Possible Changes to TRICARE Prime

You Could be Bounced from TRICARE Prime

A new DoD policy aimed at "cleaning up" TRICARE Prime enrollment at military treatment facilities (MTF) could mean some significant changes for many Prime enrollees.

TRICARE has long had established travel access standards to help beneficiaries receive timely health care. The standards require that enrollees shouldn't be assigned a primary care manager (PCM) at a military hospital or clinic that's more than a 30-minute drive from the beneficiary's home address.

As a practical matter, DoD never really enforced that policy. But it will be enforced now.

If they want to continue to be seen in the MTF, current Prime enrollees in the U.S. who live farther away than a 30-minute drive from the MTF will have to request a waiver of the drive-time standard from the MTF commander or the TRICARE Regional Office. Drive times will be determined by a computer program similar to MapQuest. Approved waivers will have to be renewed annually from now on.

Unless they apply for and are granted a waiver before October 1, enrollees who live more than 30 minutes (but less than 40 miles) from the MTF will be assigned a civilian primary care manager closer to their residence. Absent a waiver, those who live more than 40 miles from the MTF will be disenrolled from Prime and revert to TRICARE Standard as of October 1.

TRICARE contractors are mailing letters to all affected beneficiaries, providing detailed instructions on the waiver process.

How do you feel about this action? Contact S. Ward Casscells, Assistant Secretary for Health Affairs and Director of TRICARE Management Activity.