Thursday, October 2, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

171,000 retirees likely to lose Tricare Prime option

By
From page B10 | November 11, 2012 |

With the presidential election over, Defense officials are expected to announce soon that military retirees and their dependents living more than 40 miles from a military treatment facility or base closure site will lose access to Tricare Prime, the military’s managed care option.

These beneficiaries would be expected to shift to Tricare Standard, their fee-for-service insurance option, which would mean an increase in out-of-pocket costs for beneficiaries who are frequent users of health services.

A total of 171,000 retirees and dependents are expected to have to shift coverage when remote Prime networks go away. Tentative plans are for this to occur April 1, 2013, in the west region, which would coincide with UnitedHealth Military and Veterans Services taking over the region’s support contract from TriWest Healthcare Alliance after 16 years.

The North and South Tricare regions are expected to close down Prime service areas beyond 40-mile catchment areas of bases or base closure sites by Oct. 1, 2013, the date when current Prime enrollment periods expire for most beneficiaries.

Active-duty members and their families generally would not be affected. Drilling National Guard members and reservists living far from military bases could see small increases to health costs. This would occur if they have been taking advantage of modest discounts available under Tricare Reserve Select when network providers are used. Such discounts would end in areas far from bases if the Prime option goes away.

Under Tricare Prime, beneficiaries get managed care through providers in the network. They pay an annual enrollment fee of $269.28 for individual coverage or $538.56 for family coverage. Retirees and family members also are charged co-pays of $12 for each doctor visit.

Under Tricare Standard, beneficiaries can choose their own physicians and pay no annual enrollment fee. But when they need care, retirees must cover 25 percent of allowable charges. Retirees also have an annual deductible of $150 for the individual or $300 per family. Total out-of-pocket costs, however, are capped at $3000 per family.

In most Prime service areas, about half of eligible retirees already choose to use Standard rather than enroll in the network.

The end of Prime outside of 40-mile “catchment” areas of military treatment facilities has been anticipated since 2007, when Defense officials drafted the third generation of Tricare support contracts. It called for returning the managed care option to its original concept of being a backup network to military clinics and hospitals when they can’t provide managed care to all beneficiaries living nearby or in areas where bases have been closed and military health facilities shuttered.

Through the first two Tricare contracts, on the assumption that managed care saved money for the government, contractors had financial incentive to establish networks beyond 40-mile catchment areas. In the South Region, for example, the contractor has offered Prime everywhere. But experience has shown that providing Prime far from bases can add costs to the system, Tricare officials concluded.

Though they wrote the new generation of support contracts to constrict Prime service areas, health officials wanted the shift to occur across all regions simultaneously. That hasn’t been possible until now because of delays in finalizing contract awards, the result of multiple protests and even a few reversals of original contract awards.

Contracts for every region are now settled. Health Net Federal Services has been running the North Region under the new contract since April 2011. Humana Military Healthcare Services has operated the South Region under the new contract since April this year. But all Prime service areas have been maintained with contract modifications, awaiting final word from Defense that Prime area restrictions are to be implemented.

The new contracts were drafted during the Bush administration and are intended to be more comprehensive and efficient. But sensitive to how a change in Prime eligibility might be used by politicians this fall, Defense officials ordered plans to end Prime for retirees living outside catchment areas, including draft notification letters, shelved until after the election.

Plans for implementation have not changed, congressional and health sources said. But they also have not been announced officially yet.

“The Department is considering whether to maintain the same number of PSAs (Prime service areas) as it has now,” said Cynthia O. Smith, a spokeswoman for the Department of Defense. Until a decision is final on reducing PSAs, the department won’t confirm the number of beneficiaries potentially affected or the likely dates for executing the changes.

Some members of Congress already are concerned. Sen. Dean Heller, R-Nev., told Dr. Jonathan Woodson, assistant secretary of defense for health affairs, in recent letter he was “dismayed” by news reports that Prime “will be cut for many of the military families and constituents I represent, not only in Reno but also throughout the northern part of the state.”

Heller said the plan would cause “more out-of-pocket expenses and longer drive times. . . . I am very troubled by these changes and am concerned that these alterations are not being made in a transparent manner. If changes are made, I hope you will notify those affected immediately.”

A spokesman for Heller said Woodson had not yet answered the letter. Given the nation’s debt crisis and the budget cuts looming for defense programs, Congress is not expected to block this long-standing plan to tighten access to Prime and hold down costs. To do so likely would require lawmakers to find equivalent budget savings elsewhere.

