Health Care Happenings

Well, the dreaded time has finally come…what has been chatter and mounting talk about budget cuts and increases in health care fees is here.

No more what if’s.

No more maybe’s.

No more speculation.

The Defense Department put some information about proposed cuts on the table yesterday when the Secretary of Defense, Leon Panetta announced details of his FY2013 budget. 

Though the full details will not be released until February 13 when the President releases his buget to Congress, the targets for significant cuts are clearly in eye sight…

        Uncle Sam wants you to give back money you, and your family have earned through a full career of service and sacrifice

“…Given the significant fiscal constraints that have been imposed on this Department, our approach was to use this as an opportunity to maintain the strongest military in the world, to not hollow out the force, to take a balanced approach by putting everything on the table, and to not break faith with the troops or their families…,” said Panetta.

Retirees, under age 65, will be hit hardest by major increases in health care fees. 

Here’s what the Pentagon wants from YOU (see more details in this week’s MOAA Legislative Update):

• New enrollment fees and additional fee increases for those enrolled in TRICARE by creating a ‘tiered’ approach based on retired rank.  This means-testing will require senior grade retirees to pay more for their health care than junior retirees;
• An enrollment fee for TRICARE for Life beneficiaries 65 and older; and,
• Additional increases in pharmacy co-pays with the goal of increasing the use of generics and the mail order pharmacy.

Should Congress approve the ‘tiered’ approach to health care fees, then that would make military retirees the only group of government retirees to be subject to means-testing  

In other words, the longer and more successfully you serve, the less benefit you earn

So what do you think–Does this break faith with the troops or their families” (SecDef’s words)?

Tell us what you think…And, even more important, tell your legislators what you think about these and other drastic cuts. 

Please send your legislators a MOAA-suggested message and ask them to oppose these dramatic cuts…let MOAA help you communicate with lawmakers to stop these cuts.

Happy New Year?

2012 didn’t start out so Happy

In fact, President Obama and the Secretary of Defense Leon Panetta rolled out their plan to cut defense spending by $450 billion over the next decade.  Maybe you saw MOAA’s report on the plan in last week’s Legislative Update, “Troops-Pay-Healthcare Cuts Coming.”

The plan to target troops, retirees and their families reminds me of the arcade game Wack-a-Mole, only there is nothing fun about this.  The threat of targeting military and retiree benefits for cuts, particularly health care, is nothing new–the difference is reality is less than a month away–then we’ll know more of the ugly details when the President submits his budget to Congress the first week in February.

In announcing his priorities outlined in a ‘Sustaining U.S. Global Leadership: Priorities for the 21st Century Defense,’ the President stated,

“Most importantly, we will keep the faith with our troops, military families and veterans who have borne the burden of a decade of war and who make our military the best in the world.”

In reading the report I noticed a great deal of focus on national security, cost of doing business, economic challenges, rebuilding readiness, reducing manpower costs and reductions in the growth of compensation and health care costs…

It was a rather sterile report, with little mention of military people and their families–the very strength of our national security.

I don’t know about you, but I’m not going to let my military benefits be taken from me so easily–WILL YOU?

The impact of these cuts will be tremendous on my family–and, even more devasting to those with far fewer resources.

There are always unintended consequences in budget cuts like these.

I’m going to do all I can to let my legislators know this is unacceptable–and, I’m going to tell my military friends and their families to use there voice too.  MOAA makes it easy to let your members of Congress know what you think about these cuts and other issues.  We also like to tell your stories.

Silence isn’t good–it just signals to policy and law makers that everything is okay.

But it takes all our stories–all our voices to turn this tide.  Let’s pull the plug so there will be no more WHACKING our military, retirees, veterans, and their families and survivors.

Use your voice and DO SOMETHING FOR YOU, YOUR FAMILY AND OUR MILITARY COMMUNITY–sign up for MOAA Legislative Updates to stay informed and let us help you take action–visit www.moaa.org/email or call MOAA’s Member Service Center at 800-234-MOAA (6622).

