The Defense Department will reduce the number of Tricare Prime service areas in the United States beginning Oct. 1, affecting about 171,000 retirees and their family members.
Those beneficiaries, who mostly reside more than 40 miles from a military clinic or hospital, received a letter earlier this year explaining their options. They will receive a second letter later this month.
Tricare Management Activity officials said changing the location of Prime service areas has been planned since 2007 as part of the move to the third-generation of managed care support contracts and will allow them to continue their commitment to making high-quality health care available while supporting DOD efforts to control the rising cost of health care for 9.6 million beneficiaries.
Health care under Tricare Prime costs about $600 more annually per enrollee, but on average, each member of a family of three using Tricare Standard will pay only about $20 more per month than if they were using Prime.
“The first thing Tricare beneficiaries should know about the reduction in the number of Prime service areas is that it doesn’t mean they’re losing their Tricare benefit,” said Dr. Jonathan Woodson, assistant secretary of defense for health affairs.
“Next, it’s important to remember this change does not affect most of the more than 5 million people using Tricare Prime, and [it affects] none of our active duty members and their families.”
All affected beneficiaries will receive a letter this month following up on their initial notification to ensure they have the time and information to make important decisions about their future health care options, officials said.
Current details on Prime service areas and the option for beneficiaries to sign for email updates are available at http://www.Tricare.mil/PSA. A ZIP code tool is available on the site to help beneficiaries determine if they live in an affected area.
As always, officials noted, Tricare beneficiaries still are covered by Tricare Standard. For those living within 100 miles of a remaining Prime service area, re-enrolling in Prime may be an option, depending on availability. To do this, beneficiaries must waive their drive-time standards, and they may have to travel long distances for primary and specialty care.
“I urge all impacted beneficiaries to carefully consider their health care options ― they should talk them over with family members and their current health care provider,” Woodson said.
“Many beneficiaries may be able to continue with their current provider using the Standard benefit. Being close to your health care team usually offers the best and safest access to care.”
Those enrolled in Tricare Prime are assigned a primary care provider who manages their health care. Retirees pay an annual enrollment fee and have low out-of-pocket costs under this plan.
Tricare Standard is an open-choice option with no monthly premiums and no need for referrals, but it has cost shares and an annual deductible.
The Prime service areas being eliminated are not close to existing military treatment facilities or base realignment and closure sites, officials said.
Prolonged protests resulted in a staggered transition, they added, and all Prime service areas were retained until all three new regional contracts were in place. The West region completed the transition April 1.
To provide affected beneficiaries with enough time to plan, Defense Department officials elected to delay the Prime service area reductions until Oct. 1.