Healthcare Benefits Grow for Retirees Age 65 and Over

Dr. H. James Sears, executive director of the TRICARE Management Activity, said that after Oct. 1, 2001, TRICARE becomes the "second payer" to Medicare for retirees and their spouses age 65 and over. As second payer, TRICARE will cover many of the costs not covered by Medicare.

Officials urged over-65 beneficiaries to consider their healthcare coverage needs carefully before canceling private supplemental insurance.

How to Update the Defense Eligibility Enrollment Reporting System   Eligible beneficiaries may update their addresses in DEERS in a number of ways, listed below. Visit local personnel offices that have an ID card facility. Call the Defense Manpower Data Center Support Office Telephone Center at 1-800-538-9552. The best time to call is Wednesday through Friday between 9 a.m. and 3 p.m. Pacific Time. Fax changes to 1-831-655-8317. Mail the change information to the DMDC Support Office, Attn: COA, 400 Gigling Road, Seaside, Calif. 93955-6771. Visit a military treatment facility. E-mail information to addrinfo@osd.pentagon.mil and include the following information: sponsor's name and Social Security number; names of other family members affected by the address change; the effective date of address information; and the telephone area code and number, if available. Note: Internet users should use all lowercase letters because some e-mail systems are case sensitive. To change information in DEERS other than address data, however, beneficiaries may visit an ID card facility, mail or fax changes with appropriate documentation to the address or fax numbers provided above. To learn what documentation is required, contact the nearest military ID card facility.

The second benefit is a new prescription drug program beginning April 1, 2001.

Dr. J. Jarrett Clinton, acting assistant secretary of defense for health affairs, said the plan to make TRICARE second payer to the nation's 1.4 million Medicare-eligible military retirees would likely cost about $3 billion the first year and $2 billion a year thereafter. He stressed the estimates could vary considerably by the time the program is implemented.

The new rules may increase the number of Medicare-eligible retirees who may be seen in military medical treatment facilities. Health affairs and TRICARE officials are working to figure out how many people this might be, Clinton said.

The true costs of the program will depend on how many people use military facilities and how many choose to use civilian physicians with TRICARE as the second payer, he added. Beneficiaries will have a choice, but there will likely be limits on the number of Medicare-eligible retirees who can use military facilities for their primary care.

"We don't want to displace active duty and their families, and we are concerned that nothing be done to suddenly displace ... retirees who are not yet 65," Clinton said.

The readiness benefits of providing care to some older retirees include "a greater range of medical and surgical issues for our providers," he said.

"Readiness is the reason we have a military medical program. We are now identifying the capacity of our military medical facilities to take on additional patients, particularly in specialties such as orthopedics, surgery and anesthesia. We don't know today how many patients will actually choose to use the military facilities; that, too, we are working to find out," Clinton said.

To take advantage of the new rules starting Oct. 1, eligible retirees must be enrolled in Medicare Part B and must have their Medicare status recorded in the Defense Eligibility Enrollment Reporting System.

The new law provides the older retirees with the same pharmacy benefits of retirees under age 65, said retired Air Force Col. Pat Hobbs, a contractor in TRICARE's Programs Operations Division. The benefit includes continued cost-free access to military medical treatment facility pharmacies and, with co-payments, access to the National Mail Order Pharmacy Program and retail networks managed by TRICARE regional support contractors.

The program also includes access to nonnetwork retail pharmacies, but co-payments are higher and an annual deductible of $150 per person or $300 for family members applies, Hobbs said.

A person who turns 65 before April 1, 2001, may participate in the pharmacy program without having Medicare Part B, but a person who turns 65 after April 1 must be enrolled in Medicare Part B to participate, Hobbs said.

Another provision in the authorization act makes TRICARE the first payer for retirees living overseas. Currently, military retirees age 65 and over living overseas must secure their own health insurance or pay for their care directly, because Medicare doesn't extend overseas. These retirees will be eligible for TRICARE benefits after Oct. 1, 2001, provided they have Medicare Part B.

The legislation also extends the TRICARE Senior Prime demonstration for another year. In the demonstration, Medicare reimburses DoD for care that retirees and their spouses age 65 and over receive in military medical facilities. Roughly 30,000 people currently participate in TRICARE Senior Prime, which was first authorized by the 1997 Balanced Budget Act.

To participate in most of the new programs, TRICARE officials emphasized that retirees must be enrolled in Medicare Part B and that their personal information in DEERS be accurate.

DEERS records should contain correct addresses and any changes in family status such as marriage, divorce, birth or adoption. Home addresses are important because the one on file is used to send out health benefits information, officials explained.

Eligible beneficiaries who are not sure if they are enrolled in Medicare Part B can check the back of their Social Security cards for this information. To enroll, beneficiaries must submit an application for Medicare Part B directly to the Social Security Administration. A general enrollment period for Medicare Part B is held annually from Jan. 1 through March 31, and Part B coverage starts July 1 of that year.

For details on enrollment in Part B, beneficiaries may call the Social Security toll-free number, 1-800-772-1213, or visit any Social Security office. They also can find information on the Medicare Web site, http://medicare.gov.

For more information, visit the TRICARE Management Activity's Internet home page at www.tricare.osd.mil.