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Preface The National Defense Authorization Act for Fiscal Year (FY) 2000 established the authority for a demonstration program under which eligible beneficiaries were to be permitted to enroll in the Uniformed Services Family Health Plan (USFHP) at any time. Congress directed that the Department of Defense (DoD) test the feasibility and advisability of providing “continuous open enrollment” for a twoyear period at a minimum of two of the seven USFHP sites; submit a report to Congress by March 15, 2001, evaluating the benefits and costs of the program; and make a recommendation concerning whether to authorize continuous open enrollment at all USFHP sites on a permanent basis. RAND performed the evaluation for the TRICARE Management Activity of the Office of the Secretary of Defense for Health Affairs as part of a project entitled “TRICARE Senior Supplement and Uniformed Services Family Health Plan Demonstration Evaluations.” The work was carried out jointly by RAND Health’s Center for Military Health Policy Research and the Forces and Resources Policy Center of the National Defense Research Institute. The latter is a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the unified commands, and the defense agencies. The report should be of interest to members of Congress, DoD, the seven USFHP programs, and military retirees and their dependents.
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Tables 4.1. 5.1. 5.2. 5.3. 5.4. 5.5. 5.6. 5.7. 5.8. C.1.
Focus Group Participants ............................... Health Insurance Options Available to USFHP Eligibles......... Selected Comments from Focus Group Participants ............ Selected Focus Group Comments Regarding Satisfaction with USFHP ............................................ Selected Focus Group Comments Regarding Enrollment in USFHP ............................................ Selected Focus Group Comments Regarding Continuous Open Enrollment ......................................... USFHP Enrollment, 1996 and 2000 ........................ Enrollment Under the Continuous Open Enrollment Demonstration....................................... Enrollment at Non-Demonstration Sites .................... Medicare Managed-Care Market and Plan Descriptions in USFHP Continuous Open Enrollment Demonstration Sites Compared with Typical National Plan and Rates ..............
14 18 21 23 24 25 27 28 30
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Summary The National Defense Authorization Act for Fiscal Year (FY) 2000 established the authority for a demonstration program under which eligible beneficiaries were to be permitted to enroll in the Uniformed Services Family Health Plan (USFHP) at any time. We will refer to this policy as “continuous open enrollment.” Congress directed that the Department of Defense (DoD) test the feasibility and advisability of providing continuous open enrollment for a two-year period at a minimum of two (out of seven) USFHP sites; submit a report to Congress by March 15, 2001, evaluating the benefits and costs of the program; and make a recommendation concerning whether to authorize continuous open enrollment at all USFHP sites on a permanent basis.
Background The USFHP sites are designated providers of the TRICARE Prime program (TRICARE Prime is one of the three components of TRICARE, the health insurance program for current and former military personnel and their dependents). Except for active duty personnel, all military beneficiaries living in the seven USFHP service areas are eligible to enroll in and receive care from USFHP. USFHP is currently the only TRICARE product available to Medicareeligible military beneficiaries. Military retirees and their dependents who live in a USFHP service area have had the option of directly enrolling in USFHP during a designated 30-day period in the spring of each year; the ex