Opinion: What will beneficiaries gain from higher TRICARE fees?

As they review the Defense Department’s latest plan to raise TRICARE fees and co-pays, particularly for working-age retirees and their families, key congressional panels are asking what beneficiaries can expect in return.

Faster appointments, more evening clinic hours, more physicians spending more time seeing patients, more base hospitals operating at full capacity were some answers given this week by military healthcare leaders.

Perhaps the most important commitment came from Dr. Jonathan Woodson, assistant secretary of defense for health affairs, who said he, the new director of the Defense Health Agency Vice Admiral Raquel C. Bono and the surgeons general of Army, Navy and Air Force all recognize the need “to pivot to a full patient-centered, customer-focused delivery system.”

The comment came in response to Rep. Joe Heck (R-Nev.), an Army Reserve physician who said that while assigned to military treatment facilities “we did not have a taxing schedule of patient flow,” while doctors in civilian hospitals “see many more patients in the same period of time.”

Woodson seemed to give a less satisfactory response to Rep. Susan Davis (D-Calif.) who asked what to tell beneficiaries who want to know what they stand to gain from having to bear a larger share of overall health costs.

Their share of total health costs would climb from eight percent to 10.4 percent, Woodson said, modestly compared to 27 percent when TRICARE was rolled out two decades ago. The catastrophic cap on total health expenditures by individuals and families would rise for the first time since 2001, Woodson said, yet remain low relative to other insurance plans.

“There’s also a second-payer option put forward which lowers the fees for those who have other health insurance,” Woodson said. “We’ve also set the fee structure so it incentivizes” use of military treatment facilities where users fees are “very low cost or no cost.”

The Senate and House armed services’ personnel subcommittees took different approaches in separate hearings as they moved closer to deciding how to reform to TRICARE, the multi-option military health insurance benefit.

The House subcommittee chaired by Heck pressed Woodson and Bono about proposed fee hikes while praising its intention to simplify three TRICARE options down to only TRICARE Select (currently called Prime) for managed care and Choice (Standard), the fee-for-service insurance plan.

Retirees younger than 65 would see the biggest pop in out-of-pocket costs. Their cost to enroll in managed care would climb about 25 percent in 2018. Working age retirees who prefer Choice also would have to pay to participate ($450 for individuals, $900 for families) or lose health coverage.

A first-ever enrollment fee for older retirees who use TRICARE for Life (TFL) to Medicare Part B would apply only to new TFL users, not current TFL beneficiaries. But most anyone filling prescriptions off base would see increasingly higher co-pays, including through mail order.

A promised improvement in health insurance for Reserve and National Guard members will not be ready until next year, Woodson said. TRICARE needs more information on these members’ current insurance choices before deciding on an option to replace or enhance the unpopular TRICARE Reserve Select (TRS) with some version of active duty TRICARE Choice.

The big complaint with TRS is that families often have to switch doctors when members are called to active duty. To end that turbulence in continuity of care, Woodson said, several options are being studied.

One would be to pay reservists a Basic Allowance for Health Care when called to active duty so families could afford to keep civilian insurance coverage. Another might offer a version of TRICARE Choice to Reserve and Guard members through civilian employer health plans.

“We need to really poll and assess the reserve community about what they are doing for insurance now, what the options are,” said Woodson. “Because we don’t have enough data to make the right answer now.”

A day earlier, the Senate subcommittee led by Sen. Lindsey Graham (R-S.C.) heard first from a panel of industry healthcare experts on ways to reform TRICARE, before it ask Woodson, Bono and the surgeons general to testify on current efforts to make TRICARE more responsive and efficient.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at:

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