The final report of the Pentagon-appointed Task Force on the Future of Military Health will call for a new "modest" enrollment fee for 1.9 million elderly military beneficiaries who use their TRICARE for Life medical benefits.

The task force, as expected, also will call for higher TRICARE fees, deductibles and co-payments for three million younger retirees and their families. In an interim report last May, the task force said Congress should restore the relative cost share that retiree under age 65 paid when TRICARE began more in the mid-1990s.  TRICARE fees, deductibles and co-pays have not changed since then. Defense officials have tried twice to raise fees on younger retirees but Congress blocked the plan this year and in 2006.

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The idea of a new enrollment fee for TFL beneficiaries was not in the task force's May report. It is expected to anger older generations of retirees who have argued for decades they were promised free health care for life. 

Dr. Gail R. Wilensky, an economist who co-chairs the task force, outlined its 12 major recommendations during a public meeting of the Defense Health Board Dec. 11 in Crystal City, Va.

Part of one recommendation is a small enrollment fee for TFL, she said.  It is not intended to cut program costs but "to foster personal accountability and to be consistent with the task force philosophy that military retiree health care should be very generous but not free."

Seven of 14 task force members are active or retired star-rank officers. Military Update asked Wilensky if the TFL enrollment fee won a consensus even among these officers. It sparked "a lot of discussion, as you can imagine," she said, and there was "difficulty coming to complete consensus.  But you'll see how we handle that in the report" next week.

TRICARE for Life is second payer insurance to Medicare. To be eligible, beneficiaries pay Medicare Part B premiums just like civilians. For 2008, the standard Part B premium will rise a few dollars to $96.40 a month.

Given that other Medigap plans are "quite expensive" and that TFL is an "important and extensive" benefit, Wilensky said, task force members felt it was time to establish a small enrollment fee.

It will "bind the retiree closer" to the health benefit, which could help TRICARE in promoting healthy lifestyle initiatives, she said.  Also, a fee "just makes the point that these extensive benefits are not literally ‘for free.' "

Dr. Gregory A. Poland, Defense Health Board president, praised the task force's final report. He noted from its pages that military health costs doubled from $19 billion in fiscal 2001 to $40 billion in 2007. If changes aren't made, he said, medical spending will hit $64 billion by 2015 and consume 12 percent of the defense budget versus 4.5 percent back in 1990.

Proposed Enrollment Fees for TRICARE Prime (Family)

Note: Current Prime Enrollment fee for a family is $460. Individual beneficiary rate is $230. Under new fee structure, individual rate would stay at half the family rate. Actual fees beyond 2008 would be higher due to annual indexing.

Proposed Enrollment Fees for TRICARE Standard (Family)

Note: TRICARE Standard users currently pay no enrollment fee. Proposed annual fees after 2008 would be higher than shown due to annual indexing.

Higher Deductibles for TRICARE Standard (Family)

Note: Family deductible for TRICARE Standard is $300 a year. Individual rate is $150. Under new fee structure individual deductible remain half that for a family. Proposed deductibles after 2008 actually would be higher than shown 2008 due to annual indexing tied changes in TRICARE cost growth.

Proposed Pharmacy Co-payment Structure

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