Starting Oct. 1, military retirees and their family members in Japan, Korea and Guam will have to foot the bill for commercial airfare to routine medical appointments.

Pacific Air Forces announced the policy change in a memorandum this week to PACAF military treatment facility commanders, underscoring that retirees from all branches, and their dependents, still are eligible for priority and urgent aeromedical evacuation on military aircraft.

“Retirees are part of our military family and we are doing all we can to help them understand the issue and to work on their behalf to help them keep up their routine medical care,” said Lt. Col. Kelley Counter, PACAF chief of manpower, personnel and financial management.

The memorandum states that come Oct. 1, “Pacific Air Forces will no longer be able to fund commercial tickets for retirees living or traveling outside the United States to routine medical appointments,” or non-emergency care.

The change comes almost a year after the Air Force retired its fleet of C-9A Nightingales, a jet dedicated to aeromedical evacuation.

With orders showing they’re travelling for medical reasons, retirees could fly on the C-9, which in the western Pacific shuttled passengers to routine medical appointments once or twice a week. After the plane was taken out of service in fall 2003, those throughout the western Pacific not needing in-flight medical care were allowed to fly commercially at government expense. Now all aeromedical evacuation is “requirements based,” meaning that only patients requiring in-flight medical care are moved via military aircraft.

Active duty members and their dependents covered by Tricare Prime are eligible for military funded commercial travel for routine medical care, said Frank McEvoy, Tricare Pacific marketing representative. Military retirees overseas, however, are eligible only for Tricare Standard, which does not entitle them to commercial transportation to a medical facility.

The PACAF Surgeon General’s office footed the bill for retirees after the C-9s were retired. But PACAF officials note that the Joint Federal Travel Regulations do not authorize funded travel for retirees and their family members for routine medical care. The regulations govern travel and transportation allowances for members of the uniformed services. The regulations pertain to government travel and transportation allowances.

“It was a decision by the PACAF surgeon general, knowing that a lot of the care is farther away than in [U.S. Air Forces Europe,] where people can drive,” Counter said. “He wanted to bridge the gap.”

“They made a command decision to continue funding in the transition year,” said Lt. Col. Stephen Clutter, PACAF spokesman. “They really aren’t authorized to do that. They were leaning a little bit too forward in doing that.”

The change doesn’t affect active duty members and their dependents but civilian employees could be affected, PACAF officials said, though they declined to discuss it officially because the regulations still are being drafted.

Counter said for fiscal 2004, which ends Sept. 30, PACAF estimates it will have paid $350,000 to transport retirees and their dependents on commercial flights for routine medical care. That’s out of a total $3.9 million “for everybody in the command for the different services,” Counter said. “It’s not a funding issue, it’s the policy.”

As of the end of August, PACAF had paid airfare for about 300 retirees and non-medical attendants of retirees — someone, for example, accompanying and carrying bags for a retiree with a broken leg. An estimated 16,000 military retirees live in Japan, Korea and Guam, according to PACAF officials.

Retired Chief Master Sgt. Herman Tinnirella from Misawa, Japan, thinks lower-ranking retirees will be especially impacted by the policy change. They’re “on a very limited income and some of our local retirees have some serious medical problems,” he said, noting about 150 military retirees live in the Misawa area. “The local medical group takes great care of our retirees but there are limitations on what they can do locally.”

Retirees already pay for lodging and other per diem costs when traveling for medical care.

Carl Howard, a retired Air Force master sergeant living near Yokota Air Base, Japan, said he knows retirees who need to see specialists at Tripler Army Medical Center in Hawaii, although “for my personal self, I don’t want to go to Hawaii, anyway. I can go downtown.”

Tinnirella recommends military retirees who are permanent residents of Japan, and don’t fall under the U.S.-Japan status of forces agreement, enroll in the Japanese health care system. The cost is fairly reasonable, he said; co-payment for those over 70 is about 10 percent.

“I’m enrolled in the program just as a fall back,” he said.

PACAF officials noted that U.S. Transportation Command now is reviewing a proposal to assign retirees a higher space-available category on military aircraft if they have medical invitational orders. Retirees are Category 6, the lowest priority for seat assignment in space-available travel.

“We think it will, if approved, encourage retirees to try to make routine medical appointments,” Counter said. “It would give them another option, and we think it has real merit.”

Some retirees, however, noted that Patriot Express — the military’s chartered commercial air service — is to be eliminated over the next two years in South Korea and Japan, as well as most military bases around the world, in effect limiting opportunities for space-available travel.

Clarifying medical travel for retirees

Movement Precedence Categories developed by the Patient Movement Requirements Center during peacetime:

• Routine: Non-emergency/urgent care that does not require in-flight medical care and the specialty is not available locally.

• Priority: Requires in-flight medical care. Applies to a patient who requires prompt medical care not available locally. Normally movement begins within 24 hours but may vary based on the patient’s condition.

• Urgent: Requires in-flight medical care. Applies to a patient who requires movement as soon as possible to save life, limb or eyesight, or to prevent serious complications of injury or an existing medical condition. In almost all urgent aeromedical evacuation cases, the driving factor is that the medical expertise or equipment is not available to treat the patient in a local medical facility.

— Staff report