Health Care Happenings

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

Last week, in conjunction with MOAA’s Annual Meeting in San Antonio, the MOAA Board of Directors Healthcare Committee was  provided a tour of the “new” Brooke Army military medical center located on the grounds of Fort Sam Houston.  We had a first hand view of one of the military’s premier hospitals and observed the care they give to our wounded warriors and their families.

Many will no doubt remember that BRAC 2005 directed the realignment of the inpatient medical function of the 59^th Medical Wing (Wilford Hall Medical Center) to Brooke Army Medical Center (BAMC) in San Antonio to create the San Antonio Military Medical Center (SAMMC). This deadline was met on Sept. 6, 2011, when the final relocated inpatient service opened at Brooke Army Medical Center. BAMC, the hospital, is now known as SAMMC. Brooke Army Medical Center now refers to the headquarters that oversees all Army clinics in San Antonio and the surrounding area. Wilford Hall Medical Center is now known as the Wilford Hall Ambulatory Surgical Center.

The SAMMC medical center serves as a world class health science center for inpatient and ambulatory care, consisting of Graduate Medical Education (GME) & training, a Level 1 Trauma Center, and the only American Burn Association verified Burn Center within the DoD.  We had an extensive tour of this burn center and it is truly state of the art.  They not only take care of patients air-evaced from the theatre of war, but also care for the severely burned victims from the surrounding civilian community.

Wounded warriors and their families are also cared for in a holistic approach.  One of the unique features on the grounds of the medical center is the Warrior Family Support Center.  This center grew from a conference room filled with food, clothing and shelter for wounded families to a state of the art 12,500 square foot facility.  This center is a haven for recreation and support and boasts of a miniture golf putting green, to a large multi-use kitchen which frequently serves family feasts.

The San Antonio community is known as the most “military friendly” city in America.   By the end of our visit we certainly felt the same way!

We’ve talked about the White House proposal to establish an escalating enrollment fee for TRICARE For Life, but that budget-cutting proposal included several other cutbacks that would affect all Medicare-eligibles, including those on TFL.

The other proposals included:

a. Requiring pre-approval for some kinds of imaging (e.g., MRIs and CT scans), beginning in 2013

b. Further reducing the Part B subsidy levels (that is, further increasing Part B premiums) for the four income categories above $85K, starting in 2017

c. Freezing the income thresholds beyond current freeze expiration (FY19); change would freeze them until 25% of eligibles exceed them

d. Adding $25 to the Medicare deductible for new enrollees in 2017, another $25 for new enrollees in 2019, and another $25 for new enrollees in 2021 (strange system would require Medicare to track four different deductible rates, depending on when beneficiaries became Medicare-eligible

e. Establishing a $100 copay for home health services for new Medicare eligibles starting in 2017, indexed to the growth in average payment

f. Starting in 2017, establishing a Part B premium surcharge (they estimate it would be about 30% of the standard Part B premium) for beneficiaries whose Medicare supplements provide first-dollar coverage (as TFL does) (this would be in addition to any TFL enrollment fee)

It remains to be seen what the Super Committee will do with these and other proposals.

We’ve received additional details on the White House’s recently-announced plan to impose an annual enrollment fee for TRICARE for Life.

We previously reported the proposal would establish a fee of $200 per person, starting in FY2013.

Now we’ve seen the legislative language behind the plan, and it wouldn’t stop there.

For FY2013, the Administration plan would raise the enrollment fee to $295 per person.

For FY2015 and beyond, it would give the Secretary of Defense authority to raise the fee each year based on some index of medical health cost growth. The legislative language and accompanying explanation includes a chart that assumes the enrollment fee would grow at roughly 6% per year.

MOAA opposes any enrollment fee for TFL, and opposes tying any fees to medical inflation….especially one that’s left to the discretion of the Secretary of Defense.

We’ve seen the result of that kind of statutory discretion — the next time there’s a budget crunch, the Secretary has the leeway to change the rules and jack up fees to virtually any level.

The recent budget proposal put forth by the White House has the explicit intention to “Make the military’s healthcare more in line with and like other civilian healthcare plans.”  What exactly does this mean?

It implies that the Military’s plan is too good a benefit and should be put more in line with the average civilian plan such as Blue Cross/Blue Shield, Aetna etc. which the federal government among other corporate entities offer to their employees.  The military will no longer have the EARNED “gold standard”, but will be relegated to the middle of the pack in healthcare plan rankings – as evidenced by achieving parity in pharmacy co-pays for example.

It should be noted that while these drug co-pays do not apply to the active military member, that member is still responsible for higher co-pays for their family.  This particurlarly affects active duty Guard and Reserve families who are mostly assigned away from military facilities.  Additionally, changing retail medications to a percentage of the cost of the medication penalizes the sickest most, for example military children with disabilities and chronic  illnesses.

This move to make “the military more like civilian plans” is inappropriate and fails to distinguish the very radical difference between military and civilian working conditions.  It ignores that fact that military people and their families pay large premiums up-front for their health coverage through decades of service and sacrifice.  Those “healthcare premiums” have been earned and should continue to earn “gold standard” health coverage that is significantly better than typically offered for civilians who do not incur those sacrifices for their country.

The United States military both past, present and future deserve a benefit which should be in the top rung … not the middle rung.