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Retirees Not Near Bases to Lose TRICARE Prime Oct. 1
Tom Philpott | January 10, 2013
The military's managed-care option -- TRICARE Prime -- will be ended Oct. 1 for retirees, their family members and for military survivors who reside more than 40 miles from a military treatment facility or from a base closure site, TRICARE Management Activity announced Wednesday.
Most of these 171,400 beneficiaries will need to shift health coverage from Prime to TRICARE Standard, the military's fee-for-service health insurance option. For beneficiaries who use more than preventive health care during the year, the shift will mean higher out-of-pocket costs.
[Let your elected officials know how you feel about this change in TRICARE benefits.]
Defense officials expect the move to save the health care system up to $55 million a year.
The rollback in number of Prime service areas will not impact active duty members or their families living far a military base for tours as recruiters or in other remote assignments. Their health insurance through the separate TRICARE Prime Remote program will not change.
But grown children of members or of retirees who elected coverage under TRICARE Young Adult insurance will, like retirees, lose access to managed care providers under Prime if they reside more than 40 miles from a base.
TRICARE had considered ending Prime in remote service areas of the West Region on April 1, to coincide with changeover for that region's TRICARE support contactor. On that date, the TriWest Healthcare Alliance will give way to UnitedHealthCare Services of Minnetonka, Minn.
"The primary concern was the beneficiaries. We didn't feel like we had enough time to notify them and help them through the transition," explained S. Dian Lawhon, director of beneficiary education and support at TRICARE Management Activity headquarters in Falls Church, Va.
Congressional committee staffs also had complained about a staggered start across regions to a major benefit change. So the Prime service area rollback will occur in the North, South and West regions simultaneously next fall. This will cause another set of challenges in remote areas of the West Region that an April 1 start there would have avoided.
TriWest needed years to build its current network of providers far from military bases across the region. UnitedHealth will now be paid additional monies under a contract change order to build its own remote networks of providers. Those networks will only operate until October.
How successful UnitedHealth can be in luring providers, or even beneficiaries, to new networks that will be dissolved quickly is anyone's guess but the scheme has skeptics.
"They are just kicking the can for six months at significant expense to the government," said one TRICARE contracting official with knowledge of the move. "When they have a [defense budget] sequester looming, proceeding down that path really doesn't make a lot of sense."
TRICARE's far more critical challenge, however, is to educate impacted beneficiaries that their Prime coverage will end and most of them will need to shift to TRICARE Standard. An aggressive information campaign is planned with the first of three letters of explanation and warning to be sent to affected beneficiaries and families within 30 days, Lawhon said.
Under Prime, beneficiaries get their care from a designated network of providers for a fixed annual enrollment fee, which for fiscal 2013 is set at $269.28 for individual coverage or $538.56 for family. Retirees and family members also are charged a co-pay of $12 per doctor visit.
Under TRICARE Standard, beneficiaries choose their own physicians and pay no annual enrollment fee. When in need of care, retirees must pay 25 percent of allowable charges themselves. They also pay an annual deductible of $150 for individual or $300 per family. Total out-of-pocket costs, however, cannot exceed a $3000 per family catastrophic cap.
Some beneficiaries who see local Prime coverage end will be able to enroll in a remaining Prime network near base. To do so they would have to reside less than 100 miles from that exiting network and would have to waive the driving-distance standard that TRICARE imposes for patient safety. That standard when enforced required that an assigned network provider be within a 30-minute drive of the beneficiary's home.
If displaced Prime beneficiaries meet the two requirements, then an existing network will make room for them regardless of number of beneficiaries enrolled, Lawhon said. But joining a new network also will mean new doctors. So most displaced Prime beneficiaries are expected to choose to use TRICARE Standard instead to get care locally and, in many cases from the same physicians who treated them under TRICARE Prime.
"People who use Standard are very, very pleased with it," Lawhon said. As a group they report higher scores on customer satisfaction surveys than do Prime user, she said.
