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DoD Details TRICARE Medicare Demonstration

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Sept. 19, 1996 – Up to 10 percent of military retirees over age 65 will be selected to participate in a test demonstrating health care for Medicare-eligible patients at DoD medical facilities, officials announced.

TRICARE Medicare Prime will test expanding health care to older retirees while not increasing the costs to DoD or the Department of Health and Human Services, which administers Medicare. The law currently prohibits Medicare reimbursements to DoD facilities for treatment of Medicare-eligible patients.

Congress must pass enabling legislation before the demonstration announced Sept. 11 by President Clinton can begin. DoD officials are confident the current session of Congress will pass the legislation before it ends.

"There's strong bipartisan support for the demonstration," said Ernestyne Forbes, deputy director of TRICARE marketing. "The demonstration will begin no later than Jan. 1, 1997."

The demonstration will take place in two of TRICARE's 12 stateside regions, 6 and 11. Wilford Hall Medical Center and Brooke Army Medical Center in San Antonio, Texas, will enroll a combined total of 6,000 individuals. Madigan Army Medical Center, Tacoma, Wash., and Naval Hospital Bremerton, Wash., will enroll a combined total of 8,000 people.

To participate, Medicare-eligible retirees over 65 must enroll in TRICARE Medicare Prime ($230 per year for one or $460 per year for the retiree and eligible dependents). In addition, they must be covered by Medicare Part B; agree to receive covered services only through TRICARE; reside in the geographical area where enrollment in the demonstration is offered; and have used a military medical facility before July 1 or became eligible for the Medicare aged program after June 30.

Besides receiving normal inpatient and outpatient care available to TRICARE Prime enrollees, participants will receive pharmacy reimbursements. At the same time, Medicare will cover nursing home and home health care expenses currently unavailable through TRICARE.

Forbes said DoD will notify persons eligible to participate in the demonstration.

DoD and HHS will select a contractor to evaluate the demonstration and provide periodic reports. Based on findings, the departments may choose to suspend or terminate the demonstration, adjust DoD and HHS costs or take steps to make Medicare a permanent TRICARE benefit, Forbes said.

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