TRICARE Nonenrolled Beneficiaries Report Improved Satisfaction, Access to Care

TRICARE beneficiaries who used the Department of Defense’s healthcare program reported improved satisfaction and access to care through 2 of the program’s health plans, according to a new report from the Government Accountability Office.

Through TRICARE, the Department of Defense offers healthcare services to more than 9 million eligible beneficiaries. There has been a recent change to the TRICARE plans. Prior to January 1, 2018, TRICARE offered 3 basic plans—Prime, Extra, and Standard. To use Prime, a managed care option, beneficiaries had to enroll, but they didn’t have to enroll to receive care under Standard or Extra. However, those options were both terminated with a new option called Select starting January 1, 2018. Under the new option, beneficiaries have similar benefits for obtaining care from network and nonnetwork providers.

The report compared results from surveys conducted between 2012 and 2015 with surveys conducted between 2008 and 2011 on the adequacy of access to care for nonenrolled beneficiaries, who received care from nonnetwork civilian providers in Standard or network civilian providers in Extra.

According to the report, the nonenrolled beneficiary population is made up of 60% of retired service members and their dependents, 19% inactive guard/reserve members and their dependents, 17% dependents of active duty members or of guard/reserve members on active duty status, and 4% other, including dependent survivors of the deceased.

In general, respondents noted improved access to care and a more positive experience. In the most recent surveys, 29% of respondents said they had problems finding a civilian provider, compared with 31% in the prior surveys. Furthermore, 90% of nonenrolled beneficiaries now report they always or usually can obtain a nonurgent appointment as soon as they need it, compared with 87% during the 2008-2011 surveys.

To determine beneficiaries’ experiences, the surveys asked about experiences in 5 categories: primary care, specialty care, health plan, mental health care, and healthcare. In the primary care, specialty care, and health plan categories, the positive experience ratings increased over the earlier survey. In the mental health care and healthcare categories, the ratings stayed the same. The percentage of nonenrolled beneficiaries who reported a positive experience ranged from 71% (health plan) to 83% (primary care provider).

The surveys also gauged provider awareness of TRICARE. While awareness increased slightly (82% to 84%), the percentage of providers who were accepting new TRICARE patients decreased from 58% to 55%. Acceptance rates for primary and specialty care providers had been unchanged during the time, but acceptance rates for mental health care providers decreased.

Overall, the results of the surveys indicated that access to providers may be “particularly problematic” in New York, Washington, Texas, and Washington, DC.

“Specifically, in these locations, beneficiaries reported more problems finding providers who accepted TRICARE and providers reported lower acceptance of TRICARE, compared to national averages,” the report concluded.

References

Government Accountability Office. Defense health care: TRICARE surveys indicate nonenrolled beneficiaries’ access to care has generally improved. GAO website. https://www.gao.gov/products/GAO-18-361. Published March 29, 2018. Accessed March 30, 2018.