MEDICARE SUBVENTION DEMONSTRATION: DOD's Pilot HMO Appealed to Seniors, Underscored Management Complexities
Abstract
Historically, the Department of Defense (DOD) health system and Medicare were entirely separate. DOD's TRICARE health plans covered military retirees to age 65. 1 However, once eligible for Medicare, retirees were no longer eligible for TRICARE and could not enroll in DOD s managed care plan, TRICARE Prime. As nonenrollees, Medicare-eligibles had access to care at military treatment facilities (MTF) only to the extent that space not utilized by TRICARE s enrolled population was available. By law, DOD could not receive payments from Medicare and was not responsible for providing the full range of benefits to Medicare-eligibles. Recently, the situation has changed. In 1997, Congress authorized the DOD Medicare subvention demonstration for a 3-year period. 2 Under this demonstration, DOD formed Medicare managed care organizations that enrolled and served Medicare-eligible military retirees at six sites. The DOD Medicare plan, which was called TRICARE Senior Prime, combined TRICARE with Medicare benefits and requirements. The demonstration also authorized DOD to receive payment from Medicare if certain conditions were met. Senior Prime gave enrollees the same priority for military care as younger retirees enrolled in TRICARE Prime, with minimal out-of-pocket costs. With TRICARE Prime as its foundation, Senior Prime illustrated issues that arose in bringing older retirees into DOD managed care. A major change in health care arrangements for Medicare-eligible retirees from the uniformed services will take place October 1, 2001. Under provisions of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001, 3 these retirees will become eligible for TRICARE and will be able to use their Medicare benefit within TRICARE. The new program is commonly termed TRICARE For Life. Experience under Senior Prime illustrated some issues that TRICARE might face
Document Details
- Document Type
- Technical Report
- Publication Date
- Jun 01, 2001
- Accession Number
- ADA391381
Entities
Organizations
- United States Government Accountability Office