So What Will You Do This Year to Stop the Cuts? 

Before the holidays we provided an update on the ongoing Walgreen’s – Express Scripts negotiations and the plan for the way ahead if not resolved.  We now know that Walgreen’s will cease to be a network provider for TRICARE through the Express Scripts government contract.  Below we have addressed many of the questions that our blog readers had.  Here they are:

Responses to MOAA Members Concerns

1. Why isn’t TRICARE weighing in on the dispute between Walgreens and Express Scripts?

According to the September 15, 2011 American Forces Press Service article, “TRICARE Promises Continued Access to Prescription Meds.” Navy Rear Adm. Christine Hunter, deputy director of the TRICARE Management Activity, called the dispute between Walgreens and Express Scripts, Inc. “a business matter.”

RADM Hunter also stated, “Don’t let that advertising, letter and Internet outreach campaign scare you. Even if contract renewal negotiations fall through and Walgreens drops out of TRICARE’s retail pharmacy network on Jan. 1, beneficiaries still will have plenty of other options for getting their prescriptions filled.”

To read the full article, please visit http://www.defense.gov/news/newsarticle.aspx?id=65353

2. I am concerned about the safety of my medications when they sit in my mailbox all day.   

Throughout the year, Express Scripts works diligently to ensure your medications are sent to you in the safest way possible and in compliance with the medication manufacturers suggested shipping standards.  According to Christopher Meilinger, a Senior Pharmacy Director at TRICARE Pharmacy Home Delivery, “The vast majority of non-refrigerated medications are not negatively affected by the temperature differences seen during the normal shipping process. Express Scripts has done, and continues to do, research into the stability and potency of various medications as it relates to shipping during all months of the year. Using the research and information obtained from pharmaceutical manufacturers, medications are evaluated for the need for special packing and shipping processes during the warmer months of the year.”

Express Scripts pharmacists are available to answer questions you have about your medication 24 hours a day/7 days a week. Call 1-877-363-1303 to contact Express Scripts.

3. Can Express Scripts ship refrigerated medications to me?

Yes. Express Scripts will ship medications requiring refrigeration in cold packs. Please note, refrigerated medications cannot be shipped to APO/FPO addresses. To learn more, visit www.express-scripts.com/TRICARE or contact Express Scripts at 1-877-363-1303.

4. I am concerned that my medication could be stolen from my mailbox.

If your medication is stolen from your mailbox, contact Express Scripts at 1-877-363-1303. A Patient Care Advocate will work with you to obtain replacement medication.

5. I am going on vacation, and I do not have enough medication to last me while I am traveling.

If you do not have enough medication to last you while you are traveling, contact Express Scripts at 1-877-363-1303. A Patient Care Advocate will work with you to obtain a refill.

If you are traveling to a destination for a longer period of time, Express Scripts can ship your medications to a temporary address.

Express Scripts ships to the following destinations:

• All 50 states
• PO boxes
• APO/FPO addresses
• U.S. territories

To change your shipping address, contact Express Scripts at 1-877-363-1303 or update your address information online at www.express-scripts.com/TRICARE.

6. I normally have my prescriptions filled at Walgreen’s. Where can I find a listing of pharmacies who participate in the TRICARE program?

To find other pharmacies in your area who participate in the TRICARE program, Contact Express Scripts at 1-877-363-1303. A patient care advocate will locate participating pharmacies in your area, or go to www.express-scripts.com/TRICARE. Click on the Find a Pharmacy link in the Resources section. Enter your zip code to find a participating pharmacy.

You can also manage your prescriptions on the go with any Web-enabled mobile device to order refills, check status, find a pharmacy, and more. Visit http://www.express-scripts.com/mobile/ to learn more.

