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1 [1] (February 2, 2017)

handle is hein.crs/crsmthmbbzf0001 and id is 1 raw text is: Defe Congressional Research Service ~~Info irmg the legvIsaive debte since 1914 Defense Primer: Military Health System February 2, 2017 The Department of Defense (DOD) operates a healthcare delivery system that in fiscal year (FY) 2017 will serve an estimated 9.4 million beneficiaries both on the battlefield and off. With a 2017 budget request of $49 billion, the DOD's unified medical program represents about 8% of DOD's total budget. Beneficiaries may obtain care from DOD-operated and staffed medical and dental facilities (referred to collectively as military treatment facilities) or through care from civilian providers purchased through an insurance program known as TRICARE. Purchased care accounts for approximately 52% of the total cost of care delivered through the military health system. The conference report version of the National Defense Authorization Act for Fiscal Year 2017 (P.L. 114-328, herein 2017 NDAA) makes significant changes to many of the features described below that DOD will need to implement in the coming months. Purpose The underlying reason DOD has a military health system is medical readiness. The medical readiness mission involves promoting a healthy and fit fighting force that is medically prepared to provide the Military Departments with the maximum ability to accomplish their deployment missions throughout the spectrum of military operations. The military health system also serves to create and maintain high morale in the uniformed services by providing an improved and uniform program of medical and dental care for members and certain former member of those services, and for their dependents (10 U.S.C. 1071). In addition, the resources of the military health system may be used to provide humanitarian assistance (10 U.S.C. 2561) and to perform medical research (10 U.S.C. 2358). Organization The Under Secretary of Defense for Personnel and Readiness (USD(P&R)) is the principal staff assistant and advisor to the Secretary and Deputy Secretary of Defense for Total Force Management as it relates to readiness issues including health affairs (see 10 U.S.C. 136). Key Military Health System Organizations Office of the Assistant Secretary of Defense for Health Affairs (OASD(HA) Defense Health Agency (DHA) Surgeons general of the Army, Navy, and Air Force The Assistant Secretary of Defense for Health Affairs (ASD(HA)) reports to the USD(P&R). The ASD(HA) is the principal advisor to the Secretary of Defense on all DoD health policies, programs and activities and has primary responsibility for the military health system (see Department of Defense Directive 5136.01). Reporting to the USD(P&R) through the ASD(HA), the Defense Health Agency (DHA) is a joint, integrated combat support agency whose purpose is to enable the Army, Navy, and Air Force medical services to provide a medically ready force and a ready medical force to combatant commands in both peacetime and wartime. Beneficiaries Military retirees and their families are estimated to account for about 57% of the 9.4 million total military health system beneficiaries in FY2015. An estimated 3.3 million active duty service members and their family members accounted for 35% of the total with reserve component members and their families primarily making up the remainder. Tricare Options and Beneficiary Cost Sharing With the exception of active duty service members (who are assigned to the TRICARE Prime option and pay nothing out of pocket for TRICARE coverage, TRICARE beneficiaries, depending upon their status (active duty family member, retiree, reservist, child under age 26 ineligible for family coverage, Medicare-eligible, etc.) and geographic location, military health system beneficiaries may have a choice of plan options. Each plan option has different beneficiary cost-sharing features. Cost sharing may include, depending upon the option, an annual enrollment fee, annual deductible, monthly premiums, copayments, and an annual catastrophic maximum. Pharmacy copayments are established separately and are the same under each option. The 2017 NDAA renames and consolidate some of the options effective January 2018. Several of the current major plan options are listed below. TRICARE Prime TRICARE Prime is a health maintenance organization (HMO)-style option in which beneficiaries typically get most care through military treatment facilities. Retirees may be eligible to enroll in this option if they live within or near a designated Prime Service Area. TRICARE Prime features an annual enrollment fee for retirees but does not have an annual deductible and has minimal copayments. TRICARE Standard/Extra TRICARE Standard and Extra may be used in tandem. They do not require enrollment or an annual enrollment fee but do have an annual deductible and copayments which vary depending upon the provider type and plan participation. www crs.gov 17-5700

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