Military Families
TRICARE Question
Does anyone else have to pay alot of money for TRICARE? I thought that it was going to be fairly inexpensive but it is actually the opposite. I haven't had insurance and the only reason we are trying to add it for me is because we are ttc.... any thoughts??
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Re: TRICARE Question
Ditto this.
The only way you pay for TRICARE is if you opted to have TRICARE Standard in which you can choose your own Dr's and such. In that case the costs can vary by location and the Drs office.
This. Is there a reason you didn't choose TRICARE Prime? Or are you under a special circumstance? I know the benefits of TRICARE Standard are that you can pick from a list of providers, whereas in a military facility it's whoever is available (although they are really good where i am about trying to keep my appts with the same dr). The con is the co-pay though...which depending on where you are can be costly.
Let me preface this by saying that I am not a TRICARE expert, but have been on TRICARE Standard since January 2009.
First, you don't pay for TRICARE if you or your sponsor is AD. You pay a portion of the cost of each visit to the doctor. Depending upon the doctor you see, it is 20% or 15%. The cost does not vary depending upon where you live. The cost is set on what TRICARE has agreed to pay for treatment. TRICARE pays on the same rate as Medicare and Medicaid--which is, often, a pittance. OB services are covered in full, once the pregnancy has been confirmed, if you are on Standard.
As far as choosing doctors on Standard--you are able to choose to see any doctor who accepts TRICARE. It seems, more and more doctors are not accepting new patients with TRICARE (or Medicare or Medicaid) because it is just insufficient payment to cover their expenses.
You did not have to enroll your baby up for Standard because they don't have pediatricians on base. Your baby would/should have been assigned a civilian provider. When we lived in Nashville, we were too far from Fort Campbell to be seen there. My son was enrolled in TRICARE Prime but I was able to select his civilian pediatrician in Nashville. All of his appointments, except the one that I did not get the referral done properly for, were covered in full. He has seen several specialists--and with the one exception, it was fully covered (and that was my fault).
To the OP--is it safe to assume that your DH is not Active Duty? I don't know how much a private (non-TRICARE) plan would be to cover you. Have you looked into that? Its been four years since I had "civilian" health coverage, but you may be able to find something less expensive. Just be sure to ask about prenatal care and coverage. Good luck!
Hopefully Ilumine will see this tonight/tomorrow and correct me if/where I'm wrong and pass along any other needed info. She's got a lot of experience with TRICARE and will be most helpful.
That's how it is supposed to work. I wonder if the posters above was give incorrect info. She should not have had to enroll her newborn in Standard because there aren't pedis on base. The baby could be on Prime and have a civilian PCM and have everything covered.
They told you to switch to Standard? If there are no available pediatricians they should have given you a referral. DD was assigned to a family practice doctor at the local MTF because the pedi clinic was full. I also said "not good enough" and they switched us to a civilian doctor out in town but we are still considered Prime. It was very simple. Just told them it didn't meet our standards and filled out a form.
My husband is in the Reserves. The plan that they told him I would go on is TRICARE Reserve Select (or somethig to that tune...).
same for us. nothing can beat how little we pay for TRS. if we had to get insurance though DH's civi job we wouldn't be able to afford it.
Ilumine is one of the affected Bumpies, she can't post, but she asked me to pass along the following from her:
Kaylasue89, is your DH Active Duty or Guard and Reserve not activated?If your DH is AD, you automatically have TRICARE Standard and will have to enroll in Prime.
If you are on Standard, there will be some out-of-pocket expenses (20% of the bill) until you reach the yearly CAT CAP of $1000. Once you reach that, you wont have to pay anymore until the next fiscal year.
There are two caveats to this. First, you have to go to a TRICARE authorized provider. If not, then TRICARE won't cover you, just like any other HMO.- you have to stay in your network .
And another from Ilumine:
Second, just because a Provider accepts TRICARE, does not mean that they will sent the bills directly to TRICARE for you. They will expect you to pay them upfront and for you to send the bill to TRICARE for reimbursement.If this is the case, it is pretty easy to submit the EOB and Statement for reimbursement.
However, if your DH is a non-activated G&R, then yes there is going to be higher cost, to include premiums ($180.17 a month for families) and cost shares.
If there is something else going on, let me know. Ilumine
TRS follows the same plan as standard, the only difference is that you have a monthly premium.
15% for in-network and 20% for out-of-network, deductable depends on rank. also remember that the yearly cap is $1000, so when you think about it, it doesn't really matter if you chose an in-network or out-of-network provider, in the end you'll still only pay $1000 out of pocket for the entire family (other than the montly premium for TRS), it's just a matter of how fast you'll reach that cap (prescriptions go towards that cap as well....we've already met our cap and now everything for the rest of the year is free...it's so nice when going to the pharmacy to pick up our meds a couple times a month and hearing you owe $0)
Were you told you had to go standard? I am on Prime and when I got pregnant there were no OBGYNs at our base so I got to choose from a list of civilian drs and had it all covered free of charge, this is also the case for all my Gyno appts as well... not sure if it matters by branch of service or by area but MH is Marine Corps and we are stationed at an Army base.
