Health Matters
TRICARE Information	Air Evacuation	Health Links	Korean Dental Care

11-10-09 2010 TRDP Premium Increase: Effective Oct 1, 2009, the monthly premiums for TRICARE Retiree Dental Program (TRDP) insurance increased as follows:

• Single – from $36.97 to $38.20, an increase of $1.23
• Two Persons – from $71.25 to $73.60, an increase of $2.35
• Family (3 or more) – from $118.30 to $121.83, an increase of $3.53

3-02-09 Shingles Vaccine Available: The Brian Algood Army Community Hospital at Yongsan has Shingles Vaccine available without requiring a prescription. The Centers for Disease Control and Prvention (CDC) recommends Zostavax for use in people 60 years old and older to prevent shingles. There has been a change in the dosage, however. Before it was one shot. Now it is two shots — the second between two to four months after receiving the first. Zostavax does not treat shingles once it develops or post-herpetic neuralgia (pain after the rash is gone).

Shingles is a painful localized skin rash often with blisters that is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. Anyone who has had chickenpox can develop shingles because VZV remains in the nerve cells of the body after the chickenpox infection clears and VZV can reappear years later causing shingles. Shingles most commonly occurs in people 50 years old or older, people who have medical conditions that keep the immune system from working properly, or people who receive immunosuppressive drugs.

A person's risk for getting shingles begins to rise around age 50. However, shingles vaccine (Zostavax) is only recommended for persons age 60 and older because the safety and effects of the vaccine were only studied in this group, which accounts for about half of all cases of shingles occurring each year in the United States. Future research will determine if the recommended age for vaccination should be lowered.

For more details, check this CDC information sheet. (Thanks for the tip, Gene).

5-25-08 Army Medical Care Update: COL (Dr)Greg Jolissaint, Commander of the 18th Medical Command, was Guest Speaker at the USAG Humphreys Retiree Appreciation Day on May 17, 2008. He said that Army medical care in Korea is finally, after more than 50 years, moving away from the battlefield support mentality to become a Medical Activity (MEDDAC). It is the only regular asset in the Army with tactical medicine providing care for the entire population.
(Update: Later in 2008, the 121st Combat Support Hospital became a MEDDAC and was renamed the Brian Allgood Army Community Hospital (BAACH). For those who did not know him, COL Brian Allgood was the Commander of the 18th Medical Command 2004-2006. He became the Command Surgeon, MNF-Iraq, and died in Iraq in the crash of a Blackhawk helicopter on Jan 20, 2007.)

There are currently 36 hiring actions being processed and these will be allocated to the BAACH and Army clinics throughout Korea. For example, the clinic at USAG Humphreys will get five of the new positions. Forty more positions have been requested and approval is expected shortly.

Continuing on with USAG Humphreys, he said that the construction of a replacement hospital for the BAACH is moving slowly. He estimated that it will be at least five years before the construction proposal is even put out for bid. Then bids must be assessed and finally the contract will be awarded and construction will begin. (I've been telling people that we should see the new hospital in 2015. We might not even know by that time who will be doing the construction. Jack Terwiel)

In the meantime, the population shift from Areas I and II will continue into Area III. His solution until the new hospital is built is to create a 'field hospital' that will be sufficient to care for the growing population. It will be operating from the building near the airfield that's currently used to store the deployable medical kits. That facility must be available within two years as the population balance shifts to USAG Humphreys.

With the change in image, the 18th Medical Command will also change its name. The 18th will be deactivated and the 65th Medical Brigade will be activated. Interestingly, COL (Dr) Jolissaint is going to his new assignment in Hawaii in June. Subsequently, he will reactivate the 18th Medical Command in Hawaii as a deployable hospital that he will command.

So what do the changes mean for retirees? Retirees will be part of the prioritized care population following the active duty forces and their dependents. The only ones not part of the priority care are DoD civilians. In addition, he estimated that TRICARE Overseas will be coming to Korea in 8-12 months and that will then make TRICARE Prime available to under-65 retirees and their families. (For Osanites, he was unable to say whether the Air Force would be participating in the TRICARE Prime contract.)

