By Donna Miles American Forces Press Service
WASHINGTON
(AFRNS) — Defense Secretary Robert M. Gates is seeking modest premium
increases for working-age military retirees who use the TRICARE Prime health
plan.
Secretary
Gates unveiled sweeping cost-cutting initiatives Jan. 6, including a
recommendation to increase TRICARE Prime premiums for working-age retirees in fiscal 2012, the first increase in the plan’s 15-year history.
“For some time, I’ve spoken about the department’s unaffordable health costs, and in particular the benefits provided to working-age retirees under the TRICARE program,” the secretary told reporters. “Many of these beneficiaries are employed full-time while receiving their full pensions, and often forego their employers’ health plan to remain with TRICARE,” he said. “This should not come as a surprise, given that the current TRICARE enrollment fee was set in 1995 at $460 a year for the basic family plan, and has not been raised since.”
Secretary Gates noted the dramatic increase in insurance premiums during that period for private-sector and other government employees. Federal workers pay roughly $5,000 a year for a comparable health insurance program, he said. “Accordingly, with the fiscal year 2012 budget, we will propose reforms in the area of military health care to better manage medical cost growth and better align the department with the rest of the country,” Secretary Gates said. “These will include initiatives to become more efficient, as well as modest increases to TRICARE fees for … working-age retirees, with
fees indexed to adjust for medical inflation. “These initiatives could save the department as much as $7 billion over the next five years, he said.
Military retirees automatically are enrolled in one of two TRICARE plans, program spokesman Austin Camacho explained. Retirees who join TRICARE Prime, the system’s managed-care option that covers active-duty members, pay an annual enrollment fee of $230 per year for an individual or $460 for a family. Those in TRICARE Standard, a fee-for-service plan, pay no enrollment fee or premium. Instead, they pay a yearly deductible of $150 per person or $300 per family, as well as co-payments or cost shares for inpatient and outpatient care and medications, up to a $3,000 annual cap on out-of-pocket expenses.
TRICARE
Prime, the managed-care option that covers all active-duty members and many
retirees, costs the government $4,202 per beneficiary per year, said Mr.
Camacho. TRICARE Standard, the program’s fee-for-service plan, costs
$3,584 per beneficiary per year. TRICARE for Life, for beneficiaries age
65 and older, costs the government $3,874 per patient per year.
Military retirees are not required to report whether they have jobs that offer insurance plans, Mr. Camacho said, noting that having other insurance does not take them off the TRICARE rolls. Rather, he explained, TRICARE becomes the “second payer” for health care, picking up co-payments and deductibles
from the primary insurance plan.
Meanwhile,
the senior TRICARE officer told American Forces Press Service the system is
poised to support Secretary Gates’ new efficiency measures and already is
making progress as it strives to provide the best health care at the best cost.
“All of these things help us work together to help us achieve the secretary’s goals, and we are already starting to make progress,” Navy Rear Adm. (Dr.)
Christine S. Hunter said.
Dr. Hunter cited several initiatives already bearing fruit. More beneficiaries
are using the lower-cost mail-order pharmacy option to fill prescriptions. They are getting their immunizations and increasingly participating in a new concept called “patient-centered medical homes” that provide more comprehensive and personalized healthcare. They are making greater use of online appointment services and health care education materials. And they are increasingly using expensive emergency-room services only for actual emergencies. “We need to be very aware that there is a pressure [to improve efficiency and control costs] and the resources are not infinite,” said Dr. Hunter. “But we are all part of the solution.”
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