The National Defense Authorization Act (NDAA) for fiscal year (FY) 2001 made sweeping changes to the way that health care furnished by civilian providers to Medicare-eligible military retirees is financed. The law directed the Department of Defense (DoD) to implement what is now commonly referred to as TRICARE for Life (TFL). As of October 1, 2001, TFL provides TRICARE as supplemental health insurance for all Medicare-eligible military retirees age 65 or older who are enrolled in Medicare Part B. As of 2003, approximately 1.6 mil- lion military retirees are eligible for TFL. In general, TRICARE for Life covers all cost-sharing for Medicare-covered services and standard TRICARE cost-sharing for services that are covered by TRICARE but not by Medicare. Thus, TFL provides Medicare-eligible military retirees with one of the most comprehensive health insurance benefit packages in the United States.
The National Defense Authorization Act (NDAA) for fiscal year (FY) 2001 made sweeping changes to the way that health care furnished by civilian providers to Medicare-eligible military retirees is financed. The law directed the Department of Defense (DoD) to implement what is now commonly referred to as TRICARE for Life (TFL). As of October 1, 2001, TFL provides TRICARE as supplemental health insurance for all Medicare-eligible military retirees age 65 or older who are enrolled in Medicare Part B. As of 2003, approximately 1.6 mil- lion military retirees are eligible for TFL. In general, TRICARE for Life covers all cost-sharing for Medicare-covered services and standard TRICARE cost-sharing for services that are covered by TRICARE but not by Medicare. Thus, TFL provides Medicare-eligible military retirees with one of the most comprehensive health insurance benefit packages in the United States.
Military medical care is a congressionally authorized entitlement that has expanded in size and scope since the late 19th century. Chapter 55 of Title 10 U.S. Code, entitles certain health benefits to military personnel, retirees, and their families. These health benefits are administered by a Military Health System (MHS). The primary objectives of the MHS, which includes the Defense Department's hospitals, clinics, and medical personnel, are (1) to maintain the health of military personnel so they can carry out their military missions and (2) to be prepared to deliver health care during wartime. Health care services are delivered through either Department of Defense (DOD) medical facilities, known as military treatment facilities (MTFs) as space is available, or through civilian health care providers. As of 2017, the MHS operates 681 MTFs, employs nearly 63,000 civilians and 84,000 military personnel, and serves 9.4 million beneficiaries across the United States and in overseas locations. Since 1966, civilian care for millions of retirees, as well as dependents of active duty military personnel and retirees, has been provided through a program still known in law as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), more commonly known as TRICARE. TRICARE has three main benefit plans: a health maintenance organization option (TRICARE Prime), a preferred provider option (TRICARE Select), and a Medicare supplement option (TRICARE for Life) for Medicare-eligible retirees. Other TRICARE plans include TRICARE Young Adult, TRICARE Reserve Select, and TRICARE Retired Reserve. TRICARE also includes a pharmacy program and optional dental and vision plans. Options available to beneficiaries vary by the sponsor's duty status and geographic location. This report answers selected frequently asked questions about military health care, including How is the Military Health System structured? What is TRICARE? What are the different TRICARE plans and who is eligible? What are the costs of military health care to beneficiaries? What is the relationship of TRICARE to Medicare? How does the Affordable Care Act affect TRICARE? When can beneficiaries change their TRICARE plan? What is the Medicare Eligible Retiree Health Care fund, which funds TRICARE for Life? This report does not address issues specific to battlefield medicine, veterans, or the Veterans Health Administration.
Contents: Recent Developments; Background; Subjects: Purpose of DoD¿s Military Health System (MHS); Structure of the MHS; Unified Medical Budget; Medicare Eligible Retiree Health Care Fund; Cost of Military Health Care to Beneficiaries; Changes in MHS in Recent Years; Eligibility to Receive Care; Assignment of Priorities for Care in Military Medical Facilities; Relationship of DoD Health Care to Medicare; Military Personnel and Free Medical Care for Life; Payment of Private Health Care Providers; Effect of Base Realignment and Closure on Military Medical Care; Pharmacy Benefit; Medical Benefits Available to Reservists; Congressionally Directed Medical Research Program; Tricare and Abortion; and Use of Animals in Medical Res. or Training.
Pilot survey of military retirees provides useful information on retirees' health care status, civilian health insurance enrollment, and reliance on TRICARE, the Department of Defense sponsored health care plan. Findings suggest that retirees with civilian health insurance also continue to rely on TRICARE for medical and drug coverage and that higher premiums for civilian health insurance may cause them to shift entirely to TRICARE.
The primary objective of the military health system, which includes the Defense Department's hospitals, clinics, and medical personnel, is to maintain the health of military personnel so they can carry out their military missions and to be prepared to deliver health care during wartime. The military health system also covers dependents of active duty personnel, military retirees and their dependents, including some members of the reserve components. The military health system provides health care services through either Department of Defense (DOD) medical facilities, known as “military treatment facilities” or “MTFs” as space is available, or through private health care providers. The military health system currently includes some 56 hospitals and 365 clinics serving 9.7 million beneficiaries. It operates worldwide and employs some 58,369 civilians and 86,007 military personnel. Since 1966, civilian care to millions of dependents and retirees (and retirees' dependents) has been provided through a program still known in law as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), but more commonly known as TRICARE. TRICARE has four main benefit plans: a health maintenance organization option (TRICARE Prime), a preferred provider option (TRICARE Extra), a fee-for-service option (TRICARE Standard), and a Medicare wrap-around option (TRICARE for Life) for Medicare-eligible retirees. Other TRICARE plans include TRICARE Young Adult, TRICARE Reserve Select and TRICARE Retired Reserve. TRICARE also includes a pharmacy program and optional dental plans. Options available to beneficiaries vary by the beneficiary's duty status and location. This report answers several frequently asked questions about military health care, including: How is the military health system structured? What is TRICARE? What are the different TRICARE plans and who is eligible? What are the costs of military health care to beneficiaries? What is the relationship of TRICARE to Medicare? How does the Affordable Care Act affect TRICARE? What are the long-term trends in defense health care costs? What is the Medicare Eligible Retiree Health Care fund, which funds TRICARE for Life? The Government Accountability Office (GAO) and the Congressional Budget Office (CBO) have also published important studies on the organization, coordination and costs of the military health system, as well as its effectiveness addressing particular health challenges. The Office of the Assistant Secretary of Defense for Health Affairs Home Page, available at http://www.health.mil/, may also be of interest for additional information on the military health system.
