You may have heard about some new, major Tricare changes proposed this week -- but what do they mean? Here is your handy, dandy in real-human-English guide to the president's proposed cuts that impact military families.
First, the usual caveat: all of this stuff is a proposal. And, as in past years, all of this is unlikely to happen just the way it's laid out in what the president submitted to Congress. For example, last year a similar proposal was made and we saw almost no changes. Congress has said they want to put in place some Tricare reforms, but word on the street is that they will be incremental -- and that lawmakers don't particularly like this idea of recasting the current system under different titles (what one staffer called "putting lipstick on a pig").
Big Tricare Price Increases ProposedWhat is proposed? As in years past, the president is proposing rehashing the way Tricare is laid out into two primary new plans.
For you Active Duty people who like Tricare Prime.Tricare Prime would be recast as "Tricare Select" and pretty much nothing would change. You would still have no co-pays and no deductibles as long as you continued to use your Tricare-appointment primary care doctor (usually at a Military Treatment Facility) and get referrals for your specialty care.
The big cost increase is in what happens if you act without a referral -- you'll be coughing up a 50 percent point of service charge on TOP of the system deductible for out-of-network care, which would $200 or $600 per family, depending on rank.
For my Active Duty Tricare Standard folks.Tricare Standard would be changed to "Tricare Choice." Instead of being thrown into the world as you are currently, you would have the option of being assigned a primary care manager (PCM) at the military treatment facility (MTF). You could also receive specialty care there, although it's unclear how self-referring to specialty care in the MTF would work. If you decided to go to providers on the outside, you would be paying $15 per primary care visit, $25 per specialty care visit (to include therapies like speech therapy or physical therapy), $50 per emergency room visit and $80 per hospital admission.
The proposal doesn't break-out maternity care at all, making it look like there would be quite the price bump for having a baby on Choice compared to what's happening today on Standard. According to what's in this plan, you would pay $25 for every visit to your OB (or midwife) and $80 for the hospital experience.
And that fee cap? Bumped to $1,500 per year.
For my Retirees.Here's where we get neck deep in bad news for people who don't want to pay more for healthcare (and isn't that, well, everyone?).
There's no other way to say it -- retirees really get screwed with this new plan. Enrollment fees go from what they are now -- zero, if you're on Tricare Standard -- to $350 for an individual and $700 for a family to move into the new "Choice " program. And for the folks currently on Prime who now pay $282.60 per year for a single person or $565.20 for a family, the fee increases to $450 and $900 respectively.
Most care received at MTFs will continue to be free for retirees, but if they live far away from one or can't get in there (more about that in a second) they'll be stuck paying $20 for primary care visits, $30 for specialty, $75 for an emergency room visit, for example.
And the deductibles and catastrophic caps are also higher -- $600 for families as a deductible and $4,000 as a catastrophic cap.
For medical retirees and Gold Star families.You all would still be treated as if you are Active Duty families. That means you would choose between Select and Choice detailed above and be subject to the same fees and changes Active Duty is dealing with.
For everyone who uses medications.The prescription fees would continue their price march forward. Right now you're paying $10 for a 30-day supply of drugs at a retail pharmacy, and $24 for name-brand. If you go mail order, you're paying nothing for a 90-day supply of generic drugs, $20 for brand names and $49 for anything non-formulary (which mostly aren't available at a retail pharmacy at all unless you want to pay full price).
According to this proposal, fees would increase ever so slightly for generics every year starting in 2019. By 2026 you'll be paying $14 for generics at retail pharmacies, and $14 for them by mail. For brand-name drugs, you'll see an increase by 2026 to $46 for both retail and mail order. Non-formulary drugs, still available only by mail, will cost $92 for that 90-day supply.
The only thing that wouldn't change under this plan is that drugs received a MTF pharmacy would still be totally free. So... yay?
So many questions.There are a lot of "we don't know yet" things going on here. For example, if they want to push more and more people into the military treatment facilities, how in the world are they going to have enough appointments? Right now I can't get an appointment with my MTF doctor unless I'm willing to call in for a same-day "sick" appointment or wait two months.
Also, the maternity question lingers. Are they really going to start charging that much more for having a baby on the new plan?
Other family program changes.The good and bad news is that there really aren't any proposed in these documents. Childcare funding is seeking a bump. Although just why isn't clarified, my guess is it's to cover the cost of increasing hours at on-base care centers to meet the secretary's goal of extending hours.
The commissary is looking for a slight funding decrease, although, again, they don't say why. This article speculates it's because they are proceeding with a plan to close a few stores in Germany considered redundant and won't need the money.
Otherwise, all the other funding seems to be exactly as it has been in the past. The budget documents say that keeping funding for spouse employment and other similar programs is important. That's nice of them.
The process of deciding whether or not to move forward with these proposed changes is a long one -- and you know I'll keep you updated as we go along. Goodnight, and good luck.