The push to end Prime in areas away from bases began in 2007 with design a third generation of TRICARE support contracts. It took years to settle on winning contractors for the three regions, however, due to various bid protests and award reversals. Health Net Federal Services has run North Region under the new contract since April 2011. Humana Military Healthcare Services has had the South Region under the new contract since April 2012. Along with TriWest, these contractors have continued to run remote Prime networks under temporary order while waiting final word from TRICARE on imposing Prime area restrictions written into original contracts.
The driver behind new restrictions on Prime is cost. Managed care is more cost efficient for the private sector but more expensive for the military to offer than traditional fee-for-service insurance. This is true in part because Congress won't allow Prime fees to keep pace with health inflation. So more beneficiaries using Standard means less cost to TRICARE.
Of beneficiaries impacted by the Prime area rollback, more than half, almost 98,000, reside in South Region. Roughly 36,000 are West Region beneficiaries and more than 37,000 are in the North Region.
Let your elected officials know how you feel about this change in TRICARE benefits.
Two notes before jumping in:
Applebee’s – free meal, Friday, Nov. 11:Last year, Applebee’s served 1,024,000 million free meals to military veterans and active servicemembers. Applebee’s is again offering a free meal to military veterans and active-duty service members on Veteran’s Day, Friday, Nov. 11, 2011. There will be 7 entrées to choose from. Military ID or proof of service required. Find locations at http://applebees.com/.
Chili’s – free meal, Friday, Nov. 11. Chili’s is offering all military veterans past and present their choice of one of 6 meals. This offer is available during business hours on November 11, 2011 at participating Chili’s in the U.S. only. Dine-in from limited menu only; beverages and gratuity not included. Veterans and active duty military simply show proof of military service. Visit their website to find locations.
Golden Corral – Free meal, Monday Nov. 14: The 10th annual Golden Corral Military Appreciation dinner will be held on Monday, November 14, 2011 from 5 pm to 9 pm in all Golden Corral Restaurants nationwide. The free “thank you” dinner is available to any person who has ever served in the United States Military. If you are a veteran, retired, currently serving, in the National Guard or Reserves, you are invited to participate in Golden Corral’s Military Appreciation Monday dinner. For more information visit http://www.goldencorral.com/military/.
Special thanks to Golden Corral: To date, Golden Corral restaurants have provided over 2.5 million free meals and contributed over $4.3 million to the Disabled American Veterans organization.
Hooters – Free Meal, Friday, Nov. 11. Hooter’s is serving up a free meal to military veterans all day on Veterans Day. Offer good for all veterans and active duty military personnel. Choose one of the new specialty items on the Hooter’s menu. Offer valid at participating Hooters only; open to all active duty and military veterans with valid military ID or proof of military service. Drink purchase required. For more information, visit, www.HootersVeteransDay.com.
Krispy Kreme – Free doughnut. Available only at participating Krispy Kreme stores. Offer available to all active-duty, retirees & veterans on Friday November 11th. Be sure to call ahead to verify your local Krispy Kreme is participating.
McCormick & Schmick’s Seafood Restaurants – free lunch or dinner, Sunday Nov 13, 2011: McCormick & Schmick’s is celebrating their 13th annual Veteran’s Appreciation Event on Sunday, November 13th. Veterans will be able to choose a complimentary lunch or dinner entrée. Veterans must provide proof of military service. Be sure to contact your local McCormick & Schmick’s as this is valid at participating restaurants only. Also, Space is limited and reservations are highly recommended. For more information visit: M&S Veterans Appreciation Event.
