Near-final regulations released last week by the Defense Health Agency to implement sweeping Tricare reforms on Jan. 1 include a surprise restructuring of appointment fees for active-duty families and retirees under 65 and their families, who get their health care outside of military treatment facilities.
Agency leaders insist the new "fixed dollar" fees for the newly renamed "Select" option, to replace Tricare Standard and Extra, merely reflects "average" out-of-pocket costs occurring under the traditional cost-share method of charging users a percentage of Tricare's allowable charges per appointment.
Advocates for beneficiaries are skeptical. They have asked to see the math behind the new Select rates, particularly for primary and specialty care appointments under the fee-for-service insurance option.
Unlike with Standard and Extra, beneficiaries will need to enroll in Select annually, as they do for Prime, the managed-care plan, to sustain their coverage. For 2018, however, a start-up year for a host of Tricare reforms, current Prime enrollees automatically will stay enrolled in Prime, and Standard and Extra users automatically will be enrolled to Select, but can switch during the year.
By 2019, enrollment in one or the other option will be mandatory before the start of every calendar year to keep Tricare coverage. By 2021, enrollment in Select for working age retirees will include an enrollment fee, as required by Prime.
Elderly or disabled retirees who use Tricare for Life, the military's supplemental insurance to Medicare, and families of active duty enrolled in Prime will not impacted by the new fees.
Military associations weren't surprised that the health agency, in drafting rules to implement the Tricare reforms, shifted to fixed fees for Select users. Defense health officials had been urging Congress to allow them to scrap fees tied to percentages of allowable charges for years.
What stunned advocacy groups last week was the size of fixed fees unveiled for Select. They are higher than appointment fees planned for new entrants into service in 2018 and beyond, meaning the current fight over whether to protect active duty families and working-age retirees has been turned on its head.
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