Tagged: TRICARE

House Defense Budget Proposal Calls for Overhaul of Military Retirement System

Posted by Debi Teter
militaryauthority_us-capitalHouse lawmakers are set to unveil a defense budget this week that will not include any changes to Tricare health insurance or commissaries, but which calls for overhauling the military retirement system by 2017. blended 401(k)-style retirement system was suggested in January as part of a landmark study by the congressionally appointed Military Compensation and Retirement Modernization Commission (MCRMC) and has sparked wide-ranging debate among servicemember and veteran groups.

Under the proposed blended retirement system, the military would give all new servicemembers a Thrift Savings Plan account and provide matching contributions throughout their service. Troops who separate after 20 years would still get a pension but only 80 percent of what those already in the system today will get.

The Armed Services Committee has stated it will modify the compensation commission proposal by continuing the TSP contributions beyond 20 years for those who want to continue serving. The loss of contributions was a sticking point for some military groups.

Servicemembers who are serving now would see no change or reduction to their retirements if they choose but could opt into the new system.

The committee’s bill must pass the House and eventually be merged with the Senate’s version, but the work this week — including the retirement overhaul — will set the course for what eventually gets passed into law.

#TSP #ThriftSavingsPlan #tricare #militaryretirement

Will Your Taxes Be More Complicated This Year?

Posted by Debi Teter
Tax return checkThere’s been a lot of buzz already in 2015 about how complicated it will be to file taxes thanks to the new requirement to prove you have enough mandatory health insurance coverage. (There’s also buzz about how the IRS isn’t staffed well enough at their help centers to handle all of the questions, but we won’t get into that today.) Why is filling out taxes going to cause a bigger headache for most Americans, and will the typical military family need a jumbo-sized bottle of aspirin to survive? If you are active duty military, you will probably escape the headache pretty easily. The good news is that all the ways that make this tax season especially confusing for most of America don’t really apply to the active duty military. That’s because troops and almost all of their dependents have coverage through Tricare. Long before the Affordable Care Act (ACA), aka Obamacare, started requiring everyone to have a certain level of health care coverage. You still have slightly different requirements this year, though. Like every other tax-filing American, Tricare users will need to “self-identify” on their tax forms as having the minimal required coverage. There are three versions of the basic 1040 federal income tax return: the 1040EZ, the 1040A, and the regular 1040. Each form has a line that says Health Care: individual responsibility (see instructions), and then the words Full-year coverage and then a box.  IF you had an acceptable forms of Tricare for the entire 2014 calendar and tax year, then you just check the box and you are done. What are the acceptable forms of Tricare? Any of these:
  • Prime
  • Standard
  • Tricare for Life
  • Overseas
  • Remote
  • Uniformed Services Family Health Plan
  • Tricare Young Adult
  • Tricare Reserve Select
  • Tricare Retired Reserve
Minimum required coverage is also provided by the Department of Veterans Affairs (VA) to those who are enrolled with the VA for health care, and for those who are enrolled in the Civilian Health and Medical Program of the VA (CHAMPVA.) Dependent parents and parents-in-law using Tricare under their active-duty military children’s plans are the only users whose Tricare plans DON’T meet that requirement. Because they use Tricare on a space-available basis, it doesn’t meet the rule for minimum coverage. They need to buy other coverage or pay a fine starting next year. For this year, however, they are covered under an exemption (which can be claimed by filing Form 8965.)

