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Tricare overhaul hits early snags but promises expanded healthcare access

The chairmen of the House and Senate Armed Services committees promise to begin to reform the $50 billion military health system, and their staffs already are doing groundwork.

By COREY DICKSTEIN | STARS AND STRIPES Published: January 12, 2018

WASHINGTON — The military’s largest overhaul to its Tricare health system in two decades began Jan. 1, promising users expanded access to health care and simplified out-of-pocket rates for visiting doctors, but the changes have come with system failures and snags, officials and users have reported.

Since Jan. 1, servicemembers, their families and veterans attempting to use Tricare have reported difficulties connecting to the online systems and long waits to speak with customer service representatives by phone about the problems. Tricare’s Facebook page, as of Friday, was riddled with dozens of complaints from users detailing long periods on hold, dropped phone calls and difficulties registering on the new websites run by Tricare contractors.

In 2016, Congress mandated an overhaul of Tricare, the government-managed military health care program administered by the Pentagon, citing rising costs to the Defense Department and a need for greater flexibility for medical care for Tricare users. In that year’s National Defense Authorization Act, Congress authorized about $440 million for the Pentagon to reform the Tricare system, which provides coverage to some 9.4 million active-duty and reserve servicemembers, their family members and veterans. Tricare officials on Thursday pledged the issues would be worked out, placing the blame for the website problems on the contractors – Humana Military and HealthNet Federal Services – who are “working diligently” to fix them, according to a Tricare statement that said the websites would be “fully functioning soon.”

The customer service issues were largely blamed on a massive influx of tens of thousands of calls per day from users seeking information about the changes to Tricare, the statement added.

“In an attempt to resolve inquiries in one call, call center staff are spending a longer time with beneficiaries,” the Tricare statement reads, stating they aimed to answer all calls to customer service within 30 seconds. “There has been noticeable improvements in the last few days, and they are expected to improve even more in the coming days.”

The changes to Tricare include new contractors running the health systems, a blending of two old coverage options into a new one, an adjustment to how customer copays are calculated and an increase next month in the out-of-pocket costs for prescription drugs for users who are not on active duty.

On Jan. 1, Tricare shifted from three coverage regions to two as Tricare North, South and West became Tricare East and West. That means all users, other than ones previously in the Tricare South area, are now under a new Tricare management contractor. For people in Tricare West that contractor is HealthNet and for people in Tricare East that is Humana, according to the Defense Health Agency, the Pentagon agency that manages Tricare.

Tricare officials said the change would allow for greater coordination between military hospitals and clinics and civilian health care providers within those regions. However, they acknowledged it could also mean some users would have to change their civilian doctors, if those doctors do not opt in to the new system.

Another major change is the merging of the former Tricare Standard and Tricare Extra plans for dependents of active-duty servicemembers into a single new coverage plan called Tricare Select. The new program largely mirrors the former plans, according to Tricare, allowing users greater freedom of choice of doctors than Tricare Prime, a standard option for active-duty servicemembers and their families.

Tricare Prime will not change under the new system. HealthNet and Humana will select primary care managers for the users. Under Tricare Select, users can choose their own medical providers, but they will pay more money out of pocket to see a provider outside of their network, according to Tricare.

Additionally, Tricare has moved to a standard out-of-pocket fee for users who visit civilian health care providers, as opposed to its previous system that required patients to contribute a copay of 15 to 20 percent of their bill. For example, family members of active-duty servicemembers on the new Tricare Select plan would pay $21 out of pocket for a visit to a primary care doctor, according to Defense Health Agency documents. The same patient would pay a $31 copay for a specialty care visit and an $81 copay for an emergency room visit.

Military retirees and their families on the Tricare Select plan would pay $28 for a primary care visit, according to the documents. They would pay $41 for a specialty care visit and $109 for an emergency room visit.

Beginning in the fall, Tricare will also change the time of year for its open enrollment season, moving to a calendar-year system similar to most civilian health insurance options.

The open enrollment season will begin on the Monday of the second full week in November and run through the Monday of the second full week in December, allowing all beneficiaries to make changes to their coverage options during that period. It also allows for users to change their coverage options following qualifying significant life events, such as marriage, changes in military status, or having children.

dickstein.corey@stripes.com
Twitter: @CDicksteinDC

 

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