Bread Crumbs

Most TRICARE Beneficiaries Unaffected by Prime Service Area Reductions

4/4/2013

FALLS CHURCH, Va. – TRICARE Prime will remain a health care option for 97 percent of approximately 5 million beneficiaries eligible for Prime. The 3 percent difference, comprising about 171,000 beneficiaries, will automatically revert to the TRICARE Standard health care option on Oct. 1, 2013. Those beneficiaries, who mostly reside more than 40 miles from a military clinic or hospital recently received a letter explaining their options and will receive a reminder letter in June or July.

“The first thing TRICARE beneficiaries should know about the reduction in the number of Prime Service Areas (PSAs) is that it doesn’t mean they’re losing their TRICARE benefit,” said Dr. Jonathan Woodson, assistant secretary of defense for Health Affairs. “Next, it’s important to remember this change does not affect most of the more than 5 million people using TRICARE Prime, and none of our active duty members and their families.”

TRICARE is committed to keeping beneficiaries informed about these changes. As a follow-up to the initial notification, a second letter will be mailed in early summer to make sure all affected beneficiaries have the time and information to make important decisions about their future health care options.
The TRICARE website, www.tricare.mil/PSA, has the most current details and gives beneficiaries the option to sign for e-mail updates. A ZIP code tool is available on the site to help beneficiaries determine if they live in an affected PSA.

As always, TRICARE beneficiaries are still covered by TRICARE Standard. For those living within 100 miles of a remaining PSA, re-enrolling in Prime may be an option depending on availability. To do this, beneficiaries must waive their drive-time standards and, possibly, travel long distances for primary and specialty care.

“I urge all impacted beneficiaries to carefully consider their health care options – they should talk them over with family members and their current health care provider,” said Dr. Woodson. “Many beneficiaries may be able to continue with their current provider using the Standard benefit. Being close to your health care team usually offers the best and safest access to care.”

In TRICARE Prime those enrolled are assigned a primary care provider who manages their health care. Retirees pay an annual enrollment fee and have low out of pocket costs under this plan. TRICARE Standard is an open-choice option with no monthly premiums and no need for referrals, but there are cost shares and an annual deductible.

The Department of Defense first planned to reduce the number of PSAs in 2007 when it requested bids for the third generation of regional health care support contracts. The PSAs being eliminated are not close to existing military treatment facilities or Base Realignment and Closure sites. Prolonged protests resulted in a staggered transition and it was decided to keep all PSAs in place until all three contracts were in place. On April 1, 2013, the West region completed its transition.

By eliminating select PSAs, TRICARE and DoD can better control costs while continuing to deliver a high quality health care benefit to all 9.6 million TRICARE beneficiaries.

Last Updated 9/30/2013