MHS Changes Care Model To Avoid Systemic Issues Similar To the VA

Posted by Debi Teter
Care-changes-in-Military-Health-SystemThe New York Times has reported months’ worth of investigation showing “a pattern of avoidable errors that has led to injuries and contributed to some deaths” in Military Health System (MHS) facilities.  The reports document widespread problems in infection control and patient safety. Some startling findings included that mothers giving birth at MHS facilities were significantly more likely to hemorrhage after childbirth than mothers at civilian hospitals and found that babies born in military hospitals were twice as likely to suffer injuries as newborns nationally. The DoD has acknowledged systemic problems across the Military Health System (MHS) for active-duty and retired troops similar to the pattern of poor care and management that has plagued the VA.  The MHS has 56 hospitals and 361 clinics worldwide serving 9.6 million beneficiaries in a system that is separate from the VA. The beneficiaries include 1.45 million active-duty service members, 1.7 million active-duty family members and 610,000 retired service members who are served by more than 133,000 military and civilian doctors, nurses, medical educators, researchers and other health professionals. The problems in care and management at the MHS come at a time when Defense Secretary Hagel and the service chiefs have been seeking to cut or at least slow the growth of health care costs in the military. In testimony to Congress, Hagel has repeatedly pointed out that military health care costs have more than doubled since 2001 to the current annual cost of about $52 billion. Meanwhile, the MHS has also been undertaking a major shift in the way it delivers services. In March, MHS leadership communicated to its employees that “after more than a decade of war and in a period of national evolution in concepts of health care, the Military Health System must re-engineer processes by which we bring health to the 9.6 million beneficiaries we serve.” The new MHS plan is to shift the focus to a “patient-centered medical home model,” described as being central to the strategy to form a partnership with each patient for whom the MHS provides primary care.

The home model “holds promise as a way to improve health care in America by transforming how primary care is organized and delivered,” MHS said.

       

Lawmakers seek answers on Tricare reimbursement policy

Posted by Debi Teter
Burr-Hagan-question-Tricare-policy_mililtaryauthority.comA 2013 move by Tricare that compels beneficiaries to get certain kinds of medical testing from military treatment facilities rather than through civilian medical providers, has finally drawn the attention of lawmakers concerned that the change may limit beneficiaries’ access to the tests. In early 2013, Tricare changed its reimbursement policy by discontinuing payment for certain molecular pathology laboratory tests and other laboratory developed tests (LDTs) which were obtained from civilian providers rather than a military treatment facility (MTF). Among the procedures in question are tests used to detect conditions and diseases that may develop during pregnancy, including cystic fibrosis, fragile X syndrome and spinal muscular dystrophy. A letter signed by a bipartisan group of 51 senators and representatives was sent to Defense Secretary Chuck Hagel on Feb. 27. It states in part: “We are concerned that Tricare’s refusal of coverage and reimbursement for certain LDTs outside of a MTF denied military families and patients access to care simply because they either choose to receive care at a civilian medical provider or are unable to access a MTF.” Headed by North Carolina Republican Sens. Richard Burr and Kay Hagan, the group expressed concerns that “Tricare arbitrarily changed a reimbursement policy which negatively impacts a significant population of patients and military families.” The lawmakers also questioned whether beneficiaries and providers were properly notified of the change. The members have asked for details on how Tricare came to the decision to change the policy, whether beneficiaries and providers were provided with opportunities to comment and provide input on the new policy, and whether patient access to care was considered in making the decisions. The lawmakers have asked for a response by March 14.

VA Health Care and ObamaCare – What Veterans Need to Know

Posted by Jason Van Steenwyk

militaryauthority.com VA health care and obamacareFirst, the easy part: If you are enrolled in TRICARE, you do not need to do anything different under the Affordable Care Act. Your TRICARE benefits are fully qualified under the terms of the ACA and you don’t need to take any action as long as you are in TRICARE. 

 

ACA Penalties

For honorably discharged veterans, however, the situation is quite a bit more complicated. Unless you meet certain unusual conditions* the Affordable Care Act requires you to obtain a qualified health insurance policy by March 31, 2014. If you fail to do so, you will be subject to a fine of $95 per adult individual and $49 per family member, up to a max of $285 per family, or 1 percent of family income – whichever is greater. 

After Jan 1, 2015, those penalties go up sharply: To $325 per adult and $162 per child, up to a family maximum penalty of $975, or 2 percent of annual income, whichever is less. 

The penalty increases again on January 1, 2016. The penalty for that year is $695 per adult and $347 per child, up to $2,085 per family, or 2.5 percent of income, whichever is greater. 

