by Pam Zubeck
Some military retirees will no longer be able to access health care at the Air Force Academy clinic under TRICARE, the academy announced today.
That probably means local hospitals and clinics will have to absorb those patients covered by the military insurance provider that notoriously pays less than most traditional insurance plans.
Here's the academy's news release. Town hall meetings are not open to the media.
1/11/2012 - U.S. AIR FORCE ACADEMY, Colo. — New changes to enrollment policies at the 10th Medical Group will affect retirees turning 65, and those seeking enrollment for the first time at the facility.
New enrollment to the facility is now limited to active-duty service members assigned to the Academy and any TRICARE Prime active-duty family members. TRICARE Prime eligible retirees and their dependents who are new to the community will be asked to enroll with a civilian TRICARE network provider, or another local Military Treatment Facility if the capacity exists.
The new policy will affect retirees and beneficiaries currently enrolled who become Medicare eligible on or after Jan. 1, 2012. They will no longer be able to enroll at the Air Force Academy. Medicare eligible retirees enrolled to TRICARE Plus prior to Jan. 1, 2012 will not be affected by this change and will maintain their enrolled status.
This change in policy is driven by a mandated reduction in the number of assigned Academy healthcare providers as well as a directed reduction of enrollees per provider in an effort to improve quality of care.
The 10th MDG commander will host two Town Hall meetings at the Air Force Academy Community Center Auditorium from 6-8 p.m. Jan. 12 and Jan. 17 to discuss changes to its enrollment policies with those affected.
Questions & Answers
Q: Why is the 10th MDG making this change?
A: Directed downsizing of clinic staff and services over the past two years and a recent mandated change to the Air Force patient-care model has decreased the clinic's capacity to see patients. The patient-to-provider ratio was changed from 1,500:1 to 1,250:1. As a result, the clinic is no longer able to have an open enrollment policy and must now limit the number of patients assigned.
Q: Does this change apply to all retirees and eligible beneficiaries, or just those over 65?
A: This change applies to eligible retirees and their dependants of any age wishing to enroll at the 10th Medical Group. Those eligible retirees and dependants who are currently enrolled at the clinic may continue their enrollment as long as they maintain their TRICARE Prime status. However, this change also applies to those beneficiaries who become eligible for Medicare at age 65. These Medicare-eligible beneficiaries will no longer be able to be seen by a primary care manager at the Academy. The clinic staff is also recommending the transfer of care to a community TRICARE network provider for a select number of high acuity patients who require internal medicine services that are not currently available at the 10th MDG.
Q: Will beneficiaries referred off base have to pay a co-pay?
A: Yes, TRICARE Prime retired service members and their TRICARE Prime dependants pay a $12 co-pay each time they see their TRICARE network provider. Emergency room visits incur a $30 co-pay for TRICARE Prime retirees and their TRICARE Prime dependants. For Medicare-eligible beneficiaries, Medicare is the primary pay or under TRICARE For Life and normal Medicare rules apply.
Q: Can I still get my prescriptions filled at the Academy Clinic?
A: Yes, access to the pharmacy, laboratory and radiology services will remain available and at no cost to covered beneficiaries regardless of who their provider is.
Q: Do other Colorado Springs bases provide medical services to retirees?
A: Yes, Peterson Air Force Base and Fort Carson provide limited services to retirees. Enrollment opportunities at these locations are subject to their unique capacity issues and may vary from time to time. We recommend affected beneficiaries contact the TRICARE Service Centers at Peterson AFB and Fort Carson for more information.
Q: Will retirees and their family members currently enrolled at the Academy be asked to receive their care from a local provider?
A: The changes only affect those retired beneficiaries and their dependants who wish to enroll at the Academy Clinic for the first time and those beneficiaries turning 65 years of age who become Medicare eligible. We also encourage those not yet 65 to select a PCM off base before they turn 65. This will help establish them with an off-base PCM and make their transition to Medicare easier. Providers are more likely to keep established patients that turn Medicare eligible than they are to accept new and unknown Medicare-only patients.
Q: Where can I find more information about enrolling for care off base?
A: Beneficiaries may visit the TRICARE Service Center located off the 1st floor lobby of the Academy Clinic or call 1-888-TRICARE (874-9378). TRICARE enrollment information is also available at www.TRICARE.com.