A year ago, under the title "The Affordability of a Priceless Benefit," John Molino wrote about the promise of lifetime healthcare for military beneficiaries. He told of the passage of legislation that, after years of work by advocacy groups like AUSA, would, in essence, finally authorize lifetime healthcare without the need for supplemental insurance. The new program, called TRICARE for Life (TFL), would pay authorized costs not covered by Medicare for Medicare-eligible military beneficiaries enrolled in Medicare Part B. In essence, TRICARE serves as second payer to Medicare. At the time the article was written, the issue was how the enormously costly program would be funded. Fortunately, a year later, funding the program is no longer an issue. Congress has taken care of that and authorized full funding for military health care programs. Now we can look at how well TFL has been implemented, what else needs to be done to improve the program and which other health care initiatives are in need of attention. The ultimate goal must be to create a consistent, reliable and equitable benefit regardless of beneficiary age or location.
So, how is the start-up going of a "company" that has 1.3 million customers worldwide with a budget of $3.9 billion per year? All in all, very well -- although as with any enterprise so large, there have been some problems. Not too long after the implementation of TFL, a computer glitch prevented electronic claims exchanges between TRICARE and Medicare for about 13 percent of the TFL-eligible population. The TRICARE Management Activity (TMA) quickly contacted those affected and worked to get the computer error corrected.
Other glitches involved beneficiaries who visited doctors who do not accept Medicare assignment. They can charge up to 115 percent of the Medicare-allowable charge and TFL will cover the extra 15 percent. Some TRICARE claims processors initially denied the extra payment. That problem has also been solved. Finally, there were some problems with beneficiaries who cancelled their supplemental health insurance, and for one reason or another, the TFL system still showed the beneficiary had other insurance (which by law must pay before TRICARE). Their claims were denied. That problem has also been resolved.
A recent problem that the Department of Defense has asked all advocacy groups to help publicize has to do with expired military ID cards. A number of claims for spouses and widows are being denied because their ID cards were not renewed upon expiration. Perhaps they no longer live near a military base or are in situations where they cannot get to a renewal location easily, but in order to solve the problem in the long term, ID cards must be renewed. Those who need to do so can call the Defense Manpower Data Center Support Office toll-free at 800-538-9552 or the TFL call center toll-free at 888-363-5433.
For a system that has received more than 5 million claims, which have been paid to the tune of $107 million so far, this is an excellent track record. For the great majority of beneficiaries, TFL is working well, and TFL leaders are committed to solving identified problems quickly. AUSA will continue to work with TMA directly and in conjunction with the military coalition to identify and fix problems as they are identified. We've gone from "how will it be funded?" to "how can we fix the glitches?" -- wow, what a difference a year makes.
So, what else is on the military health care plate? In the world of retiree health care, the issue of forced choice continues to be discussed. The current administration has a goal to make military retirees choose whether the Department of Veterans Affairs (VA) or the Department of Defense (DoD) will provide their health care. The administration believes that such a choice would enhance quality and continuity of care and prevent duplication of services and costs. Most people believe the emphasis is on cost reduction, not enhancement of care. Department of Defense and VA care are quite different, and each has areas of expertise that the other might not. For example, VA care for spinal injury and prosthetics is world class, yet TRICARE offers far more localized routine health care options in more locations than does the VA. Military retirees have earned access to both systems, and AUSA will fight to keep that dual access available while supporting efforts to enhance VA-DoD health care coordination.
Some other issues that AUSA is working on this legislative year include obtaining authorization for the purchase of health care benefits with pretax dollars including TRICARE Prime enrollment fees and premiums for TRICARE supplemental, long-term care and dental insurance premiums. AUSA also wants to waive the Medicare Part B late enrollment penalties for retirees who delayed enrollment and ensure that DoD maintains a comprehensive pharmacy benefit with a robust formulary as well as portability of pharmacy benefits among TRICARE regions. AUSA also supports TRICARE wraparound coverage as an option for reserve component personnel on a fee basis prior to activation and TRICARE benefits for up to one year after deactivation.
AUSA's ultimate goal is to preserve and enhance health care coverage for all categories of beneficiaries. TRICARE for Life is a great boost toward fulfilling the commitment to lifetime health care and with its funding taken care of, we can look forward to refining its implementation and directing additional energy to the many other health care issues still in need of attention.
WILLIAM B. LOPER is AUSA's director of government affairs.