 

I’m a Veteran. Does VA Insurance Count? 

Yes, VA insurance counts. But you actually have to enroll in the VA health program to have it qualify. It is not sufficient just to be a veteran. You must take positive steps to make sure you’re enrolled with the VA. Not everybody qualifies. For example, if you’re a Guard or Reserve member, and you’ve never been mobilized, and your only active duty time was for training, you don’t qualify for VA coverage. 

Generally, you will qualify if you either served 24 consecutive months on active duty, or for the full period for which you were called for active duty if you were mobilized, and you enlisted after September 7th, 1980. 

However, if you didn’t make 24 consecutive months, or had to leave duty early because of a wound or service-related injury, you can still qualify. You aren’t going to get disqualified just because you got hurt. 

 

How to apply for VA coverage.

You aren’t automatically covered just because you are an honorably-discharged veteran, even if you meet the criteria. To enroll, visit the VA Benefits Explorer page on the Web. From that page, you can do a trial run to see if you qualify for VA coverage, and specifically what benefits and price structure you qualify for. (There are no premiums for VA coverage, but you will have to pay some copays and there are limits). 

 

What about family members?

In most cases, the veteran’s family members will not qualify to enroll in the VA health care system. Spouses and children will generally need to obtain qualifying coverage, either through an employer plan or through an individual plan. The individual plan can be purchased either via the online exchanges or through a licensed health insurance agent. 

 

VA Priority Groups

If you qualify, the VA will assign you to one of eight priority groups, based on your location, income and the nature of your service. If you qualify for more than one group, the VA will put you in the higher of the available groups. The groups are listed below: 

Priority Group 1

  • Veterans with VA Service-connected disabilities rated 50% or more.
  • Veterans assigned a total disability rating for compensation based on unemployability.

 

Priority Group 2

  • Veterans with VA Service-connected disabilities rated 30% or 40%.

 

Priority Group 3

  • Veterans who are former POWs.
  • Veterans awarded the Purple Heart Medal.
  • Veterans awarded the Medal of Honor.
  • Veterans whose discharge was for a disability incurred or aggravated in the line of duty.
  • Veterans with VA Service-connected disabilities rated 10% or 20%.
  • Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”

 

Priority Group 4

  • Veterans receiving increased compensation or pension based on their need for regular Aid and Attendance or by reason of being permanently Housebound.
  • Veterans determined by VA to be catastrophically disabled.

 

Priority Group 5

  • Non-service-connected Veterans and noncompensable Service-connected Veterans rated 0%, whose annual income and/or net worth are not greater than the VA financial thresholds.
  • Veterans receiving VA Pension benefits.
  • Veterans eligible for Medicaid benefits.

 

Priority Group 6

  • Compensable 0% Service-connected Veterans.
  • Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki.
  • Project 112/SHAD participants.
  • Veterans who served in the Republic of Vietnam between January 9, 1962 and May 7, 1975.
  • Veterans who served in the Southwest Asia theater of operations from August 2, 1990, through November 11, 1998.
  • Veterans who served in a theater of combat operations after November 11, 1998, as follows:
  • Veterans discharged from active duty on or after January 28, 2003, for five years post discharge

 

Priority Group 7

  • Veterans with incomes below the geographic means test (GMT) income thresholds and who agree to pay the applicable copayment.

 

Priority Group 8

  • Veterans with gross household incomes above the VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copays.

 

Veterans eligibility for enrollment:

Noncompensable 0% service-connected and:

  • Subpriority a: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status.
  • Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less

 

Veterans eligible for enrollment:

Nonservice-connected and:

  • Subpriority c: Enrolled as January 16, 2003, and who remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status
  • Subpriority d: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less

 

Veterans not eligible for enrollment:

Veterans not meeting the criteria above:

  • Subpriority e: Noncompensable 0% service-connected
  • Subpriority g: Non-service-connected

 

*Exceptions apply if you are: 

  • A member of a religious group that is opposed to accepting benefits from an insurance policy
  • You are an illegal alien
  • You are incarcerated
  • You are a member of an Indian tribe
  • Your family is below the income threshold for filing an income tax return ($10,000 per individual and $20,000 for family members starting in 2013)
  • You have to pay more than 8 percent of your income for health insurance, net of any tax credit or employer contribution. 