We are also getting sent to an eye specialist for DSs eye and it too is covered under Prime.
Further more, when you are not enrolled in Prime and you use a non-network doctor you're using Tricare Standard (20% cost share). When you use a network doctor you're using Tricare Extra (15% cost share).
My advice to anyone with Tricare... READ YOUR MANUAL. Do not rely on the Tricare staff to tell you the correct answers.
This is true. I am not being callous - this is the MHS reasoning - As an ADFM, it is YOUR choice to not enroll in Prime (the Free Option), therefore YOU take on the Risk and Costs. Health Care is extremely expensive and it costs them SO much less to provide care on Base or through the Prime Network. They are making up for the extra costs no matter where they can.
This is especially true with Maternity Care, something they didn't really care about to begin with (god the stories fromn 20 years ago are down right scary). It took an act of legislation to force them to cover Maternity at the low cost share under Standard.
For YOUR case, did you try to appeal - Directly to HealthNet? Sometimes the Manage Care Support Contractor will waive those extra costs. Of course now that they lost the contract, it may be too late.
I guess this is a good point. The civilian insurance at my previous job was way cheaper... only about $50 per month. But I guess once you add a baby to the plan, it actually is a savings. Thanks for your adive!
I have learned a lot about Tricare over the years
We are guard right now, and pay for Tricare Reserve Select. The insurance was the #1 reason DH re-enlisted. It's sooo NOT expensive. We pay about $190 a month, I believe. If our family was covered through my work, we'd be paying $125 per WEEK
PLUS all those deductibles and co-pays. And expensive prescriptions. Scary. This is much, much better. Also, everything is covered for my pregnancy. DH had to spend the night in the ER back in January for a staph infection and I think we paid just under $200. The total cost of the bill was well over $5,000. He had 2 or 3 prescriptions and paid $3 each for the generic. I feel extremely blessed for our health care coverage. The average American pays so much more.
In the past we have had Prime (when DH was on active orders) and the previous posters are correct. If there is no Dr. for what you need on the base, you will be referred to a civilian Dr. free of charge. There is no reason to switch to Standard unless you want to. At Tinker there weren't a LOT of Doctors. I was referred out to a civilian OB for my pregnancy with our first child. The military takes care of it's own. They don't just leave you hanging.
Cam 6.6.10 - Autism, Global Developmental Delay, Mixed Receptive/Expressive Communication Disorder
While I am not the OP, I do appreciate the wisdom shared by those with more experience. This goes to show how important it is to do one's homework and know what you are dealing with.
Mrs. Oz, I'm glad that you were able to see the specialist that you needed. I'm sorry to hear that you had to see a specialist and had to pay more to do so. . . but it is better than having no coverage at all. I hope that all is well with you and yours!
if you are on Prime and referred off-base, it's covered at no cost. If you are on Standard, you pay a deductible.
I'm on TriWest Select, DH is in the Reserves. If you are in AZ then I assume you are also on TriWest Select.
For YOUR case, did you try to appeal - Directly to HealthNet? Sometimes the Manage Care Support Contractor will waive those extra costs. Of course now that they lost the contract, it may be too late.
I talked to just about everyone I could think of. I was going to write my congressmen but I got busy with the baby and all. I guess it's written into Federal law and the most I ever got out of anyone was, "you should have thought about that before you signed up for Standard." Well, I did. I signed up for it when we lived in a different region and my high risk doctor DID participate. My one year lock out wasn't up until after the baby was born. I even called the Navy hospital and asked if they could just see me for medical care...nope. Too bad, so sad. Now that the baby is born, I love Standard because I really do have choices, however limited they might be.
SmudgesMom-
Everything is fine now. I am glad that we have what we have. I am bothered that they make it so difficult. It really not the doctor's fault. They told me the reason why they don't participate with Tricare is because Tricare doesn't pay them very much. Heck, I don't even blame Tricare, I blame Congres which inturn falls back on me. I should really pay more attention to where these people stand on Medicare/Tricare issues before voting. I think that when people move to a new region they should be able to evaluate the medical providers in the area and be able to be let out of the 1 year block if sticking with Standard would cause them financial hardship. I was getting NST's and ultrasound twice a week. My growth US's were billed at $900 a piece! 15% of that is still a lot of money.
I must say that my old health insurance with BCBS was AMAZING and I should have continued it with COBRA. I would have ended up paying less doing it that way that droping it and sticking with Tricare. But I didn't know of the doctor situation before moving here.