TRICARE Plus limited by capacity of local clinics
Military Update focuses on issues affecting pay, benefits and lifestyle of active and retired servicepeople. Its author, Tom Philpott, is a Virginia-based syndicated columnist and freelance writer. He has covered military issues for almost 25 years, including six years as editor of Navy Times. For 17 years he worked as a writer and senior editor for Army Times Publishing Co. Philpott, 49, enlisted in the U.S. Coast Guard in 1973 and served as an information officer from 1974-77.
By Tom Philpott
Military beneficiaries enrolled in TRICARE Senior Prime or other programs to receive primary care through military treatment facilities soon will be able to continue that care through a new enrollment option, TRICARE Plus.
TRICARE Plus isn't limited to "impaneled" beneficiaries; anyone eligible for military health care, in theory, will have an opportunity to enroll. But the enrollment ceiling at each base will be limited by primary care capacity of the hospital or clinic.
Some smaller facilities won't be able to accommodate the program at all.
To put TRICARE Plus in perspective, amid the swirl of other benefit gains, recall that J. Jarrett Clinton, acting assistant secretary of defense for health affairs, announced last fall three goals for 2001. One was to establish the TRICARE Senior Pharmacy Program, which began smoothly on April 1. The second was to launch TRICARE-for-Life, the "golden" insurance supplement for Medicare-eligible beneficiaries, set to begin Oct. 1.
A third goal for TRICARE, Clinton said, was to decide what to do about TRICARE enrollment at military treatment facilities.
Congress last year ordered an end to the TRICARE Senior Prime demonstration by Dec. 31, 2001. TRICARE Plus is the Defense Department's response to that order.
It means many beneficiaries comfortable with having a military doctor as primary care provider will be able to keep that arrangement.
Enrollment in TRICARE Plus, however, will be "capacity driven," said Steve Lillie, director of over-65 benefits for the TRICARE Management Activity based in Falls Church, Va. Enrollment priority will be given to those with existing links with military treatment facilities.
"There isn't going to be much space," Lillie cautioned.
One drawback to TRICARE Plus is it's not a comprehensive health plan. It provides access to primary care; military specialty care is not assured. If referred outside to civilian providers, TRICARE Plus enrollees will have to rely on whatever health insurance they have. This could include Medicare, backed by the new TRICARE for Life.
"TRICARE Plus doesn't mean the department takes responsibility for all your health care needs," said Lillie.
While beneficiaries impaneled to a military treatment facility will have priority for enrollment, anyone eligible for in-service care can apply. In fact, the financial incentive will be for military treatment facilities to enroll as many under-65 beneficiaries as possible, rather than the elderly.
TRICARE Plus will differ from TRICARE Prime or Senior Prime in other ways. For example, there are no enrollment fees. Beneficiaries are not locked into managed care, that is, enrollment does not impact eligibility for TRICARE Extra or Standard or for Medicare. TRICARE Plus is not "portable"; beneficiaries cannot use enrollment in one facility to gain primary care access at another. Also, for the elderly, enrollment in Medicare Part B is advised but not mandatory.
TRICARE officials hope to have Plus running in some areas by Oct. 1, when TRICARE for Life begins. Some areas will begin marketing the program in August and September.
More information on TRICARE Plus is available at 1-888-DOD-LIFE (1-888-363-5433) and its Web site.
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