Why Tie Military Kids to Medicare?

November 4, 2016

Medicare, the federal health insurance program for America's elderly, is causing real problems for military children. 


You might ask how that can be, but it's because TRICARE payments to medical providers are tied to Medicare's.

And Medicare's payments are mainly designed for older patients, not for kids.

The result is TRICARE often doesn't pay for services unique to children. 

One particularly awful example is coverage of hospice care for children facing late stage terminal illness.  

Normally, when someone has a terminal illness and faces a short prognosis (e.g., less than six months), they can elect to begin hospice care. Hospice provides medical services, like pain and symptom control, and an option to be at home with caregiving assistance. But it also provides emotional support for the ill and their families, with counseling and support in preparing for death. 

Under Medicare rules, electing hospice care requires giving up coverage for curative care. So TRICARE does, too. 

That means, when a military family has a child in hospice care and the child has a medical crisis, TRICARE won't cover readmission or treatment in hospital for curative care. 

In other words, the family must make the decision to let the child die, or bear the full cost of any medical treatment. 

But a child's body is not like an adult's body. Children are faster healers, and every part of their body is still growing, developing, and renewing, while adults are in a steady state of aging. 

The health variables are much higher for children, and their quality of life needs are different. Parents shouldn't have to forego all needed curative efforts in order to use hospice programs. 

Nearly 10 years ago, a DoD-commissioned study concluded, “The requirements for these services severely restrict pediatric access and do not provide appropriate pediatric care.” But this egregious policy is still in place. 

It is unclear whether the Defense Health Agency (DHA) can fix this without legislation. When the policy was identified to DHA, it reached out to families facing this choice with additional options, but it remains unclear what additional services they are receiving and how such flexibility will be applied going forward. 

MOAA and the TRICARE for Kids Coalition are committed to making a change to this regulation - and a law change, if necessary - a top priority.




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