Write Military Update, P.O. Box 231111, Centreville, VA, or email milupdate@aol.com or twitter: Tom Philpott @Military_Update.

LEAVE A COMMENT

Discussion | No comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

.

Solano News

 
Vacaville man earns Carnegie heroism medal

By Ian Thompson | From Page: A1 | Gallery

 
Head-on crash sends 2 to trauma centers

By Amy Maginnis-Honey | From Page: A1, 1 Comment | Gallery

 
Mundy fifth-graders share their thoughts

By Mayrene Bates | From Page: A2

 
Veterans meet set in November

By Susan Hiland | From Page: A3

 
Solano Tea Party Patriots meet next week

By Susan Hiland | From Page: A3

Bevy of vintage warbirds expected at Nut Tree air show

By Ian Thompson | From Page: A3 | Gallery

 
Dickey’s Barbecue Pit hosts grand opening

By Barry Eberling | From Page: B6, 1 Comment

 
Weather for Thursday, Oct. 2, 2014

By Daily Republic staff | From Page: B12

Fairfield police log: Sept. 30, 2014

By Susan Hiland | From Page: A12

 
Suisun City police log: Sept. 30, 2014

By Susan Hiland | From Page: A12

.

US / World

FBI turns animal cruelty into top-tier felony

By The Associated Press | From Page: A3

 
California Catholics challenge abortion order

By The Associated Press | From Page: A4

San Francisco expands free public Wi-Fi access

By The Associated Press | From Page: A4

 
Judge: Stockton must treat pension like other debt

By The Associated Press | From Page: A4

Liberia short on ambulances for Ebola patients

By The Associated Press | From Page: B5

 
Wife of slain Los Angeles-area mayor released

By The Associated Press | From Page: A5

Ebola patient told hospital he was from Liberia

By The Associated Press | From Page: B5

 
Caltrans: Bay Bridge tower rods exposed to water

By The Associated Press | From Page: A5

Secret Service chief quits due to security lapses

By The Associated Press | From Page: B5

 
2 children in Los Angeles County have enterovirus

By The Associated Press | From Page: A5

Palestinians: Israeli occupation must end in 2016

By The Associated Press | From Page: B5

 
Infant’s body found in California trash facility

By The Associated Press | From Page: A5

Mexico’s probe of army slayings raises doubts

By The Associated Press | From Page: B5

 
John Wayne’s heirs lose ‘Duke’ legal brawl

By The Associated Press | From Page: A5

Hong Kong protesters threaten to occupy buildings

By The Associated Press | From Page: B5

 
Man convicted of murder in killing over loud music

By The Associated Press | From Page: B5, 1 Comment

3 Afghan soldiers who fled say they can’t go home

By The Associated Press | From Page: B5

 
Poll: Divided voters still focus on economy

By The Associated Press | From Page: B5

Respiratory virus seen in 4 deaths; role unclear

By The Associated Press | From Page: B5

 
920 California chickens killed with golf club

By The Associated Press | From Page: A5

App teaches kindergartners basic computer coding

By The Associated Press | From Page: A12

 
2 white Ohio women sue over sperm from black donor

By The Associated Press | From Page: A12

.

Opinion

It’s time to teach history

By Jay Ambrose | From Page: A11

 
Read this column ASAP or immediately

By Reg Henry | From Page: A11

Real reasons neighborhoods are in trouble

By Letter to the Editor | From Page: A11

 
Editorial Cartoon: Oct. 2, 2014

By Daily Republic Syndicated Content | From Page: A11

 
Crazy? Violent? Lose your guns

By Kelvin Wade | From Page: A11

.

Living

Today in History: Oct. 2, 2014

By The Associated Press | From Page: A2

 
Community Calendar: Oct. 2, 2014

By Susan Hiland | From Page: A2

Horoscopes: Oct. 2, 2014

By Holiday Mathis | From Page: A9

 
Our son’s suicide has made us feel like outcasts in our community

By Kathy Mitchell and Marcy Sugar | From Page: A9

.

