Military Update: Tweaking Tricare for Guard, Reserve
January 31, 2004
A congressional spending cap and challenges with tracking Tricare costs for mobilizing and deactivated reservists have left thousands of Reserve families as of yet unable to take full advantage of some new pre- and post-mobilization health-care benefits.
The unusual circumstances have Tricare officials advising reservists to save medical receipts, explanations of benefits and other documents that could be useful weeks or months from now in filing Tricare claims for reimbursements once the full range of new benefits is available.
The benefits in question, called the Temporary Reserve Health Care Program, will improve access to care from the time reservists learn they will be mobilized through a new 180-day transition health period following active service.
President Bush signed the Reserve health initiatives into law Nov. 6 as part of the $87 billion emergency spending bill for Iraq and Afghanistan. Several benefits took effect that day. Despite the work of a task force set up even before the law was signed, implementation has been difficult.
The biggest challenge has been modifying the Defense Enrollment Eligibility Reporting System used to verify that beneficiaries are properly enrolled and eligible for Tricare. DEERS is being reprogrammed to recognize several new benefits and to identify as eligible thousands of individual reservists and their families.
Modifying DEERS also is critical for tracking the cost of the initiatives, said Rear Adm. Richard Mayo, deputy director for the Tricare Management Activity. Congress imposed a $400 million funding limit on those initiatives from Nov. 6, 2003, through Sept. 30, 2004.
The complexity of the task is reflected in details of the new benefits:
Coverage for Reserve or Guard members begins upon notice of a pending call-up, or receipt of a delayed-effective-date order for mobilization. Family members are covered if the planned mobilization is to last longer than 30 days.
Length of Tricare coverage before activation can be up to 90 days, but only for individuals who learned of mobilization on or after Nov. 6. Reservists previously had been eligible for Tricare only when on active duty.
To add more complexity to this and other benefits, it is set to expire Dec. 31 unless Congress votes to extend it.
Military transitional health coverage is lengthened to 180 days from 60 days or 120 days, depending on length of deployment, under the old rules. The extra coverage applies to those deactivated or separated from service after Nov. 6, 2003. Members and families who intend to use the extra 60 to 120 days’ coverage should save their health-care receipts and file claims for reimbursement when they receive word the benefit is available. This benefit also is set to expire Dec. 31.
The services received authority to screen and provide needed medical and dental care to members of the Ready Reserve. Reservists previously had to be on active duty to be screened and receive care. This new authority is permanent.
The most controversial initiative will open Tricare to drilling reservists who either are unemployed or have no health insurance through current employers.
About 170,000 are eligible but far fewer could elect to pay the premiums, to be set roughly at $420 a year for self coverage, $1,440 for self and family, plus usual co-payments and deductibles.
This provision will take effect when regulations are published and premium rates are set sometime later this year.
Dr. William Winkenwerder, assistant secretary of defense for health affairs, has criticized this initiative as ignoring differences “in duty and in sacrifice” between nonmobilized reservists and active duty. He also bristles at the cost, which could be “in the low billions,” he said.
Mayo said he expects uninsured drilling reservists to begin enrolling in Tricare by year’s end, if the $400 million hasn’t already been spent. After all, he said, that money must cover “the cost of implementing the changes to DEERS, the cost of contract modification, the marketing enrollment costs, in addition to the health-care costs.”
Some service associations argue that Congress still didn’t go far enough in providing medical benefits to reservists. Senate Minority Leader Tom Daschle, D-S.D., agrees. He and other colleagues introduced legislation in late January that would open Tricare to all drilling reservists.