4-19-08 Osan Hospital Update: On April 16, 2008, I attended a meeting with the Chief of the IG Team inspecting the Osan AB Hospital. I was representing the Osan retiree community that includes retirees, their families and their survivors. Although I and others thought the influx of active duty families was an additional authorization, that's not true. The expansion of accompanied positions took place several years ago. The opening of the new family housing has resulted in more active duty persons deciding it's time to bring their families to Korea now that they can live on base.

The bottom line is that retirees and other lower category health care beneficiaries (contractors, teachers, etc.) are being pushed out the back door as more family members come in the front door. Space available care is becoming less available to us. Those who have chronic illnesses such as diabetes and high blood pressure are being told to find a Korean doctor because the Osan Hospital cannot guarantee the scheduling of regular appointments needed to monitor the health status of these beneficiaries.

When the IG Team Chief asked for comments from the community representatives, I gave the following:

When I asked if there was any relief on the horizon, I was reminded that the hospital staffing is based on the number of families that had previously been authorized. We had just been fortunate that many families had chosen not to come until the new housing was completed. For retirees, "the chickens have come home to roost." We're on our own in many cases, and must find a way to either make affordable health care work, or else consider heading back to the U.S. This is particularly true of the older retirees (65+) who would benefit from having virtually all health care costs covered by Medicare Part B and TRICARE for Life. And for those who elected not to enroll in Medicare Part B when they reached age 65, the next open enrollment is not until January 2009 (ending March 31) with coverage effective July 2009.

We might find some relief when the USAG Humphreys hospital, replacing the BAACH, is completed about 2015. Of course, by that time Humphreys will have a population estimated to be 45,000 (active duty, dependents, civilian employees, contractors, etc).

This is the end of the Osan Hospital update.

The primary purpose of medical care in Korea is to maintain the health of the active duty force. The dependents of active duty personnel are also part of the primary care population treated at these facilities. Until recently, retirees were provided with medical care on a space available basis. With the advent of TRICARE Plus in in Korea in 2002, retirees were allowed to sign up for TRICARE Plus and be assigned to a health care provider. This gave retirees with TRICARE Plus a higher priority over retirees using space available. TRICARE Plus has no effect on the other TRICARE options available to retirees in Korea: TRICARE Standard and TRICARE for Life. There are two limitations to TRICARE Plus: 1) access applies only to the primary care facility where the retiree is enrolled; and 2) there is a limit to the number of retirees who can sign up for TRICARE Plus at a treatment facility.

The other TRICARE options available to retirees are TRICARE Standard and TRICARE for Life. TRICARE Standard applies to retirees and their dependents who are under age 65. TRICARE for Life applies to retirees and their dependents who are age 65 and over. When reaching age 65, a person's TRICARE Standard coverage stops, and he or she must be signed up for Medicare Part B to receive the benefits of TRICARE for Life. These TRICARE options are used when treatment is received at a civilian hospital. For details on TRICARE, click on TRICARE Information (updated 5-2d04) in the navigation bar above. Also available is an explanation of TRICARE for Life and Dual Eligibility.

Retiree Health Care

Retiree health care in military treatment facilities in Korea varies widely by location. Where the combined active duty and retiree populations are large, such as in Seoul (Yongsan Army Garrison) and Pyeongtaek (Osan AB and Camp Humphreys), access to medical care is good. In other areas, the availability of care is less, and may require referral to the Osan or Yongsan military hospitals, or to civilian health care at a Korean hospital. Air evacuation to military treatment in Okinawa, Japan, Honolulu, Hawaii, or San Diego, California, are other options available to military medical staffs. Details on this option are available by clicking on Air Evacuation in the navigation bar above (updated 5-2d04). Medical care is generally more readily available to retirees than dental care. The best option available to good health care is to assume primary responsibility for your own good health. A great deal of information on how to do this is available by clicking on Health Links in the navigation bar above.

