Military Advantage

Senate Tricare Plan Would Dramatically Raise Some Retiree Costs

(Stock image)
(Stock image)

A Senate proposal would bring forward to next year a plan to charge military retirees to use Tricare Select, increasing annual costs by at least hundreds of dollars.

The enrollment fee plan, which by current law would take effect in 2021 if Tricare meets a series of network benchmarks, would instead start in 2019 -- and cost up to hundreds of dollars more than what is currently planned.

The proposal does not affect Tricare for Life users.

Where Did These Fees Come From?

Here's a little background: Congress last year decided to revamp the Tricare programs by increasing fees for Tricare Prime retirees; setting flat-rate, out-of-pocket costs for most services; and creating an enrollment fee for future retirees in Tricare Standard, renamed Tricare Select, with the option of adding one for current retirees in 2021.

Retirees who do not live near a military treatment facility have no choice but to use the Select program. The plan was originally presented to troops, retirees and families as protecting a lower-cost benefit for currently serving troops and retirees by grandfathering them into current plan structures or setting lower fees.

But when the fees were actually revealed, an alternate reality became clear for retirees and active-duty family users of the freshly rebranded Tricare Select program. While they were temporarily safe from enrollment fees, their out-of-pocket costs were set at a higher rate than troops who joined or retired after January of this year.

For example, current retirees on Select were set to pay $41 for a specialty visit or $35 for a primary-care visit, while future retirees would by law pay $40 for specialty or $25 for primary care.

And although protected from an enrollment fee now and in the future, active-duty families have the same cost-share problem. By law, new troops and users of Tricare's purchased plans, like Tricare Reserve Select, are paying $15 for primary care, while current troops are paying $21, for example.

Meanwhile, Congress kicked the can on potential enrollment fees for current Tricare Select retirees until 2021, and even put into law requirements before it's triggered.

For it to happen, the U.S. Comptroller must submit a report in early 2020 to the House Armed Services Committee on whether Tricare is meeting network standards and overall satisfaction of Select users, among other factors.

If that report doesn't make the situation look good, Congress would then have a chance to repeal the whole thing.

According to a top Tricare official, the system is currently nowhere near meeting network standards in its West region. Health Net, which manages that region, has developed 12 central focus regions for network development. As of May, only two of them were complete. The official said it could be 2021 before they are ready.

"Congress recognized that this would be some tough work because they gave us until 2021," Ken Canestrini, who directs Tricare's health plan, told me in May.

The Senate's New Plan Skips the Review Process

Despite Canestrini's admission that the network is not ready to meet the benchmarks, the Senate is willing to skip the review process and force all Tricare Select users to pay enrollment fees.

Here's why: This year, the Senate decided to address the retiree out-of-pocket fee disparity. But it first needed to find a way to pay for it.

The answer? Ditch the 2021 timeline and current enrollment fee plan, and instead knock everyone into the new enrollment fee structure right away.

The Senate's plan makes a few changes that military retiree advocates see as incredibly worrisome.

First, it removes the review process or a chance for the whole thing to be repealed before current retirees must pay to enroll in Tricare Select.

Next, instead of annually charging current users $150 for individual enrollment or $300 for a family starting in 2021, it knocks everyone to a $450 individual and $900 family fee immediately. That means the grandfathering idea goes out the window, and both current and future military retirees will be paying out-of-pocket fees.

-- Amy Bushatz can be reached at amy.bushatz@military.com.

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