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Officials Announce TRICARE Prime Service Area Changes

By Amaani Lyle
American Forces Press Service

WASHINGTON, Jan. 10, 2013 – Active duty service members and their families will be unaffected when long-delayed reductions to areas where the TRICARE Prime option is offered take place Oct. 1, TRICARE officials said yesterday.

But as TRICARE seeks to synchronize service area shifts once staggered by contract delays, some military retirees and their dependents will be moved to TRICARE Standard coverage, S. Dian Lawhon, beneficiary education and support division director, said during a conference call with reporters. Those affected reside more than 40 miles from a military treatment facility or base closure site, she said.

The new contracts limit Prime networks to regions within a 40-mile radius of military treatment facilities and in areas affected by the 2005 base closure and realignment process, she explained. But provisions will allow Prime beneficiaries who see providers outside the 40-mile service area to remain in Prime if they reside within 100 miles of an available primary care manager and sign an access waiver, she added.

“If TRICARE retirees and young adults live less than 100 miles away from a remaining Prime service area, they can re-enroll in Prime by waiving their drive standards and there will be room made for them,” Lawhon said, adding that the networks are required to connect providers to those who elect to waive their drive standards.

Contractors such as United HealthCare Military & Veterans, Health Net Federal Services and Humana Military will continue to assist beneficiaries in obtaining providers in their regions, she added.

“Health care is best if it’s local,” Lawhon said. “We’ve established the drive standards [to enable] people to access their primary and specialty care within a reasonable period of time.”

Austin Camacho, TRICARE’s benefit information and outreach branch chief, said the out-of-pocket, fee-for-service cost of TRICARE Standard would cost a bit more, depending on the frequency of health care use and visits. No cost applies for preventive care such as mammograms, vaccines, cancer screening, prostate examinations and routine check-ups, he added.

Officials estimate the changes will lower overall TRICARE costs by $45 million to $56 million a year, depending on the number of beneficiaries who choose to remain in Prime, Camacho said.

Lawhon and Camacho said beneficiaries should speak to their health care providers and families to assess the best course of action.

“We’re hoping people will take a careful look at their health care needs,” Lawhon said. “We have seen that people using the Standard benefit are very pleased with it, and their customer satisfaction is the highest of all.” 

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