by Nick Budnick
Monday, October 22, 2012
The Pentagon’s health care program is poised to cut back its low-cost HMO-style plan across five Western states, meaning either longer drives or higher copays and additional hassle for thousands of Oregonian military retirees and their families.
Officials say details aren’t final; and the changes for Tricare, the Pentagon’s health care program, won’t go into effect until April. But the outlines of the changes were reported in Army Times, a military newspaper, late last week. Congressman Greg Walden, R-Ore., has asked the Pentagon to release more information immediately, noting that the people most affected are in the dark.
“These changes could have a significant effect on the lives of Tricare beneficiaries,” he wrote in an Oct. 18 letter to Tricare. “Affected service members and veterans should be made aware right away.”
The cuts are slated for Tricare Prime, the military’s version of Kaiser Permanente. About 13,700 beneficiaries in Oregon pay $12 copays per office visit on top of a yearly enrollment fee.
Under the new system, most retiree beneficiaries of Tricare Prime will be shifted to Tricare Standard, meaning a copay of 25 percent as well as the hassle of submitting their own claims for reimbursement.
The changes won’t affect active-duty military or their families, or retirees age 65 or over. Beyond that, Pentagon spokespeople say it’s premature to roll out details of the changes. “The department is currently reviewing this process and no decision has been made,” said Cynthia Smith of the Department of Defense.
Some people are expecting a harder time finding providers who take Tricare.
“There will be greater out-of pocket expenses for us,” said Dave Dotterrer a retired U.S. Marine and former state senatorial candidate from Ashland. “I’m going to guess there will be fewer providers willing to take Tricare, which is already an issue for many of us out here.”
The Tricare Prime benefit will continue only for those living near a participating military treatment facility. Oregon only has two facilities, the U.S. Coast Guard clinics in North Bend and Astoria. According to the Army Times, that means people within a 40-mile radius, though Tricare spokesman Austin Camacho said a 100-mile radius is also under consideration.
People outside that radius may be able to continue in Tricare Prime under certain circumstances, such as if their primary care provider signs a waiver.
These changes have been in the works for some time as the military has contracted for new Tricare providers, said Barb Cohoon, deputy government relations director for the National Military Family Association. She said the timing may cause Tricare members to look for new primary care providers even as new Medicaid members do, under health care expansion slated to kick in under federal reforms. Then there’s the possibility of budget-driven Medicare reimbursement cuts that would affect Tricare as well.
“There’s shortage out there already,” she said. “Access may be harder.”
Walden says the Pentagon needs to be more transparent. “I’ve heard some rumblings that they wanted to wait until after the election … I have it on a pretty good basis,” he said. “If they’ve made the decision they ought to tell people so they can understand what the implications are.”