TRICARE Prime Service Areas to be Reduced
According to press
reports, the Department of Defense (DoD) is apparently planning to
eliminate TRICARE Prime availability in several states and cities in the
TRICARE West region, beginning on April 1, 2013. With some exceptions,
most Prime beneficiaries in these areas will be moved to TRICARE
Standard coverage, a more costly fee-for-service TRICARE option.
Affected beneficiaries include retirees, Active Guard and Reserve
troops, and family members in Iowa, Minnesota and
Oregon, as well as in
Reno, Nev., and Springfield, Mo.
DoD is not commenting on
the plan, however, under new TRICARE contracts, TRICARE Management
Activity (TMA) is only required to provide TRICARE Prime coverage to
beneficiaries who live within 40 miles of a Military Treatment
Facilities (MTF) and in areas affected by the 2005 base realignment and
closure (BRAC) process. New contracts awarded in 2010 specified that DoD
would only pay for Prime in the vicinity of MTFs and numerous appeals of
the contract awards have delayed this action.
Exceptions to the new policy
may be authorized for some beneficiaries if there is a network of
providers beyond the 40-mile limit and within 100 miles of the
beneficiary. FRA is closely monitoring this and will provide additional
information as it becomes available.