TRICARE enrollment fee fight ahead for Congress

The Senate version of the defense authorization bill has a much more modest approach to enrollment fees for TRICARE users.

The House and Senate may duke it out in the coming months over whether family members of active duty military should pay annual enrollment fees for health care.

The Senate Armed Services Committee’s 2017 defense authorization bill does not create enrollment fees for active duty military family members on TRICARE. The language is a split from the House version of the bill, which requires enrollment fees for family members of active duty service members who join the military after 2018.

The decision is welcome news to service member advocate groups like the National Military Family Association. A representative of the group said she was “disappointed” in the House decision to impose fees.

The fees are partly a way for Congress to fund expanded TRICARE benefits and to pay for the increasing cost of military health care.

The Senate bill will not be without any extra cost, however.

Working-age retirees enrolled in TRICARE will see “modest” increases in annual fees, said a committee staffer.

Like the House version of the bill, TRICARE will be broken into two different plans: TRICARE Prime and TRICARE Choice. A third option called TRICARE Supplemental is available for those with other forms of insurance.

Under TRICARE Choice, working-age retirees would see a single annual enrollment fee of $150, which would increase by $60 a year over five years, ending at $450. For families, the fee would go from $300 to $900 in five years. After that, the fees are indexed.

For TRICARE Prime, the fees, co-payments and deductibles are indexed starting in 2018.

“Nobody likes to pay higher fees for anything,” said a Senate committee staffer. “The way we have laid it out in our bill, we feel like is a very reasonable approach. … Anecdotally, I can tell you when I go out and talk to retirees and ask them ‘Are you guys willing to pay more for your health care?’ They are like, ‘Of course we are.’”

The plan is similar to what the Obama administration suggested in February, but the fees are phased to the maximum amount instead of being imposed all at once.

The House plan adds a bigger pool of people who must pay enrollment fees by requiring active-duty family members to pay. But those fees won’t be as high.

The bill also narrowed down the number of plan choices to two. The fees only apply to family members of those who join the military after 2018.

Beneficiaries can use TRICARE Prime, which is like an HMO and uses military treatment facilities, or they can use TRICARE Preferred, which works like a PPO and offers more treatment choices.

TRICARE Prime will cost an individual $180 and a family $360 annually. Retired beneficiaries will pay $325 for an individual and $650 for a family.

TRICARE Preferred is more expensive. That plan would cost $300 for an individual annually and $600 for a family. Retired users would pay $425 individually and $850 for a family.

Senate committee staffers said senators were unwilling to impose fees on active duty military families.

Improving value for beneficiaries

Fees aren’t the only change in the Senate bill. Staffers said the goal of the bill was to provide more value to beneficiaries, while also trying to cut the cost of the health care system.

A Congressional Budget Office report stated DoD spent $52 billion in health care for service members, retirees and their families in 2012.

“The cost of providing that care has increased rapidly as a share of the defense budget over the past decade, out-pacing growth in the economy, growth in per capita health care spending in the United States and growth in funding for DoD’s base budget,” the report states.

The cost of providing health care to military and their families rose 130 percent from 2000 to 2012, the report states.

A committee staffer said the bigger cost savings will come from organizational and preventative health care reforms.

The bill tries to modernize contracts for open competition to incentivize new, innovative health plans and programs.

The bill also sets up centers of excellence at major medical centers, much like the Cleveland Clinic. In these centers, certain hospitals will be responsible for medical specialties. A staffer said this form of medical care has lowered readmission rates and provided better care.

The bill also tries to control cost by providing preventative care to high risk, high cost patients to keep them out of the emergency room.

One Senate staffer said in the long run this will decrease costs. The staffer added that savings may not be realized for five or 10 years.

The bill also provides $400 million in health care modernization.

Still, the bill has a long way to go. The full Senate must pass the bill. The House is expected to pass its version of the bill on May 18. But, as of May 16, the House version has 375 amendments that could change the face of the bill.

A statement of administration policy released May 16, recommended vetoing the defense authorization bill if it looked like the House version.

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