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New Tricare tool shows if Prime cuts affect you

Mar. 1, 2013 - 10:31AM   |   Last Updated: Mar. 1, 2013 - 10:31AM  |  
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Are you one of the Tricare Prime beneficiaries who will be affected by the shrinking of Prime service areas scheduled to take effect Oct. 1?

Tricare Management Activity has created a ZIP Code tool to help you.

Available at http://tricare.mil/Welcome/MediaCenter/CurrentTopics/ChangestoPSAs/PSALookup.aspx">PSA Zip Code Look-Up, the tool allows beneficiaries to type in their address' five digits to see if they "live in an area that is changing," according to Tricare.

The site also has information on contacting Tricare regional contractors, receiving email alerts about the upcoming changes and viewing Tricare's explanation of the Prime Service Area reductions.

Beginning Oct. 1, Tricare Prime, the military's version of an HMO, will shrink to areas within 40 miles of an active or former military base — a change that will force 173,000 retirees and family members to switch to Tricare Standard, the military's version of a fee-for-service plan.

Active-duty members and their families are not affected; they can use Standard or Tricare Prime Remote, a program for those in rural areas.

The Pentagon says the cuts will save the government $45 million to $65 million a year, based on estimates that DoD pays an average of about $600 more per year per beneficiary to provide Prime to compared to Standard.

According to the government, the retrenchment of Prime areas has been in the works since 2007, when DoD drafted a new generation of Tricare contracts. A series of appeals and award protests delayed implementation.

Military retirees in Prime pay annual enrollment fees of $269.26 for an individual and $538.56 for families, and their co-pays for outpatient care are $12. Prime requires no deductibles.

Tricare Standard has no enrollment fees but carries greater out-of-pocket costs: cost shares of 25 percent for retirees and annual deductibles for outpatient care of $150 for an individual and $300 for a family for paygrades E-5 and above and retirees.

According to DoD, a family of three using Tricare Standard averaged $2,075 in out-of-pocket costs for health care in fiscal 2009, while a similar family in Prime paid about $1,375. And, the family on Standard paid $19.50 a month more than the one on Prime.

Some lawmakers learned about the impending changes only in October. They have asked the Pentagon to provide a full report on the impact of the reduction by late March.

Provisions in the plan allow Prime beneficiaries who see a physician outside the 40-mile service area to stay in Prime if they live within 100 miles of an available primary care manager and sign a waiver saying they don't mind making longer drives.

The purpose of the initiative, however, is to get people to switch to Standard, and Tricare officials hope they do.

"People who use Standard are very, very pleased with it. Our customer service satisfaction of those using Standard is the highest of all our beneficiaries," Dian Lawhon, Tricare's director of beneficiary education and support, told reporters in January.

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