Fort Campbell, KY – TRICARE recently announced that the Defense Department will reduce the number of TRICARE Prime service areas in the United States beginning October 1st, 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, 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.Retirees and their family members living in affected areas will be disenrolled September 30th, 2013 from TRICARE Prime , but will continue to be covered by TRICARE Standard and may have the option of choosing other coverage plans.
TRICARE Management Activity officials said this change has been planned since 2007 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.
“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. All beneficiaries remain eligible for TRICARE Standard and many will have additional coverage options available.
Active duty family members who live in an affected area will be able to continue receiving TRICARE Prime benefits as long as they remain in their current Prime service areas.
“This is important for families to note because many college students have historically switched their enrollment area when they return home during the summer,” said Blanchfield Army Community Hospital commander Col. George N. Appenzeller. “If family member of an active duty service member transfers their benefits out of an affected area, they will not be able to switch back to that area again under TRICARE Prime but will have to look at other coverage options instead.”
Current details on Prime service areas and the option for beneficiaries to sign for email updates are available at 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 are still 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.
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 1st.
To provide affected beneficiaries with enough time to plan, Defense Department officials elected to delay the Prime service area reductions until October 1st.