Military retirees receiving care on bases nationwide are being quietly shifted to off-base civilian providers in a transition that has been taking place since at least 2018, Military.com has learned.
That's independent of a plan outlined in a recently obtained memo that would close 38 treatment facilities to all but active-duty patients.
The changes detailed in the Feb. 3 memo are a part of a review of military hospital operations and a system consolidation under the Defense Health Agency ordered by Congress in 2016. The memo did not list the affected facilities or make clear when the changes would start. A report on that review is expected to be delivered to Congress as early as this week.
The memo said changes would happen "in a deliberate, responsible fashion," and not until officials are "able to confirm there are available providers in the local Tricare network."
Care for military retirees enrolled in the Tricare Prime plan has long been offered at military clinics on a space-available basis, as a matter of policy.
"One of the biggest challenges and most important responsibilities we have is how to best align our resources with our patients' needs. Military hospital and clinic leaders constantly evaluate their facilities' capacity based on the number of providers available and their mix of specialties," Kevin Dwyer, a DHA spokesman, said in a statement provided to Military.com. "However, because the report to Congress has not yet been submitted, any previous changes are a result of the rebalancing of capacity based on available providers."
But as early as 2018, military hospitals and clinics had begun intentionally shifting retirees out of the hospital and into the community as a response to clinic and hospital staffing levels and restructuring sparked by the consolidation.
Related: More Than 3 Dozen Military Hospitals to Stop Treating Retirees, Families, Memo Shows
Military retirees pay an annual enrollment fee of $600 per family to use the Tricare Prime plan and gain access to on-base doctors. While care received on base has no out-of-pocket cost, retired Prime users must pay $20 per visit for primary care and $31 for specialty care received outside the military system. Tricare Select comes with slightly higher out-of-pocket costs -- $30 for primary and $45 for specialty care -- but no annual enrollment fee. Both plans have a $3,000 annual out-of-pocket cost cap.
For example, when Army officials announced plans to downsize Ireland Army Community Hospital at Fort Knox, Kentucky to a health clinic in 2018, retirees were told they could no longer be seen there for primary care.
"Military treatment facilities are able to see retirees on a space available basis, and Ireland has done that for years," Col. Kevin. Bass, commander of the medical center at the time, said in a news release. "But with a new clinic being built and the restrictions placed on its construction, we will not have the space to see retirees when it's finished."
At Naval Submarine Base Kings Bay, Georgia, retirees were sent letters late last year notifying them that they were no longer able to get appointments on base.
"Because our staffing won't accommodate everyone, we've taken a series of steps throughout this year to adjust [Naval Branch Health Clinic] Kings Bay's enrollment," says the letter, signed by Capt. Matthew Case, who commands Naval Hospital Jacksonville, Florida, of which Kings Bay is a subordinate command.
Hundreds of military retirees and their family members contacted Military.com following its first report about the memo Feb. 7, many of them stating that their local hospital or clinic had made a similar announcement. In other cases, readers said they were simply told their primary care provider was no longer available. In all instances, retirees who were no longer allowed on base faced new and unplanned out-of-pocket fees based on the Tricare Prime cost structure.
Readers reported being dropped from primary or specialty care at hospitals and clinics including Naval Hospital Bremerton, Washington; Tripler Army Medical Center, Hawaii; Scott Air Force Base, Illinois; FE Warren Air Force Base, Wyoming; Barksdale Air Force Base, Louisiana; Moody Air Force Base, Georgia; Robins Air Force Base, Georgia; Tyndall Air Force Base, Florida; and Submarine Base New London, Connecticut.
Only officials from Barksdale, Air Force Base and Naval Health Clinic New England, which oversees Navy medical care across the Northeast U.S., returned a request for comment.
A spokesman from Barksdale said they are waiting on a decision from Congress before determining whether or not their clinics will close to patients not on active duty. And Kathy MacKnight, a spokeswoman for the region, said while the clinics at New London and Naval Station Newport, Rhode Island, have not removed anyone, neither locations are accepting any new dependent enrollees, including active-duty family members.
Retirees aren’t the only ones concerned about the shift. Although the memo promised no immediate changes, active-duty families at Fort Bragg, North Carolina, Barksdale Air Force Base and FE Warren Air Force Base reported being either removed from care or blocked from enrolling at the military clinic.
In one case, for example, users at Fort Bragg's Fayetteville Medical Home reported losing their primary care doctor without warning in mid-December and being told to pick one in the community. In a separate case, a military spouse at the same clinic was told this week that clinic staff had been notified it is closing.
But a spokesman for Womack Army Medical Center, which oversees that clinic, said no changes have been made there.
"We are currently reassessing the best use of the space. No decision has been made. No one is being dis-enrolled and no employment is being terminated," Robert Kerns, a Womack spokesman, told Military.com.
Unlike retirees, active-duty family members enrolled in Tricare Prime but seen off-base do not pay out-of-pocket fees for care.
Despite an assurance in the memo that no patients will be moved "until we are confident the local market has providers available," many readers said they're worried that officials won't know care isn't available until it's too late. For example, one spouse at Fort Bragg reported having trouble finding an off-base provider with openings, while a retiree near Kings Bay said she had to wait over a month for her new off-base doctor to have an opening.
-- Amy Bushatz can be reached at amy.bushatz@military.com.
