TRICARE For Life替代方案：雇主团体豁免计划

TRICARE For Life alternative: Employer Group Waiver Plan Commissioned by Humana Government Business Andrew L. Naugle, MBADustin Grzeskowiak, FSA, MAAAJohn D. Kasey, MHAJon Hendrickson, FSA MAAA For members of the uniformed services, military retirees, and their eligible dependents, the TRICAREprogram offers a managed and coordinated healthcare benefit experience. At age 65, however,beneficiaries are disenrolled from TRICARE managed care support and may elect health benefitscoverage through Traditional Medicare with a wraparound plan called TRICARE For Life. This whitepaper explores an alternative approach to providing retiree medical benefits for TRICAREbeneficiaries based on the Employer Group Waiver Plan model. EXECUTIVE SUMMARY TRICARE provides healthcare benefits for approximately 9.6 million service members, military retirees, and their dependents. OnceTRICARE beneficiaries enrolled in the TRICARE managed care support program turn age 65, they are disenrolled. If they sign up forMedicare Part A and Part B, they are eligible for TRICARE For Life (TFL), which provides wraparound coverage for TraditionalMedicare, similar to a Medicare supplement plan. This arrangement offers important benefits including generous pharmacy benefits,overseas coverage, and very low or zero out-of-pocket costs. At the time of its authorization in 2001, TFL represented a significant benefit enhancement for older military retirees receiving healthbenefits through Medicare. Surveys show that satisfaction is very high among TFL beneficiaries. However, there are certain critiques ofthe program that arise from time to time: Abrupt transition from coordinated care to self-management.Most TRICARE beneficiaries under age 65 are enrolled inTRICARE Prime, which operates like a health maintenance organization (HMO). The program is highly managed and offershigh-touch services that help beneficiaries navigate the complex military health system. Upon turning age 65, thesebeneficiaries are rapidly transitioned from this managed healthcare system to an unmanaged one. Some beneficiaries arerequired to change physicians, and many can no longer access healthcare services at military treatment facilities (MTFs). Thetransition to TFL can be abrupt and disruptive, especially for those with chronic conditions or higher disease burdens. Increased richness of alternatives to Traditional Medicare.When TFL was introduced, it offered a significant benefitenhancement for older military retirees. It was considered a rich offering compared to the relatively new Medicare+Choiceprogram. In the 20 years since TFL was introduced, the managed care option for Medicare beneficiaries—MedicareAdvantage—has expanded in terms of enrollment and scope of benefits. Today Medicare Advantage (MA) plans offer a vastarray of supplemental benefits not covered by Traditional Medicare. The Congressional Budget Office (CBO) projects that, by2030, more than half of Medicare eligibles will be enrolled in an MA plan. Budget pressure.Funding for TFL benefits not otherwise covered by Traditional Medicare is provided through the U.S.Department of Defense (DoD) Medicare-Eligible Retiree Health Care Fund (MERHCF). As of 2020, the actuarial value of allfuture liabilities for military retirement medical benefits for Medicare-eligible beneficiaries was approximately $577.1 billion, ofwhich approximately $313.2 billion represents unfunded liabilities and a growing budgetary item for the DoD. The CBOconservatively projects that MERHCF expenditures for TFL will grow at 5% per year, exceeding $17 billion by 2031 for a 10-year price tag of $139 billion in addition to the costs borne by the Centers for Medicare and Medicaid Services (CMS) toprovide Traditional Medicare benefits for TFL beneficiaries. Forgone managed care efficiencies.Traditional Medicare with TFL is an unmanaged health benefits program. This is incomparison to TRICARE Prime and Medicare Advantage, which are both managed care programs that use administrativeprocesses to optimize utilization, manage unit costs, and improve clinical quality. While these activities can reduce beneficiary choice, it is well established that managed care strategies can reduce the overall costs of healthcare benefit programscompared to unmanaged programs. Recognizing these concerns about TFL, the Senate version of the fiscal year (FY) 2018 National Defense Authorization Act (NDAA)and the House version of the FY2019 NDAA each included proposals that would have required DoD to develop a demonstrationprogram to enable eligible TFL beneficiaries to enroll in MA plans. Although these proposals did not move forward in the final bills, theconcept of a group retiree medical benefit that leverages the MA construct already exists in the civilian market, called an EmployerGroup Waiver Plan (EGWP). Humana Government Business engaged Milliman to explore this concept with a focus on keyconsiderations for a TRICARE EGWP offered as an alternative to TRI