New Tricare fees delayed, military health system would be reorganized under bill

Broad changes could be coming to Tricare and the military health system under legislation being drafted by the House Armed Services Committee, but active-duty personnel and current retirees wouldn't see the immediate hits to their wallets that were proposed earlier this year in the Pentagon's fiscal 2017 budget.

Under draft legislation to be revealed Monday House lawmakers will propose to overhaul the military health system and Tricare health plans to maintain the “medical readiness of the force,” now and in the future, according to the HASC staff.

Those changes include reorganizing multiple Tricare programs into two options: the existing Tricare Prime program and Tricare Preferred — a network care option similar to Tricare Standard and Extra. The current fee structure would remain in place but could change in 2020 if the Defense Department meets certain standards for patient access and care.

Under the HASC proposal, all personnel now serving or who will retire before Jan 1, 2018, will elect to use Tricare Prime or Tricare Preferred and will pay the current fee structure, with enrollment fees adjusted to the cost of living.
The current fee structure would remain in place until 2020. Then, if DoD has shown to Congress that it has improved the overall quality and access to care for beneficiaries, retirees using Tricare Preferred would start paying an annual enrollment fee: $100 per an individual and $200 for a family.

Those on Tricare Prime would continue to pay the COLA-based enrollment fee.

Active-duty families would continue to not pay any enrollment fees until their sponsor retires.

Anyone enlisting after Jan. 1, 2018, would pay an annual fee, including the active-duty member, of either $180 for an individual and $360 for a family for Tricare Prime, or $300 for an individual or $600 for a family for Tricare Preferred.

When they eventually retire, they would pay $325 for an individual and $650 for a family on Prime and $425 for an individual and $850 for a family for Tricare Preferred.

Another change also would be implemented for new users in 2018: they would pay set amounts for primary and specialty care visits under Tricare Preferred, instead of the 20 percent or 25 percent rate currently used.

Beneficiaries who use Tricare Reserve Select, Tricare Retired Reserve or Tricare Young Adult would be moved into the Tricare Preferred umbrella, which allows patients to see a network provider at a lower cost or go out of network without a referral. The fee structure for those programs would remain as they are.

The Pentagon, in its fiscal 2017 budget proposal, sought to require all working-age retirees pay annual enrollment fees regardless of which Tricare program they selected or forfeit their health care for a year.

The $48.8 billion health budget request also sought to increase pharmacy fees across-the-board and proposed new enrollment fees, based on a percentage of gross retired pay, for the oldest military retirees and other Medicare eligible retirees.
The HASC rejected both those requests.

“When we looked at reforming the Tricare benefit, we looked at the goal of preserving readiness, and ensuring that military treatment facilities would remain as a readiness platform We want people to use military treatment facilities," a House staff member said.

The proposed legislation also makes changes to the military health system to "ensure medical readiness and streamline administrative structure," staff said.

The bill would require military health facilities to operate past normal business hours to improve patient access and to maintain urgent care facilities that are open until 11 p.m., or have a contract with a community based urgent care center to ensure that Tricare beneficiaries could seek urgent care without a referral.

The bill also would place military health facilities under the administration of the Defense Health Agency, with the three service surgeons general being responsible for command of military medical personnel, medical readiness, manpower, training and equipment.

And military treatment facilities would be required to be “right sized’ for their communities, with large medical centers focused on trauma and specialty care, military hospitals providing in-patient care in areas where the surrounding communities cannot provide that care, and ambulatory care clinics in areas with ample civilian emergency and specialty care services.

The draft legislation, proposed by HASC Committee Chairman Mac Thornberry, R-Texas, must be approved by the House and reconciled with the Senate before it becomes law. The Senate is expected to introduce its version of the fiscal 2017 National Defense Authorization Act in early May.