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uniformed health services [Fwd: TROA's Legislative Update, 2/18/00]
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This is TROA’s legislative update for Friday, February 18, 2000. This week’s issues: Armed Services Committee Members Introduce Health Bill TRICARE Senior Supplement Test Begins April 1 Vitter Bill Would Provide Pre_script_ion Coverage Armed Services Committee Members Introduce Health Bill Early this week, Representatives, Ike Skelton (D-MO), Neil Abercrombie (D-HI) and Gene Taylor (D-MS), key members of the House Armed Services Committee (HASC), sponsored broad-ranging legislation (HR 3655) to make several improvements in the military health care system. Specifically, the bill would: 1) Remove geographic limits on TRICARE Senior Prime (Medicare subvention) as of Jan. 1, 2001 and require nationwide implementation no later than 2006; 2) Extend the FEHBP-65 demonstration one more year until December 2003 and guarantee enrollees continued FEHBP coverage regardless of the test outcome; 3) Expand the BRAC TRICARE mail-order and retail pharmacy benefits to all Medicare-eligible beneficiaries, with NO enrollment fee; 4) Remove the requirement for Non-Availability Statements (for services in MTFs) when using TRICARE Standard (i.e., not enrolled in TRICARE Prime); 5) Reduce the TRICARE Standard catastrophic out of pocket expense limit for health care from $7,500 to $3,000 per year; 6) Eliminate copays for active duty families in TRICARE Prime (there are no annual deductibles in Prime); 7) Extend TRICARE Prime Remote to active duty families assigned to locations without TRICARE Prime; and 8) Reimburse certain travel-related expenses associated with TRICARE-referred specialty care providers that are more than 100 miles away. TROA supports the measures in this bill as critical steps toward improving health care options for active and retired members. By establishing TRICARE Prime Remote and eliminating TRICARE Prime copayments, the bill would reduce out-of-pocket expenses and eliminate current financial penalties for active duty families assigned to locations distant from military facilities. For Medicare-eligible retirees, the bill would provide greater health care access and stability by opening pharmacy programs to them and expanding TRICARE Senior Prime nationwide and making it a permanent program. The missing ingredient is FEHBP, with priority for Medicare-eligibles, patterned after HR 2966, and supported by H.R. 3573 and S. 2003. We will continue pressing to attain that goal in this Year of Health Care. TRICARE Senior Supplement Test Enrollment Starts March 1 The Department of Defense is set to begin its test offering of a TRICARE supplemental to Medicare on March 1, with coverage to begin April 1. The enrollment period is not limited, so eligible beneficiaries can enroll any time after March 1. For enrollment applications received by the 20th of any month, coverage will begin the first day of the next month. Known as TRICARE Senior Supplement Demonstration Program, the test will be limited to two sites, as prescribed in the FY2000 Defense Authorization Act. Up to 11,000 beneficiaries will be allowed to enroll. The two sites are the areas in the vicinity of Cherokee County, Texas, and Santa Clara County, California. Only members residing within designated ZIP codes in those areas will be eligible to participate. The list of qualifying ZIP codes can be found on DoD’s Web site at http://www.tricare.osd.mil/tssd/ The program is open to Medicare-eligible retirees, family members and survivors who are enrolled in both Medicare Part A and Part B. Under current law, the demonstration program will run through December 31, 2002. Specific benefits for enrollees will include: pre_script_ion drugs from DoD’s national mail order pharmacy or DoD’s TRICARE civilian network pharmacies; coverage for most or all Medicare copayments for physician, hospital and other care; extended coverage for mental health services; and coverage for certain diagnostic procedures and preventive services. However, enrollees will be ineligible to receive care or pre_script_ion drugs from a military hospital or clinic. The enrollment fee for the plan will be $576 per person per year, payable in an annual lump sum or quarterly payments of $144. Enrollees will be liable for a $150 annual deductible (the Medicare deductible is $100, and TRICARE’s is $150, but the first $100 applies to both). For Medicare-participating providers, the plan should cover Medicare copayments. Enrollees who use providers that don’t accept Medicare may incur out-of-pocket costs associated with non-reimbursed co-payments. In the case of providers who don’t participate in TRICARE, enrollees will need to file their own TRICARE Senior Supplemental claims. From a cost vs. benefit standpoint, this program provides better coverage at considerably lower cost that standard Medicare supplementals, including TROA’s. Its premium, by law, is 75% of the FEHBP premium. The extra $50 TRICARE deductible is something not found in other supplementals, but that’s minor compared to the premium savings. One potential administrative glitch is that TRICARE and Medicare operate on different fiscal years, which could cause some deductible confusion. The most significant concern is that, for now anyway, enrollees are not guaranteed reenrollment in their previous Medicare supplemental plans in the event the program is not continued after December 31, 2002. The TRICARE Senior Supplemental Program doesn’t yet enjoy that designation. TROA and The Military Coalition will seek a legislative fix to this potential problem in the FY2001 Defense Authorization Bill. Members living in the vicinity of the test areas are encouraged to attend one of several informational meetings between Feb. 29 and Mar. 8: California Meetings: Feb 29, 9:00 AM Livermore, CA; Elks Lodge, 940 Larkspur Dr. Mar 1, 9:00 AM Santa Clara, CA; VFW, 1313 Franklin St. Mar 1, 1:00 PM; Santa Clara, CA; VFW, 1313 Franklin St. Mar 2, 9:00 AM, Hollister, CA; Elks Lodge, 351 Astro Dr. Mar 2, 1:00 PM; Watsonville, CA; VFW, 1960 Freedom Blvd Texas Meetings: Mar 6, 2:00 PM; Longview, TX; VFW, 401 Ambassador Row Mar 7, 9:00 AM; Nacogdoches, TX; VFW, 2406 Hunter Rd. Mar 7, 2:00 PM; Henderson, TX; Henderson Community Center, 400 W. Main Mar 8, 9:30 AM; Palestine, TX; VFW #3907. 3800 W. Oak For more program information, call 1-877-363-8773 or visit DoD’s Web site at www.tricare.osd.mil/tssd/ Vitter Bill Would Provide Pre_script_ion Coverage February 16, Rep. David Vitter (R-LA) introduced H.R. 3697, a bill that would let Medicare-eligible uniformed services beneficiaries enroll in DoD’s mail order and retail pharmacy programs, with no enrollment fee. Currently, the only Medicare- eligibles who can use these programs are those who live in _base_ closure areas and TRICARE Senior Prime (Medicare subvention) enrollees. DoD is scheduled to test a new option for Medicare- eligibles at two sites this spring, but with a $200 per person annual enrollment fee. As mentioned above, providing the coverage envisioned in this bill is one of TROA’s goals in restoring health care equity for Medicare-eligibles, along with nationwide expansion of TRICARE Senior Prime and FEHBP. Are you getting the full benefits of TROA membership? Check out http://www.troa.org or call TROA at 1-800-245-8762. TROA members can help us deliver the mail by changing their own subscriber email addresses via TROA’s Web site. For details on how to do this, just visit http://www.troa.org/LegislativeUpdate.asp
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