Congress Passes Another Short-term Fix for Medicare Reimbursement Rate
6/25/10 - The House leadership reversed an earlier decision and approved the Senate-passed "doc fix" bill (HR 3962). The bill avoids the 21.2% cut in Medicare and TRICARE reimbursement payments to doctors required by the Sustainable Growth Rate formula (see related story in right hand column) for six months - through November 30th - and actually increases such payments by 2.2% retroactive to June 1, the date the rate cut went into effect.  Thanks to all NAUS members who contacted their Representatives about this important issue.

NAUS invites your help to continue pressing Congress for a permanent fix to the problem.  Together we must ensure that military retirees and their families have access to quality care when they need it. 

Update on TRICARE Fees and Costs…
6/2/10 - As reported in February, TRICARE beneficiaries will face no fee hikes in 2011, IF Congress approves that part of the President’s budget request, as NAUS expects. The House has passed its version of the 2011 NDAA preserving the President's funding level and specifically prohibiting any TRICARE fee or cost increases through Sep 30, 2011. But even as the President's 2011 budget was announced, and ever since, NAUS has been hearing senior adminsitration officials, and now even some members of Congress, making statements that indicate increased fees are on the horizon.

Defense Secretary Robert Gates said he wants to work with Congress to find ways to control rising military healthcare costs that are absorbing an increasing percentage of the defense budget (officials estimate that health care costs will grow from around 6% of the budget now to more than 10% by 2015). Gates said, "I ask anybody to point me to a health insurance program that has not had a premium increase in 15 years," referring to the fact that TRICARE premiums have not changed since 1995. He admitted that TRICARE benefits should be generous, but compared the $1,200 average out-of-pocket costs for a family of three under TRICARE to about $3,300 for the same family under the Federal Employees Health Care Program.

In May, the sea Service leaders, ADM Gary Roughead, USN, Chief of Naval Operations; Gen James Conway, USMC, the Marine Corps Commandant; and ADM Thad Allen, USCG, then the Coast Guard Commandant (who remains on active duty as a 4-star admiral as National Incident Commander for the Gulf of Mexico oil spill); all complained about soaring personnel costs related to health care and said increased contributions by retirees for their TRICARE coverage is overdue while speaking at a Navy League symposium in early May. ADM Roughead noted that the expense of Navy retirees "eats into our other programs." Gen Conway said there has not been an adjustment in retirees’ payments for TRICARE in twenty years "and that needs to be addressed." ADM Allen, preparing for his retirement, said he has enrolled himself and his wife in TRICARE Prime, paying only $465. "Something needs to be done about that," he said.

Now, Sen. Jim Webb (D-VA), himself a Marine veteran who fought in Vietnam, and Chairman of the Senate Armed Services Personnel Subcommittee, said in a hearing that the cost of non-cash benefits like health care and retirement – “continues to rise at disturbing rates.”

NAUS members need to be concerned and know that NAUS is continuing to work with Congress to hold the line on TRICARE costs and fees, as we have done for several years.

Rumored Threat to TRICARE Still Making the Rounds 3/10 - A December 2008 report from the Congressional Budget Office (CBO), Budget Options, Volume 1: Health Care, along with an email about this that continues to circulate, still alarms many military retirees and their families. That’s because some of the options discussed in the CBO document include raising TRICARE out-of-pocket costs for retirees as well as for active duty families.

CBO produces this report every 2 years coinciding with the beginning of a new Congress, and dis-cussing a wide range of options (brainstorming) that address potential changes in spending on federal programs and taxes. These options are developed by government economists to save money, but they are not formal proposals.

Over the last 4 years, NAUS has successfully fought Pentagon plans for higher TRICARE fees and co-pays. Our efforts have resulted in rejection by Congress of DoD and administration efforts to tax military retirees and their families with increases in the costs of earned medical care. Thousands of dollars have been saved by every military retiree, survivor and family due to our successes in blocking higher costs.

TRICARE Covers MRI Screenings for Breast Cancer
Coverage for Magnetic Resonance Imaging (MRI) screening for women at high risk of developing breast cancer is provided under TRICARE. Doctors should use the American Cancer Society’s guidelines regarding risk to determine who qualifies for the TRICARE-covered MRI. Breast cancer is the third most common cancer among TRICARE beneficiaries.

