11-2-12

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.