7. Do I have to contact Express Scripts every time I need my Home Delivery medications refilled?

No. Express Scripts offers an auto refill program, which takes the worry out of refilling your maintenance medications. Enrollment is free and when you enroll in this program, Express Scripts will automatically refill and mail your medication to you. Seven days before your medication is scheduled to be refilled, Express Scripts will notify you by phone or email that your prescription is going to be filled.  At any time before the prescription processes, you may cancel or reschedule the automatic refill. To register online for the auto refill program, visit www.express-scripts.com/TRICARE or call Express Scripts at 1-877-363-1303.

8. I like talking to my pharmacist when I pick up my medications.  Does Express Scripts offer the same service?

Yes. Express Scripts has pharmacists available 24 hours a day/7 days a week to answer questions about medication appearance, dosing, safety, side effects, drug interactions, temperature and medication sensitivity.  If you need to speak with a pharmacist, please call Express Scripts at 1-877-363-1303.

9. Can I order controlled substances through Home Delivery?

Yes, the home delivery pharmacy can fill a prescription for a controlled substance. In order to do so, your prescribing provider must provide his or her individual Drug Enforcement Administration number on the prescription and a complete street address. An adult’s signature is required upon delivery. Please note that controlled substances cannot be shipped to a PO Box.

Some controlled substances are not refillable by law. Check with your provider.

10. I recently had my prescriptions filled and noticed the copays have changed.  Can you tell me more about this?

On August 5, 2011, the Office of the Assistant Secretary of Defense (Health Affairs) approved changes to pharmacy copayments which go into effect on October 1, 2011. The following table provides the new copay structure as of October 1, 2011:

In a news release titled “TRICARE Reduces Pharmacy Home Delivery Co-Pays” dated September 7, 2011, Navy Rear Adm. Christine Hunter, deputy director of the TRICARE Management Activity, stated “These new copays make using TRICARE Pharmacy Home Delivery more affordable than ever” and “Home Delivery offers a great value for patients taking maintenance medications for chronic conditions.”

To read the full press release, visit http://www.tricare.mil/mediacenter/news.aspx?fid=736.

11. Over the last several months, my doctor has been adjusting my medications. I am concerned that if I use Home Delivery, I will be throwing away more medication than I use.

It is better to use a participating TRICARE retail pharmacy if your doctor is adjusting your medication. However, once your medication is adjusted, Home Delivery will provide you with more cost savings.

To begin using Home Delivery, go online to www.express-scripts.com/TRICARE and register or call the Member Choice Center at 1-877-363-1433.

There will be an important change to your pharmacy benefit effective the 1st of January 2012.  This concerns the retail chain of Walgreens.

As we have highlighted a few weeks ago, Walgreens will no longer be a part of the Express Scripts pharmacy network.  If you continue to fill your prescriptions at a Walgreens pharmacy after 1 January, you will have to pay 100% of your prescription costs and submit a paper claim for NON-NETWORK reimbursement, which will dramatically increase your out of pocket costs.

Walgreens remains in the TRICARE pharmacy network through Dec. 31, 2011, but the time for you to act is now.  According to ESI there are more than 56,000 pharmacies in the TRICARE network, excluding Walgreens.  On average, there is another network pharmacy within one-half mile of any Walgreens.  Now is also a good time to consider moving the medication you take on an ongoing basis to TRICARE Home Delivery.

Remember with the Home Delivery method you get:

1. Savings that add up quickly
2. Convenient delivery and refills (and refills come automatically..)
3. Safety
4. Personal service, as you can speak with a pharmacist anytime day or night from your home.

For more information on the Home Delivery option go to: www.express-scripts.com/TRICARE   and click on the ‘Get started with Home Delivery’ link on the left side of the screen.

The TRICARE Young Adult (TYA) Prime option is available for purchase on December 1, 2011, with coverage beginning January 1, 2012. Offering young adult beneficiaries TRICARE Prime coverage, TYA Prime has a monthly premiums of $201. To purchase TYA Prime, dependents must be under age 26, unmarried, not eligible for their own employer-sponsored health care coverage and reside within a TRICARE Prime service area.

