send us a letter to the editor.
> More Herald contact information.
