Despite upcoming service area reductions, TRICARE Prime will remain a health care option for 97 percent of the more than 5 million beneficiaries eligible for the health care plan, Military Health System officials said.
The 3 percent difference, which comprises about 171,000 beneficiaries who mostly reside more than 40 miles from a military clinic or hospital, automatically will revert to the TRICARE Standard health care option Oct. 1, officials said.
Those beneficiaries recently received a letter explaining their options, and they will receive a reminder letter in June or July.
“The first thing TRICARE beneficiaries should know about the reduction in the number of Prime service areas is that it doesn’t mean they’re losing their TRICARE benefit,” said Dr. Jonathan Woodson, the assistant secretary of defense for health affairs. “Next, it’s important to remember this change does not affect most of the more than 5 million people using TRICARE Prime, and (it affects) none of our active-duty members and their families.”
As a follow-up to the initial notification, he noted, a second letter will be mailed in early summer to make sure all affected beneficiaries have the time and information to make important decisions about their future health-care options.
The TRICARE website has the most current details at http://www.tricare.mil/PSA and gives beneficiaries the option to sign up for email updates. A ZIP code tool is available on the site to help beneficiaries determine if they live in an affected Prime service area.
As always, officials said, TRICARE beneficiaries still are covered by TRICARE Standard. For those living within 100 miles of a remaining Prime service area, they added, re-enrolling in Prime may be an option, depending on availability. To do this, beneficiaries must waive their drive-time standards and possibly would need to travel long distances for primary and specialty care.
“I urge all impacted beneficiaries to carefully consider their health care options — they should talk them over with family members and their current health care provider,” Woodson said. “Many beneficiaries may be able to continue with their current provider using the Standard benefit. Being close to your health care team usually offers the best and safest access to care.”
In TRICARE Prime, those enrolled are assigned a primary care provider who manages their health care. Retirees pay an annual enrollment fee and have low out-of-pocket costs under this plan. TRICARE Standard is an open-choice option with no monthly premiums and no need for referrals, but there are cost shares and an annual deductible.
Defense Department officials first planned to reduce the number of Prime service areas in 2007, when it requested bids for the third generation of regional health care support contracts. The areas being eliminated are not close to existing military treatment facilities or sites affected by base realignments and closures. Prolonged protests resulted in a staggered transition, officials said, and the decision was made to keep all Prime service areas in place until all three contracts were in place. The West region completed its transition April 1.
Eliminating select Prime service areas allows TRICARE and the Defense Department to better control costs while continuing to deliver a high-quality health care benefit to all 9.6 million TRICARE beneficiaries, officials said.