Additionally in January 2012, TRICARE Young Adult Standard option monthly premiums are lowered to $176 with the same benefit structure previously enjoyed. See TYA  for full program details.

Medicare – Making Informed Choices

Some MOAA members have been inundated recently with information from insurance companies regarding enrollment in Medicare Supplemental Insurance (Medigap plans) or Medicare Advantage plans. These can be confusing, so let’s review.

Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance). Most retirees or their spouses paid Medicare taxes during their working years and don’t have to pay a monthly premium for Part A. Part B does require a monthly premium, which is means tested. To retain eligibility for Tricare beyond age 65, military retirees must be entitled to Part A and enrolled in Part B.

Medicare Supplements or Medigap plans help cover out of pocket expenses of Medicare beneficiaries. Tricare for Life acts as a Medigap plan for military retirees and spouses. You need no other supplements.

Part D is Prescription Drug Coverage. Most military retirees don’t need to join a Medicare Prescription Drug Plan. The drug plans are run by private companies approved by Medicare. Monthly fees vary by plan.

Sidebar: Surviving spouses who may lose their Tricare coverage due to remarriage, and anyone whose limited income qualifies them for Medicaid, should consider Medicare Part D coverage.

Medicare Advantage (MA) Plans, sometimes called “Part C”, combine Parts A and B, and usually Part D. Private insurance companies approved by Medicare offer these plans. The plans are run like a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), and can have a yearly deductible, co-payments, additional monthly premiums above Part B premiums, and restrictions on referrals to out of plan providers, as well as yearly limits on out-of-pocket expenses. MA plans must include the coverage obtainable from Original Medicare, except hospice care (Original Medicare covers hospice care even if you’re enrolled in a MA plan). MA plans usually offer additional services such as vision, hearing, dental and/or wellness programs to make them more attractive to some retirees. The insurance companies providing these plans are heavily subsidized by the federal government, though those subsidies are being squeezed by tightening budgets and by changes in health care policy expected to go into effect in the next few years.

When a MOAA member contacts me regarding whether or not to enroll in a Medicare Advantage plan, I always ask first if Part D coverage is required to join that plan. If it is, I advise them to look for another plan, or choose Original Medicare. If a Medicare Advantage plan’s network pharmacy is also a Tricare network pharmacy, the plans may coordinate benefits. However, the potential savings or additional services obtainable from a MA plan rarely offset the added premiums required for Part D coverage (average $30/mo in 2011) and the potential hassle of coordinating drug benefits. If a plan does not require Part D enrollment, proceed with caution.

Once the Part D requirement is determined, the member should carefully evaluate and compare the features of the MA plans under consideration. If the plan offers features that you will likely never need or use, or cover in another way, then it isn’t worth paying any additional money to belong to that plan.

Next, if you want to use your own health care providers, determine whether or not your provider is a member of that MA plan. The best way is simply to ask your doctor if he or she participates in any Medicare Advantage plans. Some MA plans require that you get all of your care from providers in their network (emergencies are usually exceptions). Some MA plans require referrals from a primary care doctor. Some plans allow greater choice of providers, but will charge you extra if you get care from someone outside the network.

Finally, Medicare Advantage plans are offered regionally, and can vary widely around the country of even your state. If you live in more than one place in retirement, a MA plan might not be good choice.

With all the different rules from plan to plan, many retirees decide to keep things simple and stay with Original Medicare. That’s not a bad choice. Tricare-eligible retirees can use Original Medicare and Tricare for Life to great advantage.

Whatever decision you make it isn’t permanent. Most plans have enrollment periods each year. You may be stuck with your decision for a year though, so choose carefully.

For more information, see Medicare’s Plan Finder tool at www.medicare.gov/find-a-plan

Source: Medicare & You, Centers for Medicare and Medicaid Services, 2011