Entertainment

TVGrid

By Daily Republic Syndicated Content | From Page: B6

 
Lena Dunham launches tour for book of adult essays

By The Associated Press | From Page: A7

‘Interstellar’ to be released 2 days early on film

By The Associated Press | From Page: A7

 
Steinem: Domestic violence discussion a positive

By The Associated Press | From Page: A7

‘Orange is the New Black’ author talks Season 3

By The Associated Press | From Page: A7

 
Joy Behar to debut a 1-woman show in New York

By The Associated Press | From Page: A7

Tony Bennett sets mark as oldest act with No. 1 LP

By The Associated Press | From Page: A7

 
.

Sports

College notebook: Former Falcon Williams tearing it up as Torero

By Paul Farmer | From Page: B1 | Gallery

 
Bumgarner, Giants silence Pirates 8-0 to advance

By The Associated Press | From Page: B1 | Gallery

A’s part ways a day after 12-inning loss to Royals

By The Associated Press | From Page: B1 | Gallery

 
49ers prepare for familiar face in Chiefs Smith

By The Associated Press | From Page: B1 | Gallery

Raiders leave for bye after meeting with new coach

By The Associated Press | From Page: B1 | Gallery

 
JC volleyball: Solano wins twice in Falcons Classic

By Daily Republic staff | From Page: B2

JC women’s soccer: Sjoberg nets 2 goals as Solano ties Chabot

By Daily Republic staff | From Page: B2

 
Prep water polo: Rodriguez boys swim to 11-1 win over Armijo

By Daily Republic staff | From Page: B2

Prep girls tennis: Stybnarova earns victory at No. 1 singles

By Daily Republic staff | From Page: B2

 
 
Prep cross country: Armijo rolls to sweep at MEL center meet

By Daily Republic staff | From Page: B2

Drivers fear next round of NASCAR’s Chase

By The Associated Press | From Page: B2 | Gallery

 
Wambach, players file lawsuit over World Cup turf

By The Associated Press | From Page: B3

Oslo latest city to drop out of 2022 Olympic race

By The Associated Press | From Page: B3

 
Cardinals re-sign Fairfield High graduate Bishop

By Staff and wire reports | From Page: B3

LeBron warmly welcomed ‘home’ by Cleveland fans

By The Associated Press | From Page: B3

 
Trout makes playoff debut when Angels host Royals

By The Associated Press | From Page: B3 | Gallery

 
Tigers hope starters can outdo Orioles bullpen

By The Associated Press | From Page: B3

This date in sports history for Thursday, Oct. 2, 2014

By The Associated Press | From Page: B4

 
.

Business

Stocks start October with a drop

By The Associated Press | From Page: B6

 
GM looks to new vehicles, China to boost profit

By The Associated Press | From Page: B6

5 reasons bonds may be less safe than you think

By The Associated Press | From Page: B7

 
Why the bond market is more fragile than you think

By The Associated Press | From Page: B7

.

Obituaries

John ‘Bo’ M. Miller

By Nancy Green | From Page: A4

 
Laura M. Gerdes-Lemmons

By Nancy Green | From Page: A4

.

Comics

Baby Blues

By Daily Republic Syndicated Content | From Page: A8

 
Wizard of Id

By Daily Republic Syndicated Content | From Page: A8

Garfield

By Daily Republic Syndicated Content | From Page: A8

 
Pickles

By Daily Republic Syndicated Content | From Page: A8

B.C.

By Daily Republic Syndicated Content | From Page: A8

 
Frank and Ernest

By Daily Republic Syndicated Content | From Page: A8

Blondie

By Daily Republic Syndicated Content | From Page: A8

 
Sally Forth

By Daily Republic Syndicated Content | From Page: A8

Peanuts

By Daily Republic Syndicated Content | From Page: A8

 
Beetle Bailey

By Daily Republic Syndicated Content | From Page: A8

Dilbert

By Daily Republic Syndicated Content | From Page: A8

 
Rose is Rose

By Daily Republic Syndicated Content | From Page: A8

Get Fuzzy

By Daily Republic Syndicated Content | From Page: A8

 
For Better or Worse

By Daily Republic Syndicated Content | From Page: A8

Zits

By Daily Republic Syndicated Content | From Page: A8

 
Baldo

By Daily Republic Syndicated Content | From Page: A8

Cryptoquote

By Daily Republic Syndicated Content | From Page: A9

 
Sudoku

By Daily Republic Syndicated Content | From Page: A9

Word Sleuth

By Daily Republic Syndicated Content | From Page: A9

 
Crossword

By Daily Republic Syndicated Content | From Page: A9

Bridge

By Daily Republic Syndicated Content | From Page: A9