Bill Would Allow Retirees to Keep TRICARE Prime Access

Defense plans to switch 171,000 enrollees to a different plan on Oct. 1 because of downsizing.

Military retirees who are losing access to TRICARE Prime in October would be able to stay in that health care plan under a bill introduced Tuesday in the House.

The legislation, sponsored by Rep. John Kline, R-Minn., would allow affected TRICARE Prime enrollees to make a one-time decision to remain in the more affordable health insurance plan instead of moving to the program’s fee-for-service option. The Defense Department is reducing the number of Prime service areas to save money and will automatically switch 171,000 TRICARE Prime beneficiaries to the TRICARE Standard option on Oct. 1. The change affects beneficiaries who live more than 40 miles from a military clinic, hospital or Base Closure and Realignment site -- about 3 percent of the current 5.3 million TRICARE Prime enrollees.

The change does not impact active-duty service members and their families.

Kline’s bill would allow affected beneficiaries to continue their enrollment in TRICARE Prime “so long as the beneficiary resides in the same ZIP code as the ZIP code in which the beneficiary resided at the time of such election,” according to the legislation. They can switch to TRICARE Standard at any time.

“Promises made should be promises kept, and the Pentagon should not break faith with our nation’s heroes,” said Kline, who is a 25-year veteran of the Marine Corps. Also, nearly 4,000 of the affected TRICARE enrollees live in Minnesota.

TRICARE has notified beneficiaries of the upcoming change and plans to send a second letter in the summer. Fewer PSAs does not mean enrollees are losing their TRICARE benefit, Dr. Jonathan Woodson, the Pentagon’s assistant secretary for health affairs, said in an April statement. Those who live within 100 miles of a remaining PSA might be able to re-enroll in Prime, but the department warned it could increase travel times for primary and specialty care.

Defense initially planned to eliminate some PSAs in 2007, but protests and TRICARE contract changes delayed implementation.