FALLS CHURCH, Va. – TRICARE Prime will remain a health-care option for 97 percent of approximately 5 million beneficiaries eligible for Prime. The 3 percent difference, comprising about 171,000 beneficiaries, automatically will revert to the TRICARE Standard health care option Oct. 1. Those beneficiaries, who mostly reside more than 40 miles from a military clinic or hospital, recently received letters explaining their options and will receive reminder letters in June or July.
“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 none of our active-duty members and their families.”
TRICARE representatives have said the program is committed to keeping beneficiaries informed about changes. As a follow-up to the initial notification, a second letter will be mailed early this summer to make sure affected beneficiaries have the time and information they need to make decisions about their future health-care options.
TRICARE’s website, www.tricare.mil/PSA, has the most current details and gives beneficiaries the option to sign for e-mail updates. A ZIP code tool is available on the site to help beneficiaries determine if they live in an affected prime service area.
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, possibly, 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.”
In TRICARE Prime, those enrolled 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 there are cost shares and an annual deductible.
The Department of Defense first planned to reduce the number of prime service areas in 2007 when it requested bids for the third generation of regional health-care support contracts. The prime service areas being eliminated are not close to existing military treatment facilities or Base Realignment and Closure sites. Prolonged protests resulted in a staggered transition and it was decided to keep all prime service areas in place until all three contracts were in place. On April 1, the West region completed its transition.