Military Medical - Part 1

With the recent buzz on the internet regarding medical benefits being taken away from the military in order to force them to be covered by ObamaCare, I decided to find out what is going on. I decided to start at the beginning and find out what changes have been made. According to About.com the idea of military medical care for the families of active-duty members of the uniformed services dates back to the late 1700s. In 1884 Congress directed the “medical officers of the Army and contract surgeons shall whenever possible attend the families of the officers and soldiers free of charge.” There was very little change until World War II; most draftees were young men who had wives of childbearing age. The military medical care system, which was on a wartime footing, couldn't handle the large number of births or the care of very young children. In 1943, Congress authorized the Emergency Maternal and Infant Care Program (EMIC). EMIC provided for maternity care and the care of infants up to one year of age for wives and children of service members in the lower four pay grades. It was administered by the “Children's Bureau,” through state health departments. The Korean conflict again strained the capabilities of the military health care system. On December 7, 1956 the Dependents Medical Care Act was signed into law. The 1966 amendments to this act created CHAMPUS (Civilian Health and Medical Program Uniformed Services) beginning in 1967. The law authorized ambulatory and psychiatric care for active-duty family members, effective October 1, 1966. Retirees, their family members and certain surviving family members of deceased military were brought into the program on Jan. 1, 1967. In the 1980s, the search for ways to improve access to top-quality medical care while keeping costs under control led to several CHAMPUS “demonstration” projects in various parts of the US; among these was the CHAMPUS Reform Initiative (CRI) in California and Hawaii. Beginning in 1988 CRI offered service families a choice of ways in which they might use their military health care benefits. Five years of successful operation and high levels of patient satisfaction convinced Defense Department officials that they should extend and improve the concepts of CRI, as a uniform program nationwide. The new program, known as TRICARE, is now fully in place (in FY 1996 the TRICARE/CHAMPUS budget was more than $3.5 billion). Depending upon their military status family members and certain veterans receive free or government subsidized medical and dental care. For the most part, this care falls under an overall program known as "Tricare." When Tricare was first instituted, there were only three types: Tricare Prime, Tricare Standard (the closest to the old CHAMPUS pro) and Tricare Extra. Over the past few years more Tricare options have been established.

Tricare Prime is an HMO concept and requires that one enroll in the program (active duty members are enrolled automatically; there is no enrollment fee or cost-sharing for active duty members and their enrolled family members). Individuals in Tricare Prime are assigned to a Primary Care Provider (PCP) which is usually the local military medical facility (base hospital). In order to receive specialist care they must be referred by their PCP. A new option under Tricare Prime is the Point of Service (POS) enrollment option, it allows for reimbursement of medical care received from anyone other than the PCP without the referral. If the POS option is elected at time of enrollment one can use Tricare Prime and still use the Tricare Standard or Tricare Extra options.

Tricare Extra gives more flexibility than Tricare Prime but could result in additional costs. The patient sees any Authorized Tricare Provider (ATP), presents an ID Card and receives medical care. ATPs have a contract with the military for designated costs. The active duty family members pay an annual deductible. After the deductible is paid Tricare pays 85% of the office visit cost and set amount for inpatient medical and mental health care. A special note - if the ATP fills out the claim forms for a member and receives direct payment from Tricare for their portion of the costs (vs. member filling out the forms and being reimbursed by Tricare), the ATP AGREES not to charge more than the Tricare Allowable Amount unless a separate agreement is signed with the ATP which obligates the member to pay the additional amounts.

Tricare Standard gives the greatest flexibility but costs the most. Under this program, you can see pretty much any medical provider you want. There is the individual/family annual deductible for active duty family members, Tricare pays 80% of what it says the care should cost and the member pays 20%. If the provider charges more than what Tricare says it should cost, you have to pay the additional difference; inpatient care rates are the same as for Tricare Extra. A little-known provision of the Tricare Standard Program is if the provider attempts to charge you more than the authorized amount, then the member can contact the nearest Tricare Service Center and they will help arbitrate the dispute with the medical provider.

The Guard and Reserve (and their dependents) can use any of the above Tricare Options anytime the member is called to active duty for more than 30 days. Use of Tricare Prime is free, as it is with active duty members; coverage is provided up to 90 days prior to activation for members who receive a 'delayed-effective-date' order and it lasts until 180 days following deactivation; Guard and Reserve members can purchase special Health Care Coverage under the Tricare Reserve Select program, if they were activated for a contingency operation for 90 days or more.