Media sources are reporting that 171,000 Tricare beneficiaries may be moved from Tricare Prime to Tricare Standard if they don’t live within a 40-miles catchment radius of a military treatment facility. This could affect retirees under age 65 and military families. Tricare Prime is intended as a medical professional network for outsourcing of services that military treatment facilities can’t handle. This change in policy would occur on April 1, 2013, when the new Tricare contract goes into effect.
ROA belongs to The Military Coalition health care committee, where this issue is being discussed among member associations. The coalition has asked for a briefing on this from DoD’s Tricare Management Activity.
This change was actually a stipulation included in the third generation contracts to Humana, Health Net, and UnitedHealth Military and Veterans Services (that is taking over the West Region from TriWest). The wild card in this issue is that contractors are permitted to continue Prime Service Areas (PSA) under the contract. In the South Region, Humana maintained the entire region under a PSA under the old contract. How each contractor plans to adjust Tricare Prime networks is still unknown.
"The Department is considering whether to maintain the same number of PSAs as it has now," said Cynthia O. Smith, a spokeswoman for the Department of Defense in a statement made to Tom Philpott, a military freelance columnist.
Many network medical professionals will remain Tricare eligible even outside Tricare Prime areas.While beneficiaries may not have to give up their physicians, they will have to pay a 20 – 25 percent copayment under Tricare Standard. Any medical professional who accepts Medicare is Tricare eligible and can take Tricare beneficiaries.
The Reserve Officers Association will be following this issue, because it may have a greater impact on Reserve and Guard members who tend to live away from Military Bases. ROA members will be kept informed as ROA learns more.
Read the article from Tom Philpott