Government

Why is TRICARE different? It is not! Costs must be managed in a reasonable way

Logo of TRICARE, the health care plan for the ...

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Let’s say that you took a job thirty years ago in part (generally a small part) because of the employee benefits (pension, health benefits, etc.).  You also knew that if you stayed with the employer for thirty years or so you would receive health benefits during your retirement.  There was no promise for all this, but it was implied because these benefits were part of your total compensation.  In reality, you were earning those retirement benefits during the years you were working.  At the same time, the benefits were changed over the years.  The premiums retirees paid increased, the benefits changed from time to time, mostly in response to ever-rising health care costs.

Unfortunately, there was no legally binding commitment, no guarantee, so many retirees in this situation (a distinct minority of Americans by the way) see their benefits simply go away or their cost sharing rise to unaffordable levels or even coverage for their dependents eliminated.  This is not right for those already retired, but it happens.

Now let’s look at Tricare, the health benefits plan for military personnel. Remember, we are not talking about coverage for military personnel who were wounded or who have a service related disability, we are only talking about active personnel family members and retired personnel  who have put in their 20 or more years on the job.  These are individuals who may be in their early forties when they retire and who most likely have started a new career, sometimes with benefits.  In effect, they are no different from any other retiree, except they get to retiree a lot earlier with a lifetime pension. Tricare offers several options under different circumstances.

Recipients of these benefits rightly feel they earned the coverage while on active duty (actively employed), but so do retirees of any employer.  Retired veterans feel they are special, they have given something through their service, and so do retired teachers and police officers. 

Tricare provides generous benefits by today’s standards with no out-of-pocket costs for many services and low patient costs for services provided in non-government facilities. For example, Active duty service members and their families pay no enrollment fees and no out-of-pocket costs for any type of care as long as care is received from the PCM or with a referral.

Look at the pharmacy benefits: 

Military Treatment Facility (MTF) Pharmacy

  • $0 copayment for up to a 90-day supply of most medications.
  • Not all medications are available at MTF pharmacies. Call first to check availability.

TRICARE Pharmacy Home Delivery

  • $3 for generic formulary medications
  • $9 for brand-name formulary medications
  • $22 for non-formulary medications
  • May receive up to a 90-day supply of most medications

TRICARE Retail Network Pharmacy

  • $3 for generic formulary medications
  • $9 for brand-name formulary medications
  • $22 for non-formulary medications
  • May receive up to a 30-day supply of most medications

 Most employer plans carry co-pays double these amounts and if a 90-day supply is received the co-pay is virtually always double the 30-day supply amount.  These plans are generous (and costly) by any stretch of the imagination.

 For this coverage, a retired military family pays $460 per year, a premium or enrollment fee as it is called, that has not changed in fifteen years. If the individual is on Medicare they must pay the Part B premium, but between Medicare and Tricare, there are no out-of-pocket costs.  

So what is the point?  The point is that everyone is special and nobody is special.  Every teacher, firefighter, police officer, military personnel and senior citizen can make the case they are different, that they deserve more or special consideration for this or that, apparently especially when it comes to health care. 

Promises made should be kept, but that is the trouble with making promises in areas where circumstances change dramatically and you have little control over those changes.  Clearly, no one who has earned a benefit should lose it, but it still must be affordable for the people picking up the tab.  What reasonable person would claim that a premium should not change in fifteen years as costs soar?  No reasonable person, but clearly that excludes members of Congress who have blocked changes to Tricare.

Managing the cost of Tricare must be on the table like any other government expense. If politicians had done the right thing throughout the years, Tricare and many other programs would not be the burden they have become…but that is another story.

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Categories: Government, Healthcare

3 replies »

  1. Military Retirees have paid their premiums
    Military retirees have paid their premiums by time and service rendered. Although budget items are of great concern, how do you take or cut from those who already paid. In many circumstances, the price they have paid is far more then the benefits they have earned and are entitled to.

    There are areas in TRICARE that the DoD can work to reduce the overall budget and at the same time, not hurt the beneficiary. TRICARE Standard is by far the best plan for retires vs. Prime, this is a good starting place for the DoD to consider. Even though TRICARE Standard is a good place for the beneficiary, they still need a TRICARE Supplemental Insurance Plan http://www.tricaresupplement.us/index.php.

    We are concerned DoD will hurt the benefits of the Military Retirees & we agree the budget needs better control on spending in other areas. Keep in mind, after a tour of duty, many fine Americans return home with injuries and disabilities that last the rest of their lives

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    • First remember Tricare is not paying for service related illness or injury and there is no issue paying for that care. However, retired military are no different than other retirees who were years on the job. They all earned their benefits but the cost still has to be managed fairly.

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