 

You may also be exempt if: 

  • You were enrolled in Medicare, Medicaid or the Children’s Health Insurance Program (CHIP) at any time during the year
  • You’re enrolled in TRICARE
  • You’re in an employer-sponsored plan
  • You have insurance of your own that is “Bronze” level or better,
  • You have a grandfathered health plan that was in existence prior to the ACA. 

 

Under the ACA, income is defined as total income in excess of the filing threshold. The penalty is pro-rated by the number of months without coverage. There is no penalty for gaps of 3 months or less. The penalty cannot be greater than the national average cost of a Bronze-level plan offered on the exchanges. (Source: Kaiser Family Foundation).

Protect Yourself from Obamacare Fraud

Posted by Jason Van Steenwyk

militaryauthority.com obamacare fraudAny big new government initiative brings confusion with it, and the Patient Protection and Affordable Care Act – known colloquially as “Obamacare” – is no exception. The flood of information about mandates, exchanges, fines, taxes, penalties, lawsuits and rulings has boosted the noise-to-signal ratio about the ACA, and left millions – especially seniors – scratching their heads.

Naturally, a small army of frausters, shysters and criminals have stepped in to exploit the confusion. 

This article from CNBC outlines some of the scams we’re already seeing – and Obamacare hasn’t even been rolled out yet.

  • Con artists have created websites designed to fool people into thinking they are logging onto the online exchange system to buy health insurance when they are not.
  • Criminals are telling seniors that in order to qualify for coverage under Obamacare, they must buy an “insurance card.” In some cases, con artists are telling seniors they can even go to jail if they don’t buy the card.
  • Fraudsters are calling people and posing as “navigators,” there to help people through the system. Once they earn the mark’s trust, they exploit it to gain personal information, including Social Security numbers, birthdates, bank account numbers and other sensitive information. They then empty the victim’s accounts and disappear.
  • Some of these criminals are claiming to be officials with Medicare, Medicaid, the Department of Health, Obamacare, or other government agency.

Here are some things to keep in mind that are of particular relevance for veterans and military families:

Tricare beneficiaries do not need to do anything. Tricare continues as it has before, and is not affected by the Affordable Care Act at all. You don’t need ‘navigators,’ and you don’t need to go onto the online exchanges. The same applies to veterans enrolled with the Veterans Administration for their health care.

The exchanges are not even slated to be live until October 1. You cannot buy a policy under the exchanges until that date. Any website billing itself as an Obamacare ‘exchange’ and trying to sell you a policy before that date is likely fraudulent.

You do not need to buy an “insurance card.”

No one from the government is or will be calling to get personal information over the phone.

If you are not a Tricare or VA health care beneficiary and you want more information about health care and the exchanges in your state, start with www.healthcare.gov

In Conflict with Parents of Autistic Children, Defense Department Blinks

Posted by Jason Van Steenwyk

militaryauthority.com military families autistic childrenThe Department of Defense has canceled a controversial plan to restrict access to applied behavior analysis approaches to treatment for military children with autism.

The DoD planned to begin requiring parents of autistic children to have them tested every six months in order to continue receiving treatments under TRICARE, and show military doctors that they were demonstrating “measurable progress” under the therapy. After two years of therapy, after age 16, the Department of Defense proposed granting access to therapy only after the child had been granted a waiver.

The DoD actually planned on requiring two separate assessments – the Vineland and ADOS-2. Meanwhile, military families had been encountering long waiting lists just to get an assessment. In some cases, waits were as long as six months. In the meantime, access to health care services for autism spectrum disorder could have been cut off.

