April 1, 2004


An extended deadline will allow more time for some remarried surviving spouses of veterans to seek health care insurance under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). The extension applies to CHAMPVA-eligible spouses who remarry after a veteran's death. Surviving spouses lost access to CHAMPVA benefits if they remarried before their 55th birthday and before Feb. 4, 2003. Under rules announced previously, those survivors had until Feb. 4, 2004, to apply for reinstatement of their CHAMPVA coverage. The VA has now announced that they will have until Dec. 16, 2004, to apply for reinstatement. To be eligible for CHAMPVA, an individual must be a family member of a veteran who (1) has a permanent and total service-connected disability; or (2) died of a service-connected condition; or (3)died while totally disabled from a service-connected condition.

April 15, 2004

Under the Tricare Uniform Formulary final rule (previous item), beneficiaries filling prescriptions for up to a 30-day supply at non-network pharmacies will pay either $9 or 20 percent of the cost of the prescription, whichever amount is greater, for both generic and brand-name formulary medications. They will pay $22 or 20 percent, whichever is greater, for non-formulary medications. The payments kick in after they meet non-network deductible)

April 15, 2004

The Tricare Uniform Formulary final rule was published April 1, 2004. Effective May 3, the rule will allocate prescription drugs to one of three cost-share tiers: generic; formulary (brand-name); or non-formulary. Beneficiaries who use the Tricare Mail Order Pharmacy will pay $3 for up to a 90-day prescription of a generic medication, $9 for up to a 90-day supply of a brand-name medication, and $22 for up to a 90-day supply of a non-formulary drug. Beneficiaries using a retail network pharmacy will pay $3 for up to a 30-day prescription of a generic medication, $9 for a 30-day supply of a brand-name formulary drug, and $22 for up to a 30-day supply of a non-formulary medication. (See following item for non-network charges.)

April 15, 2004

Several senators involved with appropriations have warned Veteran Affairs Secretary Anthony Principi they will reject administration proposals to charge new fees to make up for a shortfall in veterans' health care funds. For example, VA-HUD appropriations subcommittee chairman Christopher (Kit) Bond, R-Mo., told Principi the proposals were unacceptable to Congress last year and he could "almost assure" him they will be unacceptable again this year. He called the plan to impose a $250annual fee on veterans to enroll in the VA healthcare system and a more than doubling of prescription drug co-payments from $7 to $15 "essentially a new tax imposed on our veterans."

April 15, 2004

Some 90,000 military beneficiaries who are ineligible for Tricare for Life and Tricare Senior Pharmacy services because they are not enrolled in Medicare Part B are still waiting for the bureaucracy to implement last year's Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Under the act, a special enrollment period for them will run through Dec. 31, 2004, but the act doesn't set a starting date. In addition, military beneficiaries who enrolled in Part B in 2001, 2002, 2003, or 2004 and are paying late enrollment penalties can have them eliminated effective Jan. 1, 2004, by demonstrating that they are covered under Tricare for Life. The Military Officers Association of America has expressed concern that the lead time to inform and assist these 90,000 individuals grows shorter each day the Center for Medicare and Medicaid Services fails to act. 

by Tom Philpott 
January 23, 2004

'Outreach' To TRICARE Standard Users Begins To Gel 

Military healthcare beneficiaries will be mailed information packets this year, explaining benefits under TRICARE, the triple-option health plan.

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 satisfaction.

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 physician network.

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 process."

"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 resources."

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 civilian physicians.

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 physician network.

"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."

April 29, 2004

As a first step of congressionally dictated outreach, Tricare officials are preparing to mail information packets to all eligible Tricare beneficiaries. This will include more thantwo million beneficiaries of Tricare Standard, which will be a first. Additionally, in response to reports that fewer providers are willing to accept Tricare patients, officials are expected to survey physicians' attitudes toward Tricare Standard. Furthermore, the Comptroller General is to review Defense Department procedures for assisting beneficiaries in gaining access to Tricare Standard. Also coming are a communication plan and an active outreach program between Tricare administrators, providers and beneficiaries. Tricare Standard, with higher costs than Tricare Prime (a managed care system) and Tricare for Life (for Medicare-eligible retirees), allows beneficiaries to choose their own providers if those in their area will accept them as patients.