washingtonscene Time Is Key With
Fee Proposals It’s not just the TRICARE fees, it’s how they’re adjusted.
T
he variety of fee changes pro- posed in the FY 2017 DoD budget will make your head spin: new
enrollment fees; new names for TRICARE Prime and Standard; means-tested fees; dif- ferent charges for seeing in-network versus out-of-network providers; changing some cost shares to flat fees that vary for different kinds of providers; adjusting fees by a new measure of health care inflation; and more. Put all those changes together, and it’s tough to figure out what they mean. It depends on whether you use TRI-
CARE Standard, TRICARE Prime, TRI- CARE Reserve Select, TRICARE For Life, etcetera. It depends on whether you get your care in a military treatment facility, from a civilian doctor in the DoD network, or from a doctor who’s not in
the network. It depends on how much health care you and your family use. Most active duty families probably
would see lower costs, while most retired families would pay significantly more. But these are only snapshots, estimat- ing what your costs would be in the first year if all the various changes were en- acted by Congress. The real penalty they entail lies in
how they would change your share of health care expenses over time. Under current law, selected fees and
copayments are adjusted annually by the same percentage as the retired-pay COLA. The new proposals would adjust all fees
TRICARE Fees: COLA vs. National Health Expenditures Adjustment $3000
$2500 $2000 $1500
$1000 $500 $0
*
TRICARE Standard (Out-of-Network) Cost Increased by DoD- Proposed Health Index (5.2 Percent Annually)
TRICARE Prime (In-Network) Cost Increased by DoD- Proposed Health Index (5.2 Percent Annually)
TRICARE Prime (In-Network) and TRICARE Standard (Out-of-Network) Cost Increased by COLA (2.5 Percent Annually)
Annual cost estimate for a retired family of four assumes: annual enrollment fee; annual deductible; six primary care visits, three specialty-care visits, and one outpatient surgery; and two brand-name and two generic prescriptions a month (initial fill retail; refills by mail-order).
and copayments annually by a measure of health care inflation called the National Health Expenditures index — which is pro- jected to grow at about 5.2 percent a year. The chart (below) shows how annual fees for a retired family of four would grow over 10 years under this index, rel- ative to current fee growth by the COLA percentage. How about the proposal to change in-network cost shares from a percentage of the provider’s charges to a flat fee? When you pay a
percentage of charges under TRICARE Stan- dard, your cost share rises over time by the same percentage as the payment to the doctor. TRICARE pay- ments to doctors are tied to Medicare’s, and Medicare payments to doctors have risen very slowly over the past decade as Congress has tried to keep a lid on health care costs. That
38 MILITARY OFFICER APRIL 2016
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028
Annual Cost*
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