The decision sparked a firestorm of protest among autism activists and military families alike, and attracted Congressional attention from Senators Kirsten Gillebrand (D – New York), Patty Murray (D – Washington) and Mark Warner (D – Virginia), who put pressure on the Administration to roll back the contemplated changes.

“Your new policy also requires a patient show progress to receive continued care. This is a significant shift in how TRICARE covers all other medical service,” wrote Senators Murray and Gillebrand in a joint letter to Secretary of Defense Chuck Hagel. “Military children with developmental disabilities such as autism often experience periods of regression due to life events (such as deployment, relocation, change in school, change in medications, etc.). Coming back from those periods of regression often takes significant time and effort (months and sometimes years), and sometimes progress may simply be the absence of regression. During these challenging times of need, discharging an individual from care is inappropriate and will have long lasting results on patient outcomes.” 

And just to drive the military bonkers, the Senators signed their letter in blue ink. 

It is unclear how many children the measure would directly affect: The Department of Defense estimates that there are approximately 8,500 children of active duty servicemembers with a form of autism; Autism Speaks, Inc., a prominent support group, says that there are 23,000 military children with autism.

On July 19th, the Defense Department blinked, however, and announced that there would be no changes to current access to care for active duty military members under either TRICARE Basic or the Extended Health Care Option (ECHO) program.

ECHO is a program under TRICARE that extends access to additional benefits for certain beneficiaries who are enrolled in the DoD’s Exceptional Family Member Program. Beneficiaries must be enrolled in DEERS to qualify.

In addition, the Department of Defense has announced a congressionally mandated 1-year pilot program to extend services to the children of retirees and survivors of deceased servicemembers. The pilot program begins July 25th, 2013, and is called the Enhanced Access to Autism Services Demonstration.

 

Current eligibility

The platform that the DoD and TRICARE have established to provide services to children with autism-spectrum disorders is called the Enhanced Access to Autism Services Autism Services Demonstration. It covers any beneficiary registered under ECHO and who have been diagnosed with an autism spectrum disorder. Services include access to an expanded network of Board Certified Assistant Behavior Analysts and non-certified tutors. The demonstration is not available outside the United States.

To enroll, you must submit your child’s Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP) to your TRICARE regional contractor.

Children who are being homeschooled where the state does not require an IFSP or IEP should provide a letter from your child’s primary care doctor or a specialized professional in the field of autisms spectrum disorder. The letter should verify that the child’s autism-related disability results in impairment severe enough that it requires special education and other support services.

The services aren’t completely free of charge: Servicemembers must pay a portion of the monthly expenses, called a “cost share.” However, services provided for autism spectrum disorder count towards the annual coverage limits under ECHO.

 

Monthly Cost Share

If you use ECHO benefits during any calendar month, you must pick up a portion of the cost. The amount you must pay depends on the TRICARE sponsor’s rank. The higher the rank, the more you must pay. The breakdown is as follows:

 

Sponsor Pay Grade

Monthly Cost Share

E-1 to E-5

$25

E-6

$30

E-7, O-1

$35

E-8, O-2

$40

E-9, W-1, W-2, O-3

$45

W-3, W-4, O-4

$50

W-5, O-5

$65

O-6

$75

O-7

$100

O-8

$150

O-9

$200

O-10

$250

Source: TRICARE

 

Costs are not shared between family members.

The total cost share for all ECHO benefits combined (not including ECHO Home Care) is $36,000 per year. As you can see, it is pretty rare for a family to reach the full cap!

Webinar: Health Care Options After Losing TRICARE Eligibility

Posted by Debi Teter

militaryauthority.com tricare optionsMark your calendars now. This webinar is only a few days away!

If you are transitioning out of the military – whether because of ETS, retirement, divorce from a servicemember or death of a TRICARE sponsor, TRICARE is offering a one-hour Webinar, or online seminar, on August 15th  from 1 to 2PM Eastern time to walk you through your options.

