TRICARE Standard Users Begins To Gel
Military healthcare beneficiaries will be mailed information packets
this year, explaining benefits under TRICARE, the triple-option health
The mailing will coincide with the June-through-November phase-in of
new TRICARE support contracts, which will merge 11 stateside TRICARE
regions into three, require all contractors to operate under the same
rules and set contractor performance goals based on customer
The mass mailing is unprecedented for a different reason, however. It
will mark the first time since TRICARE began in 1993 that the system
has reached out to all those eligible -- including more than two
million users of TRICARE Standard, the military’s traditional
fee-for-service health insurance.
More steps to support Standard users will follow, passed by Congress
in last year’s defense bill. They include a nationwide survey of
civilian healthcare providers to measure reluctance to accept Standard
patients; a U.S. Comptroller General review of Defense Department
procedures to ensure access to Standard benefits; a communication
plan, Active Outreach, to widen information flow between TRICARE
administrators, and TRICARE beneficiaries and providers, particularly
Standard users and their caregivers. Officials outlined the plan this
month in a six-page report to Congress.
For all the activity swirling around oft-neglected Standard users, it
isn’t clear yet how far the government will go to help them find
doctors. Possible actions range from encouraging Standard users to tap
existing TRICARE networks of physicians, to spending millions of
dollars to build, and update frequently, a kind of nationwide Yellow
Pages of Standard providers.
Beneficiary advocates have testified that fewer physicians are willing
to accept TRICARE patients and, of those who do, more are refusing to
accept TRICARE fees. Finding TRICARE Maximum Allowance Charges (TMAC
rates) inadequate, doctors are adding up to 15 percent, as the law
allows and which patients must pay.
Evidence of the trend has been anecdotal rather than statistically
based, leaving Congress sympathetic but, like Defense health officials
and TRICARE support contractors, not fully convinced that large
numbers of Standard users are being denied access to affordable care.
Standard users don’t enroll in TRICARE Prime, the managed care
network, and aren’t old enough for TRICARE for Life, the golden
supplement to Medicare. Many turn to Standard, with its higher costs,
to be able to choose their own physicians. Others only use Standard
benefits because they live in rural areas, away from a TRICARE Prime
The cost difference can be steep. A married retiree enrolled in Prime
pays $460 yearly for family coverage and modest co-pays for doctor
visits. The same retiree under Standard pays a $300 annual deductible
plus 25 percent of the TMAC rate on each medical procedure. They pay
an additional 15 percent when doctors or hospitals don’t accept the
TRICARE Maximum Allowance Charge, TMAC.
Sue Schwartz, a health benefits expert for the Military Officers
Association of American, views the congressional initiatives as
positive and the outreach effort for Standard users with cautious
optimism. She is "bullish"on a provider directory for Standard users
that recently was added to the TRICARE website by linking to:
Steve Strobridge, MOAA’s government relations director, is more
skeptical. He expects that gains for Standard users to be "a long-term
"We know they don’t want to spend any money,"he said, referring to
Defense officials. But the congressional initiatives already passed,
"if you do them right, [they’ll] cost more money and take more
Strobridge said TRICARE contractors don’t see the new provisions of
last December as saddling them with costly new responsibilities for
Standard patients. Interviews proved him right, in part because
TRICARE headquarters, not the contractors, will run surveys of
James E. Woy, president of Health Net Federal Services of Rancho
Cordova, Calif., manages TRICARE for states along the western coast.
Health New soon will shift to managing the TRICARE North Region.
His top responsibility, he said, "is to build a network in Prime
service areas to meet the needs of all TRICARE eligibles, whether
enrolled or not."
Woy noted that of 1.5 million beneficiaries in his current region,
900,000 are enrolled in Prime, 525,000 are not enrolled but still live
within network areas. Only 75,000 live too far from a network to
enroll in Prime.
Woy said he is confident that his network has physicians to
accommodate all 525,000 Standard users if needed. Of the 75,000
beneficiaries living in remote areas, however, "I don’t have a
requirement yet to find them providers…I don’t know who they are or
how to help them."
Humana Military Healthcare Services, which will run the South region,
is ready to help Standard users too, encouraging use of beneficiary
services and websites, said Tonya Gabbert, Humana spokesperson.
David McIntyre, president of TriWest Healthcare Alliance Corp. of
Phoenix, Ariz., which will manage the Western Region, noted that
Medicare, like TRICARE Standard, is a fee-for-service plan. Congress,
he said, wouldn’t consider approving a costly system to track down
doctors for Medicare patients. Also, he suggested, most TRICARE
Standard patients have a ready alternative: access to a managed care
"My obligation is to do whatever the Department of Defense thinks
needs to be done to service this population most effectively,"
McIntyre said. But he added, "Someone needs to ask…`Where’s the
problem?’ That’s up to association folks and the Congress to decide."