TRICARE open season may lockout options for some military families

Military spouses with new jobs or patients who want a second opinion may have a tough time getting different care once they pick a heathcare plan.

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TRICARE recipients will have the option to pick between two healthcare plans next Monday as part of the system’s first-ever open season.

While the Defense Department is touting the TRICARE open season as a better way for beneficiaries to pick their healthcare plan, some military family advocates fear participants may get stuck with treatment that isn’t right for them.

The issue revolves around military treatment facilities (MTF) and the TRICARE Prime option.

TRICARE Prime is the cheaper of the two plans and generally requires participants to use MTFs as their primary health care managers.

“With the annual open enrollment requirement, we believe DoD isn’t taking into account this unique aspect of the military health system,” said Karen Ruedisueli, government relations deputy director at the National Military Family Association. “Let’s say we have an Army family stationed at Ft. Campbell and they select the TRICARE Prime option. What they are really selecting is to be enrolled at the Army hospital that’s on Ft. Campbell and that’s where they are going to get most of their care. Most people are satisfied with the care that they get at military medical clinics, but in a huge system such as the one run by DoD, it’s inevitable that some people are going to run into problems within that system.”

Before open enrollment, if that family wasn’t satisfied with the quality of care or the wait times were too long, they could switch at any time to the more flexible TRICARE Select and access a wider range of doctors in the civilian community.

“TRICARE Select provided a sort of escape hatch from the military hospital if you felt you needed it,” Ruedisueli said.

Now that escape hatch is going away, Ruedisueli said. Unless they undergo a “qualifying life event” — like moving or having a baby — families are locked into one plan until the next year’s open season.

“Previously if you wanted to switch plans, you could do that,” said Patrick Grady, chief of the TRICARE health plan, during a Monday call with reporters. “But then you were locked out for 12 months. You could not go back and forth between plans for obvious reasons. What this open season does now, it syncs us with the way industry has done this.”

Open season gives DoD a more organized way to have its TRICARE participants switch plans, instead of letting them switch whenever they wanted.

Ruedisueli fears that will become a restricting cycle for military families, especially when their lives can be hectic with new employment or new illnesses.

“If you’re a military spouse and you’re on TRICARE Prime and you’re not necessarily living on the installation — only about 30 percent of military families live on their military installation — you could be 30 to 45 minutes away,” Ruedisueli said. “Because you’re not working and you have the time and you have a budget you are trying to adhere to, you find that it’s worthwhile for you to enroll in Prime … even though it means you are driving 30 to 45 minutes to get that care.”

But, Ruedisueli asked, what happens if the spouse finds a job and now that drive is not feasible?

“A family circumstance like that is not going to trigger a qualifying life event to change plans,” Ruedisueli said. “You will still be stuck getting your care at that military hospital even though it no longer meets your needs.”

Ruedisueli also noted that in some cases families want a second opinion. She noted one family who had a child with an illness and the MTF misdiagnosed it. A civilian hospital was able to correctly diagnose and treat the problem.

MTFs have plenty of issues. A 2011 RAND Corporation study stated DoD “increasingly confronted financial, managerial and operational challenges in sustaining health benefits for service members and their families.”

In response to Ruedisueli’s concerns, Defense Health Agency Director Vice Adm. Raquel Bono said her organization is trying to make MTF care more reliable.

On Oct. 1, DHA started taking over the management of MTFs as required by Congress.

Bono said one of the initial steps DHA is taking is to standardize access in appointments.

“We hope by standardizing that and making the experience of care of our beneficiaries more uniform, that would be something you’d be able to experience and observe [as an improvement] right off the bat,” Bono said.

She added DHA wants to increase its communication with its patients so it can identify instances where MTF users are not getting the care they need.

“That would tell me there may be an issue going on with the policies or the execution of the policies in the MTF and we want to make sure we are being very consistent,” Bono said.

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