Retirees win some, lose some in Congress

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Subject: Retirees win some, lose some in Congress

 

http://www.zwire.com/site/news.cfm?newsid=17468830&BRD=1659&PAG=461&dept_id=8103&rfi=6

Retirees win some, lose some in Congress

By: retired Capt. Donald C. Kent, MC USN

11/16/2006

Wow, that was a close one. Congress did not get to the Department of Defense 2007 Authorization Bill until the very end of their session before they left on closure of Congress so that representatives could get home and get involved in the election.

With their give and take on the various issues where they were in variance, they finally worked out a version that was acceptable. The version contains some good issues for retirees, but we seem to have lost some major ones of importance for us.

Issues included, which have pertinence for retirees are: barring the Defense Department from increasing any Tricare Prime or Standard fees or pharmacy co-pays; and a proposal to mandate use of mail-order pharmacy for all refills of maintenance was dropped.

Also dropped was the elimination of co-pays for most drugs dispensed through the mail-order system, and the requirement that drug companies give Tricare equal price discounts on drugs dispensed through retail pharmacies. The bill authorizes permanent ID cards for permanently disabled dependents of retirees and requires a Pentagon report on giving members an option to have their Social Security numbers removed from ID cards.

The accepted provisions did not include the following items for retirees: dropped Senate recommended provisions to implement 30-year paid-up SBP coverage immediately and end the deduction of VA survivor benefits from SBP when military service caused the member's death; dropped Senate recommended provision to provide full and immediate concurrent receipt for disabled retirees designated as "unemployable" by the VA; and dropped Senate recommended provision requiring additional incentive payments to doctors to take Tricare patients when they live in areas with physician shortages.

As they say, you win some, you lose some. As I review the bill, it seems like we lost most of the important ones this time.

More medications have been added to the third tier. The advisory committee has recommended that Crestor and Caduet be added. These are cholesterol-lowering drugs. There remain on the formulary 12 similar acting medications, including Lipitor and Zocor. Dr. Winkenheimer has to approve the change before it becomes active.

Retirees have 90 days before it becomes official, supposedly, to allow beneficiaries time to contact their doctor and discuss alternative measures. Many lobby groups feel this is insufficient time, particularly since DoD doesn't notify beneficiaries and expects military associations to notify them. This may be insufficient time for proper notification in their magazines, which have a lead time of 60 to 90 days to get information into print.

Recent figures from the Congressional Budget Office indicate that Tricare for Life costs continue to rise annually, from $6 billion in 2005 to $15 billion anticipated in 2016.

Nothing has been done to cancel the Medicare outpatient physical therapy services cap. As of now, the cap is $1,740 annually, which was set into effect in January 2006, but due to expire at the end of 2006.

Those getting physical therapy services after Jan. 1 under Tricare for Life may have to pay more for services out of pocket. There was an exception built into the original plan set up in January 2006 that authorized an exception if such services were deemed medically necessary, but this is also due to expire Jan. 1, 2007.

Military eligibles may have some protection in that TFL will become primary payer after the Medicare cap is reached, but Tricare deductibles and co-pays apply after that point.

Just as a reminder, beginning Jan. 1, 2007, the government will start means-testing for Medicare Part B premiums. This increase will be phased in over three years, but could mean substantial increase in premiums for those whose income exceeds $80,000 for single and $160,000 for married couples. Begin your financial planning now on this increase coming out of your budget.

There is still considerable battling going on in Washington about creating one medical service, vice the present three. The Navy and Army seem to go along with the idea, the Air Force doesn't agree. At this point it is difficult to figure out whether it will fly or not.

Certainly there are positive points in the combination, but from someone who was involved in the Navy medical program, I can see a lot of negative points, especially if it is done hastily as the plan was proposed. I do not think the Air Force will back down.

There has been an effort to allow veterans to hire lawyers to aid them in filing their benefits claims. Congress seems to want to put off a decision until after November elections are over. There appears to be considerable differences in various veteran groups as to whether this is a good or bad idea. At issue is the present law that prohibits paying lawyers to aid veterans until all administrative processes have been exhausted.

Beginning in October, the Department of Veterans Affairs began a new way to determine whether a non-service disability has been aggravated by military service. Under the new policy, the increase in severity of a disease or injury resulting from military service rather than its natural progression will be considered service-connected for benefits, but will require medical evidence.

For those utilizing TFL, there now is a new way available to determine what you can expect Tricare to pay for certain services in your area. This source provides information for more than 300 of the more common medical services for you in your geographic area.

The source is a Web site, visit  tricare's site. Click the box at the top center of the page reading "New: Allowable Charges." You can also go directly to the section by using www.tricare.osd.mil/allowablecharges
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Contributed,
YNCS Don Harribine, USN(ret)