The Straight Scoop On the Medicare Reimbursement Rate Issue
Designed as a Medicare cost-control measure in law in the late 1990's, the Sustainable Growth Rate (SGR) formula used to calculate physician reimbursement rates sets a target each year for expenditure on physician services based on growth in the gross domestic product. If expenditures exceed the target, Medicare recoups the money by cutting its physician reimbursement rate. This formula has forced Congress to step in every year since 2002 and take action to avoid cuts in the payments to Medicare doctors. But by postponing the cuts and not changing the SGR formula, the difference in the targeted and actual payments accumulates, making the cuts required under the formula even larger every year. According to the Congressional Budget Office (CBO), changing the formula would add $210 billion to the Federal deficit, the reason for the difficulty in fixing the problem.

Doctors already complain about the low reimbursement rates Medicare pays, and in some cases, this causes doctors to limit the number of Medicare patients they treat. With the linkage of TRICARE For Life with Medicare (Part B), this affects TFL beneficiaries. If cuts proceed, the American Medical Association asserts that many more doctors would be forced to limit acceptance of TFL/Medicare patients, or even stop seeing current patients. While some argue that since physician salaries in the U.S. are five times that of the average American's salary, they are already compensated well enough, the reality is that reimbursement rate cuts will affect access. The potential adverse impact on TRICARE For Life is clear if the Medicare reimburse-ment rate cuts take effect – less access to health care providers.

TRICARE Affirmation Act Signed into Law
4/26/10 - The TRICARE Affirmation Act, passed by Congress on 4/13, was signed into law by President Obama. The bill amended the IRS code to explicitly state that TRICARE programs are defined under the law as "minimal essential health care coverage" as required by the new Patient Protection and Affordable Care Act, commonly called the health care reform act. This ensures that servicemembers and their families will not need to purchase additional coverage or pay any penalty fees to meet the health insurance requirements under the new law. "Senator Webb greatly appreciates the National Association for Uniformed Services’ active engagement and support of the troops and their families on this matter in recent weeks," NAUS was told in an email from the Senator's office announcing the successful passage of this TRICARE protection measure.

DoD Task Force on the Future of Mil. Health Care
The DoD Task Force on the Future of Military Health Care’s final report issued in December 2007 and available here called for higher TRICARE fees, deductibles and co-payments for under-65 military retirees and their families; a new TRICARE For Life enrollment fee; and many other changes affecting the out of pocket costs paid by beneficiaries. NAUS has successfully lobbied Congress to block any such increases the past 4 years. The report may be resurrected in light of the statements we've heard recently. The Task Force's recommendations included:

• Increase deductibles for TRICARE Standard from $300 a year for families and $150 for individuals to $600 and $300 respectively. 
• TRICARE fees and deductibles would be indexed and automatically adjusted upwards each year to keep pace with rising healthcare costs.
• Establishment of tiers for TRICARE fees, based on grade/rank at retirement, so retirees with higher retirement pay would pay higher fees.
• A downward adjustment to the TRICARE catastrophic cap for retirees (to $2,500 from the current $3,000).
• A TRICARE Standard enrollment fee of $120 (families) and $60 (ind.) annually.
• Increases in TRICARE retail pharmacy copayments (now $3 to $22) to a range of $15 to $45.

Medicare Part D - Prescription Drug Coverage
If you are a military retiree and enrolled in Medicare Part B, you do NOT need to enroll in a Medicare Pre-scription Drug Plan - your TRICARE For Life pharmacy benefits are better than Part D plans. If you are over 65 and enrolled in Medicare Part B, but are NOT a military retiree and are not eligible for medical care through the VA, you may want to consider Medicare Part D coverage.

Low-cost Generic Drug Programs
Wal-Mart and Target sell many generic drugs for $4 per prescription. The $4 price is for a 30-day supply, and insured customers are allowed to pay the $4 per prescription price even if that is less than the co-payment required by their plan. Review the $4 drug lists of Wal-Mart and Target.