United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2001-10-31 monographic deposited born digital 37 p. GA 1.13:GAO-02-67 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-02-67 P0b002ee1803871f0 f:d0267 DGPO 2010-08-12 2011-03-28 GAOREPORTS-GAO-02-67 machine generated eng fdlp REPORT GAOREPORTS-GAO-02-67 GAO-02-67 Health care costs Health care programs Managed health care Retired military personnel Retirement benefits DOD TRICARE Senior Prime Program Medicare Choice Program Medicare Program DOD Medicare Subvention Demonstration Program DOD TRICARE Program DOD TRICARE Prime Program DOD TRICARE Standard Program DOD TRICARE Extra Program Other Written Product A02409 The Balanced Budget Act of 1997 (BBA) authorized the Department of Defense (DOD) to conduct the Medicare subvention demonstration for a three-year period. Under this demonstration, DOD formed Medicare managed care organizations--collectively called TRICARE Senior Prime--at six sites that provided enrolled older military retirees the full range of Medicare-covered services as well as additional DOD-covered services, notably prescription drugs. The Medicare program was to pay for DOD for Medicare-covered care of the enrolled military retirees if DOD continued to spend on all aged military retirees at least as much as it had historically. Under the subvention demonstration, Senior Prime enrollees' care in 1999 cost DOD far more than the Medicare capitation rate that was established for the demonstration. This mostly resulted from enrollees' heavy use of medical services, although DOD coverage of prescription drugs--not included in the Mediare benefit package--also contributed to its high costs of care. Without the demonstration, Medicare's spending in 1999 for retirees who enrolled in Senior Prime would have been, on average, about 55 percent of the Senior capitation rate. The BBA payment rules resulted in no Medicare payment to DOD in 1999. This was because they were designed to prevent the government from paying twice for the same care--once through DOD appropriations and again through Medicare. The rules also required that the payment be adjusted to account for Senior Prime enrollees' health status. These two rules resulted in Medicare paying DOD nothing for care provided in 1999. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-02-67/html/GAOREPORTS-GAO-02-67.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-02-67/pdf/GAOREPORTS-GAO-02-67.pdf GAO-02-67 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-02-67 Other Written Product GAO-02-67; Medicare Subvention Demonstration: DOD Costs and Medicare Spending; Health care costs Health care programs Managed health care Retired military personnel Retirement benefits DOD TRICARE Senior Prime Program Medicare Choice Program Medicare Program DOD Medicare Subvention Demonstration Program DOD TRICARE Program DOD TRICARE Prime Program DOD TRICARE Standard Program DOD TRICARE Extra Program Public Law 105-33 Public Law 106-398