To register, visit this page. Enrollment is limited because of the Go2Meeting software used to conduct the webinar, which imposes a maximum number of participants.

The webinar will be hosted by Mr. Mark Ellis, a senior health program analyst with the TRICARE Management Activity. He manages the Continued Health Care Benefit and TRICARE Young Adult programs, which offer premium based health care coverage to former service members and their family members when they are no longer eligible for TRICARE benefits.  He has 35 years of DoD health care experience.

Lost TRICARE: What Are My Options?

Posted by Jason Van Steenwyk

militaryauthority.com_losing-TRICARE-benefitsUnless you die in service or you retire and enroll in TRICARE for Life, sooner or later you will lose access to TRICARE and transition either to Medicare, private pay, private insurance, COBRA or the VA. But most people leaving the active duty military have little experience navigating the complex health insurance system outside of the military.

If you are transitioning out of the military – whether because of ETS, retirement, divorce from a servicemember or death of a TRICARE sponsor, TRICARE is offering a one-hour Webinar, or online seminar, on August 15th  from 1 to 2PM Eastern time to walk you through your options.

To register, visit this page. Enrollment is limited because of the Go2Meeting software used to conduct the webinar, which imposes a maximum number of participants.

The webinar will be hosted by Mr. Mark Ellis, a senior health program analyst with the TRICARE Management Activity. He manages the Continued Health Care Benefit and TRICARE Young Adult programs, which offer premium based health care coverage to former service members and their family members when they are no longer eligible for TRICARE benefits.  He has 35 years of DoD health care experience.

Resources for Military Families Affected by the Moore, Oklahoma Tornado

Posted by Jason Van Steenwyk

aftermath of Moore, OK tornadoThe Military Family Association has published a resource page for servicemembers and family members affected by the tragic tornado disaster that befell the community of Moore, Oklahoma on Monday.

The tornado struck near Tinker Air Force Base. A number of Air Force families may have been severely affected and/or rendered homeless. Base personnel who need immediate assistance with food, clothing or emergency financial assistance can contact the Tinker Family Readiness Center at 405-739-2747, 405-736-3813, or 405-736-3847. 

You can also call these numbers to volunteer. The Family Readiness Center is in the process of organizing work and relief teams to go out and assist Air Force personnel and their families in need. Alternatively, you can register as a volunteer at this link.

If you’re an Air Force member affected by the storm, visit AFPAAS and fill out a needs assessment. This will inform the Air Force that you’re accounted for and alert them to any supports or services you or your family may need.

 

USAA Field Assistance Teams

If you have insurance from USAA, you can contact one of two emergency assistance teams already on site at these locations.

First Baptist Church of Moore

301 NE 27th St. (I-35 and NE 27th)?Moore, OK 73160?Hours: 7 a.m. to 7 p.m. Everyday ?Services: Claims

Wal-Mart Supercenter

501 SW 19th St.?Moore, OK 73160?Hours: 3 p.m. – 7 p.m. Today ?7 a.m. – 7 p.m. Thursday and everyday until further notice.?Services: Claims

Members can report claims by using USAA’s Mobile App on their iPad, Android and/or iPhone smartphones, online at usaa.com/help, or by calling 1-800-531-USAA (8722).

 

Emergency Prescription Refills

If you are a TRICARE beneficiary and you need an emergency refill of your prescription (because, for example, your home was destroyed), take your prescription bottle, if you have it, to any TRICARE retail network pharmacy. To find a network pharmacy near you, click here. Alternatively, you can call Express Scripts at 1-877-363-1303.

These procedures apply to the counties for which the Governor of Oklahoma has declared a state of emergency. As of this writing, those counties are Cleveland, Lincoln, McClain, Oklahoma, Pottawatomie. Emergency refill procedures are in place for TRICARE beneficiaries through June 17.

If you lost your military ID, you’ll need to get it replaced at the nearest DEERS enrollment office. If you lost your TRICARE enrollment card, call TRICARE customer service 800-444-5445. 

More information is available from the State of Oklahoma here.