Military Advantage

Some to See TRICARE Prime Restored

The following is a response to a question sent in by a Military Update reader:

I found online your article about the 171,000 beneficiaries who lost access to TRICARE Prime Oct. 1, 2013, due to TRICARE closing provider networks more than 40 miles from a military treatment facility (MTF). I was one of those affected. Do you have any information about the new defense bill, signed by the President in late December, reinstating TRICARE Prime for these beneficiaries? PAUL SCHACK Commander, USN-Ret.
Yes. The Fiscal 2014 Defense Authorizations Act does did contain a provision (Sec. 711) that authorizes the Defense Health Agency to allow beneficiaries who lost TRICARE Prime coverage after September 30, 2013, when their network disappeared, a new chance to enroll in Prime, the military's managed care health benefit . TRICARE had viewed their previous networks as too costly to maintain so far from military bases, and therefore forced 171,000 beneficiaries to begin to use TRICARE Standard, the military's fee-for-service option, instead. Congress, however, stepped in to offer some relief at least for those beneficiaries who live within 100 miles of an MTF. They will be given a one-time opportunity to rejoin a Prime network and stay covered as long as they remain in the zip code where they re-enroll. Still to be decided by the DHA based on locality is whether to restore and maintain a network of providers in an area from 40 to 100 miles of a military medical treatment facility or whether to require re-enrolled beneficiaries to use the existing Prime network run by the nearest MTF. So TRICARE officials are studying the law, planning how to implement it, and will be providing eligible beneficiaries with more guidance in the future. – Tom Philpott
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