TRICARE and the ACA

Sep 12 2013

Published by at 7:19 am under Analysis/Editorial

The recent headlines on the Affordable Care Act have generated a lot of questions regarding the impact this act has on TRICARE beneficiaries. Including this question copied below, received on September 10th, 2013:

How [does] Obama Care affect …Tricare for life. Many of us are confused on this subject.

We have written about this issue here and on other MOAA outlets several times. MOAA members, because they primarily use TRICARE, are generally exempt from the Affordable Care Act. At the urging of MOAA and others, Congress passed separate legislation, H.R.4887 TRICARE Affirmation Act, specifically exempting TRICARE and VA beneficiaries from any potential for being taxed for not having coverage or being required to participate in pooled coverage.

For the longer term, the main potential issues we see for MOAA members are:

1 – Whether the expanded pool of the healthcare-eligible population will at some point create access problems due to more beneficiaries needing to see the same number of doctors, and

2 – The uncertainty over what impact potential future Medicare cost-saving initiatives may have on all Medicare-eligibles

It’s important to note that the potential for Medicare cutbacks was going to continue regardless of the health reform act, since rising Medicare costs pose a huge budget challenge in any scenario.

MOAA will continue to stay updated on this issue, and if there are any changes, they will be posted in our weekly Legislative Update. If you do not receive the update, you can register for it here. Eligible officers and survivors can join for free at the BASIC level and others can complete a registration to get on the mailing list.

5 responses so far

5 Responses to “TRICARE and the ACA”

  1. Wm. Greeneon 18 Sep 2013 at 11:30 pm

    I was given prompt answers by phone concerning continued medical services by Tricare for Life with Medicare. While MOAA explanation of
    this service was made in May+ July in MOAA Retired officers magazine,
    I did not see it and am ;pleased to know that my wife and I will remain covered.
    We are 86 a 85 years old and needed to know before 1 Oct 2013.
    Thank you MOAA !

  2. Patricia Brattlandon 08 Nov 2013 at 6:26 pm

    When we arrived at the our clinic this morning for our annual flue shot (11/06/13), we were advised of TRICARE PLUS…although we were told we could stay at the clinic with our assigned Dr., they really didn’t know anything about it. Advised to called TRICARE, TRICARE told us to call Balboa Naval Medical Center, the kid on the phone a very rude Corpsman, said, there was no phone for anyone with TRICARE PLUS and transferred us back to UnitedHealthcare, who didn’t know anything about it and we were to call Balboa Medical Center. I started over with Balboa and finally talked with a girl an HM3 who said, yes, if you are over 65, you need to be enrolled with TRICARE PLUS and no you can’t enroll, closed on Oct. 1st. The HM3 also said, they are not sure if they will continue with TRICARE PLUS, so we will be forced to see an outside Medicare provider anyway….However, interestingly enough, none of the clinics or depts. know about TRICARE PLUS…..
    and there you are, so are we safe if over 65?
    Anyone know anything besides the ones running it who clearly don’t know anything about it?

  3. Patricia Brattlandon 08 Nov 2013 at 6:29 pm

    When we arrived at the clinic this morning for our annual flu shot (11/06/13), we were advised of TRICARE PLUS…(you are forced out of military health care if over 65) although we were told we could stay at the clinic with our assigned Dr., they really didn’t know anything about it. Advised to called TRICARE, TRICARE told us to call Balboa Naval Medical Center, the kid on the phone a very rude Corpsman, said, there was no phone for anyone working with TRICARE PLUS and transferred us back to UnitedHealthcare, who didn’t know anything about TRICARE PLUS and we were to call Balboa Medical Center. I started over with Balboa and finally talked with a girl an HM3 who said, yes, if you are over 65, you need to be enrolled with TRICARE PLUS and no you can’t enroll, closed on Oct. 1st. The HM3 also said, they are not sure if they will continue with TRICARE PLUS, so we will be forced to see an outside Medicare provider anyway….However, interestingly enough, none of the clinics or depts. know about TRICARE PLUS…..
    and there you are, so are we safe if over 65?
    Anyone know anything besides the ones running it who clearly don’t know anything about it?

  4. Matthew LoFiegoon 09 Nov 2013 at 8:27 am

    Hi Patricia. This is an interesting scenario you laid out. Were you able to see a Dr. for the flu shot?

    All TRICARE Plus provides is the ability to schedule appointments at military health care facilities and get the same level of priority scheduling as other programs like TRICARE Prime, Standard and Medicare/TFL. Without Plus at a military facility, you are seen on a space available basis. Plus is also base-centric and does not necessarily apply to other facilities. So it sounds like Balboa has limited the number of Plus accounts they can accommodate this year and closed the enrollment period.

    But, that shouldn’t affect your coverage at all. Under normal circumstances, you don’t need to be enrolled in TRICARE Plus. You definitely don’t need to be enrolled in Plus for health care coverage. As long as you are in Medicare (over 65) and TRICARE for Life (assuming retired status), you have full medical coverage and meet the requirements of the Affordable Care Act.

    If Balboa is requiring TRICARE Plus for anyone seeking to be treated there, it may be unique to that facility, and in that case you may be better off looking for an outside Medicare provider. But by the guidance of the program, all Plus would give you would be the ability to schedule an appointment with them and allow them to be your Primary Care doctor.

    I’ll ask one of our benefits advisers to look this over on Tuesday when we are back in the office, but this doesn’t look like a situation that is related to the new health care regulations.

  5. Matthew LoFiegoon 12 Nov 2013 at 8:56 am

    Patricia, just a follow up to say that my response was correct. If you have any questions, contact our Member Service Center at 800-234-6622, 8AM – 6PM ET.

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