Outback Steakhouse – A week of Free Bloomin’ Onions and Cokes Monday Nov. 7 – Friday Nov. 11. Outback Steakhouse is honoring America’s military veterans by offering active duty military and veterans a free Bloomin’ Onion and a Coca-Cola product during the week leading up to Veteran’s Day. This offer is available to Military Personnel who have one of the following forms of identifications: U.S Uniform Services Identification Card, U.S Uniform Services Retired Identification Card, Current Leave and Earnings Statement (LES), DD form 214 Veterans Organization Card (i.e., American Legion and VFW), Photograph in Uniform, Wearing Uniform. For more information, visit,http://outback.com/companyinfo/veteransday.aspx.
The Outback understands commitment. For the past two years, The Outback, with the help of their patrons, has donated $2 Million to Operation Homefront, a non-profit organization providing everyday and emergency support for active troops, wounded warriors and their families.
Subway – Free Six Inch Sub. Select Subway locations offer a FREE six inch sub to military veterans on Veteran’s Day. However, Subway restaurants are franchises, so this offer may not be available everywhere. Please call ahead.
Texas Roadhouse – free meal, Friday, Nov. 11. Offer varies by location; our local Texas Roadhouse is offering a free meal from opening until 4pm. Other locations may vary in offer, hours, or availability. Call ahead to your local restaurant for more information.
T.G.I. Friday’s – Buy one get one free Nov 11-14. At participating locations for anyone with an old or current military ID. November 11-14.
Uno Chicago Grill, Friday, Nov. 11. Uno’s is offering a free entree or individual pizza with a purchase of an entree or pizza of equal or greater value. Offer good for all military for veterans and active duty military. ID or proof of service required: Show up in uniform (if your service permits), provide military ID, show a picture of yourself in uniform, or have other ID showing proof of service. More info here.
Update: Home Depot and Lowes 10% Military Discount Available Everyday.
Home Depot: The Home Depot(R) is offering all active duty personnel, reservists, retired military, veterans and their families a 10 percent discount off their purchases in honor of Veteran’s Day. The offer is valid on purchases of up to $2,000 for a maximum of $200 and is available at The Home Depot stores, The Home Depot Design Center locations, Yardbirds and EXPO Design Center(R) locations. The 10% discount is available everyday for active duty and retirees, but not all veterans. Home Depot makes this offer available to all veterans on most military holidays. You can also find Home Depot discounts online.
Lowes: Lowe’s Companies, Inc. will offer all active, reserve, honorably discharged, retired military personnel and their immediate family members a 10 percent discount on in-store U.S. purchases made during the Veterans Day holiday. The discount is available Nov. 7 – Nov. 11. The discount is available on in-stock and special order purchases up to $5,000. To qualify, individuals must present a valid military ID or other proof of service. Excluded from the discount are sales via Lowes.com, previous sales, and purchases of services or gift cards. Like Home Depot, Lowes offers this discount daily to active duty military members, but not to veterans. However, they extend the offer to military veterans on military holidays. You can also find exclusive discounts at Lowe’s.com.
Fee Free Day at National Parks. To honor America’s service men and women, Secretary of the Interior Ken Salazar announced that areas managed by the National Park Service would not charge entrance fees for Veteran’s Day weekend – November 11-13, 2011.Over 100 national Parks will be participating in this event.
Bed and Breakfast for Vets
In the third year of the program, B&Bs for Vets has organized over 485 (and counting) participating Bed and Breakfasts and Inns across the US and Canada which will be offering veterans a free night’s stay on November 10th, the night before Veterans Day. This offer is available to both active duty military members and veterans with ID, but space is limited. Each Inn and B&B has at least one room available for this promotion and reservations must be made directly through the participating Inns and B&Bs. For more information visit B&Bs for Vets.
Sam’s Club® locations nationwide will distribute 36,000 Hugo® canes free of charge on November 9th, 10th, 11th, 2011 to U.S. military veterans in need of mobility assistance. Limited quantities available, while supplies last. Sam’s Club® Membership is not required, but proof of military service may be required. For more information, visit HugoSalutes.com.
Jos. A. Bank Veteran’s Day coupons:
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