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Seniors Access Health Care Through TRICARE Demo

By Douglas J. Gillert
American Forces Press Service

SAN ANTONIO, Texas, Dec. 15, 1998 – A test here to see if military hospitals can deliver cost-effective health care to thousands of retirees over age 65 has netted some 10,000 participants.

"We're about two months into TRICARE Senior Prime, which allows us to get away from space-available care to space- required care for our elderly patients," said Army Dr. (Brig. Gen.) Harold Timboe, commander of Brooke Army Medical Center. This ensures better access to health care for a large segment of the Brooke patient population, he said. "The ones who signed up now have a designated primary care manager and guaranteed access to care."

In the past, military hospitals couldn't afford to staff for or treat senior retirees. Medicare funds the seniors' health care and, by law, couldn't reimburse the military's expenses.

The Health Care Finance Administration, the federal agency that administers Medicare, will reimburse Senior Prime demonstration sites for care they provide Medicare-eligible retirees. Under the plan, reimbursements to DoD can't diminish the already strained Medicare Trust Fund, and participating DoD hospitals must spend their own money before Medicare reimbursement kicks in.

Brooke and its cross-town Air Force partner, Wilford Hall Medical Center, are co-participants in the Senior Prime test. The demonstration also has begun, or will shortly, at Keesler Air Force Base, Miss.; Fort Sill, Okla.; Sheppard Air Force Base, Texas; Fort Carson, Colo.; Air Force Academy, Colo.; Naval Medical Center San Diego; and Dover Air Force Base, Del.

If the test is successful, the program is expected to eventually become available to military retirees everywhere.

Brooke and Wilford Hall each have enrolled around 5,000 retirees and dependents in Senior Prime since Oct. 1. That represents only about 3 percent of the estimated 150,000 San Antonio-area residents eligible. Those who didn't enroll are still eligible for space-available care, Timboe said. Neither Brooke nor Wilford Hall often turn away elderly patients, he said.

The Army medical center averages 200 applicants for Senior Prime a week, according to Dr. (Lt. Col.) Gregg Anders, health plan management chief at Brooke. "We anticipate additional enrollment after the first of the year," he said. "No one to my knowledge feels disenfranchised by the military health care system here."

Feelings harbored by Medicare-eligible retirees of being forgotten or abandoned by DoD's new TRICARE medical plan spawned the idea for Senior Prime. In 1987, three San Diego-area retirees began pushing for legislation that would authorize Medicare reimbursements to military hospitals.

"I personally know of many folks who went without needed treatment because they couldn't afford the Medicare cost share, and the care wasn't available at the military hospital," said retired Navy Dr. (Capt.) John Howard. "Many widows of retired enlisted men can't afford a Medicare supplement on their modest pension. Yet, they've paid into the Medicare system, and it ought to pay them back when they're eligible for it."

After failing for several years to pass legislation authorizing the demonstration, Congress finally gave Senior Prime a green light in the 1997 Balanced Budget Act.

TRICARE Senior Prime is a good deal for seniors who can't afford the cost shares required by the standard Medicare fee-for-service benefit or the premiums for Medicare supplemental policies that cover the cost shares, Howard said. "It guarantees them access to quality military health care -- a system they know and are comfortable with -- at little or no cost," he said.

Senior Prime waives the standard TRICARE Prime enrollment fee of $230 per year per individual ($460 a year per family). Participating seniors only have to pay their Medicare Part B cost share, about $44 a month, Timboe said. Right now, however, Medicare imposes a surcharge on those who don't sign up for Part B at age 65. The surcharge equals 10 percent of the monthly premium for each full 12 months when a beneficiary could have enrolled but did not.

"We're looking to get someone to waive that penalty," Timboe said. In the meantime, Brooke not only will take care of Senior Prime enrollees but any retiree on a space- available basis, he said. "Many of our older folks are long-term patients, and both they and their doctors don't want their association to end."

Timboe said Senior Prime or a similar program is critical to military medicine. "The issue of retiree health benefits has been growing over the last two decades," he said. "More and more retirees don't live near a military facility. So DoD needs to craft a health benefit for its retirees that is fair and uniform no matter where they live. Then, we can determine how to finance and deliver the care we promise."

Under the Senior Prime demonstration, enrollees can only receive their care from a military medical facility. Timboe foresees more options in the future. "Some [of their health care] can be provided in military facilities, and some must be in civilian facilities," he said. "And maybe the [Department of Veterans Affairs] will get involved."

For more information, visit the TRICARE Senior Web site at http://www.tricare.osd.mil/hpmedi2.html. [link no longer available] More information about Medicare is available at the Health Care Financing Administration's web site, http://cms.hhs.gov. (Navy Lt. Rick Haupt, TRICARE Southern California public affairs, contributed to this report)

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