Retiree Dental Care in Korea

The TRICARE Retiree Dental Program (TRDP) will become available to retirees in Korea in October 2008.

Dental care for retirees at military treatment facilities is limited, and may not be available at many locations (except for bonafide emergencies). In those locations where it is provided, dental services available to retirees include annual examination, cleaning, and basic services such as fillings and extractions. There is no TRICARE dental insurance option available to retirees in Korea, so dental treatment on the economy is paid entirely by the retiree. Some worldwide dental insurance may be available, but no information on that type of commercial insurance is provided here.

Civilian dental care in Korea has been constantly improving and retirees must now depend on these Korean dentists when military treatment is not available. Military dental clinics now refer active duty dependents to Korean dentists, and the clinics have compiled a list of referral dentists in their areas. In addition, retirees provide recommendations based on personal experience. These lists and additional comments are available at Korean Dental Care in the navigation bar above.

RAO Osan Health Tips

Skin Cancer

Link updated 6-12-08 The May 2006 issue of MOAA magazine has an excellent article on skin cancer, including how to recognize it and how to get treatment. Go to "Ask the Doctor: Skin Cancer Facts" to get the details.

Self-Care Example

5-2-04 As we age, problems develop as a result of medical and physical weaknesses, some related to a lack of exercise. One such example is a weakening of the pelvic floor muscle that could lead to incontinence, that is the inability to control the bladder and bowel functions. Several web sites offer advice on how to exercise the pelvic floor muscle, and this advice has been compiled into a single document by the RAO and is available in PDF, DOC and HTML formats. Although not medically certified as an official treatment, as one doctor put it, "it certainly can't hurt." Web site references to the sources are at the end of the document.

Diet and Sleep Loss

5-5-04 "Nutrition, exercise and rest are the 'trifecta' for weight loss," says Pat Smith, a registered dietitian and sports consultant based in Orlando, Fla. "We're in the middle of a diet debate over fats or carbohydrates (for optimal weight loss) but the part rest plays is missed in the debate," she says.

There are many causes of sleep problems, but your eating habits may be one you're overlooking, according to Smith, who recommends you abandon the "three square meals'' approach to eating for a plan of mini-meals throughout the day. "If you eat smaller amounts of food more evenly distributed during the day, it stabilizes your blood sugars, making it easier to get the sleep you need,'' says Smith, author of "The Smart Weigh'' (LifeLine Press, 2002).

She suggests five to six small meals a day, such as a piece of fruit and a carton of fat-free yogurt or a piece of fruit, a slice of whole-grain bread and 3 ounces of seafood. The regularly spaced mini-meals keep your blood sugars even, making it easier to fall asleep.

Smith also suggests you eat a wisely chosen bedtime snack so you'll be less likely to wake up in the middle of the night. "If you don't have a bedtime snack, your blood sugar drops, playing a role in that 3 a.m. wake-up a lot of people experience," says Smith. "I suggest a before-bed snack of a small bowl of whole-grain cereal and milk or a banana and milk. The cereal and the banana both have dietary fiber that allows the sugars in the cereal to be released more slowly and evenly. The protein in the milk will be released later in the night, supporting blood sugars so they don't come crashing down," Smith says.

Even if you don't like mini-meals, avoid late-night, high-fat dinners, she says. The body has to digest all that fat, which means you're not going to sleep well.

The Philippine Alternative

5-2-04 A number of Korea retirees travel to the Philippines for both medical and dental care and report that the care is very good. The cost of travel plus care is often less than the cost of care alone in Korea for both medical and dental services, particularly if the care is expensive, such LASIK surgery for the eyes, or extensive dental work. Retirees considering this option should first discuss it with someone who has used this option (the local VFW might be a good place to inquire), and particularly check on the current situation there as far as personal safety if considering a trip.