The TRICARE Senior Supplement Demonstration (TSSD), conducted from March 2000 through December 2002, offers Medicare-eligible military beneficiaries the option of enrolling in TRICARE as a supplement to Medicare. This book describes RAND's evaluation of the TSSD program. Enrollment in TSSD was very low because of several factors, particularly the introduction of the permanent TRICARE for Life (TFL) that supercedes TSSD. However, implementation of TSSD as a permanent national program is feasible and would benefit many Medicare-eligible military retirees.

The National Defense Authorization Act (NDAA) for fiscal year (FY) 2001 made sweeping changes to the way that health care furnished by civilian providers to Medicare-eligible military retirees is financed. The law directed the Department of Defense (DoD) to implement what is now commonly referred to as TRICARE for Life (TFL). As of October 1, 2001, TFL provides TRICARE as supplemental health insurance for all Medicare-eligible military retirees age 65 or older who are enrolled in Medicare Part B. As of 2003, approximately 1.6 mil- lion military retirees are eligible for TFL. In general, TRICARE for Life covers all cost-sharing for Medicare-covered services and standard TRICARE cost-sharing for services that are covered by TRICARE but not by Medicare. Thus, TFL provides Medicare-eligible military retirees with one of the most comprehensive health insurance benefit packages in the United States.

The National Defense Authorization Act (NDAA) for fiscal year (FY) 2001 made sweeping changes to the way that health care furnished by civilian providers to Medicare-eligible military retirees is financed. The law directed the Department of Defense (DoD) to implement what is now commonly referred to as TRICARE for Life (TFL). As of October 1, 2001, TFL provides TRICARE as supplemental health insurance for all Medicare-eligible military retirees age 65 or older who are enrolled in Medicare Part B. As of 2003, approximately 1.6 mil- lion military retirees are eligible for TFL. In general, TRICARE for Life covers all cost-sharing for Medicare-covered services and standard TRICARE cost-sharing for services that are covered by TRICARE but not by Medicare. Thus, TFL provides Medicare-eligible military retirees with one of the most comprehensive health insurance benefit packages in the United States.

The primary research question addressed in this thesis was: "How will the Military Health System and Medicare benefit from Medicare Subvention?" The research described the health care legislation affecting the demonstration project, titled Tricare Senior Prime. Tricare Senior Prime seeks to provide better health care services for dual-eligible military retirees without shifting costs to the DoD or Medicare. While Tricare Senior Prime adds to the health care options of dual-eligible military retirees it also adds administrative complexities to Tricare. The health care services provided under the Medicare package are compared to Tricare Care Senior Prime. Medicare does not provide long term nursing care or custodial care, and certain other health care needs such as dental care, eyeglasses, hearing aids, and most outpatient prescription drugs. Tricare Senior Prime is an attractive low cost alternative to dual- eligible military retirees searching for affordable health care. The DoD believes that it can provide health care services to dual-eligible military retirees at a lower cost than Medicare.

In this book, the IOM makes recommendations for permitting independent practice for mental health counselors treating patients within TRICARE-the DOD's health care benefits program. This would change current policy, which requires all counselors to practice under a physician's supervision without regard to their education, training, licensure or experience.