Question on TriCare Coverage

JohnDar

Prolifically Gabby Member
I'm seriously debating dropping my overpriced Blue Cross/Blue Shield medical coverage sort of provided by my former employer as a retirement benefit and using the TriCare Standard program I'm eligible for as a military retiree. Anybody had any problems with TriCare Standard or doctors/facilities trying to stick you for costs beyond what the program allows as reasonable and customary? Since there are no military facilities in my area, the Standard program is my best choice. The difference between it and my current coverage is $300 a month for the two of us. And I've never been a fan of BC/BS, anyways. We were happy with HealthPlus of Michigan until we were forced to change and see our costs skyrocket.
 

Paul & Nan

Well-known member
Paul and I were under tricare before we fell under Tricare for Life. We paid $500/year and were not in a network area.We had paid $600/ month under BC/BS. We do not have much in the way of medical care, thank goodness, but it has all worked well for us.
 

lcdrdean

Active Member
I too will be interested in any responses. My current insurance at the end of my severance period in November. I have used it as my primary insurance and Tricare Standard as my secondary. After November, Tricare standard will be my primary insurance, but since it only pays 75 percent, I intend on purchasing a supplemental policy from MOAA to cover the additional 25 percent.
 

JohnDar

Prolifically Gabby Member
I too will be interested in any responses. My current insurance at the end of my severance period in November. I have used it as my primary insurance and Tricare Standard as my secondary. After November, Tricare standard will be my primary insurance, but since it only pays 75 percent, I intend on purchasing a supplemental policy from MOAA to cover the additional 25 percent.

Tell me more about that supplemental coverage. I never thought about doing something like that as a back-up.
 

JohnDar

Prolifically Gabby Member
You are really missing out . Tricare prime if under 65 or tricare for life if over. Humana Military try this site for any questions!

Thanks, but that link is only for the South region. I put my zip code in and it called me a "Dammed Yankee." We weren't really missing out until the beginning of this year when our retirement health insurance took a major nuke. We could no longer use the provider we liked for years, the premiums tripled and the out of pocket went to the moon. Even their mail-order pharmacy is a joke.
 

ct0218

Well-known member
I'm interested in following this thread too. I'm covered through my wife's policy currently, but will be using Tricare standard starting next month as my secondary. I have 2 1/2 years to go for Tricare For Life kicks in. Currently my only use of Tricare is for prescriptions. Who knows what will change with all that is happening with healthcare now.
 

truknutt

Committed Member
Thanks, but that link is only for the South region. I put my zip code in and it called me a "Dammed Yankee." We weren't really missing out until the beginning of this year when our retirement health insurance took a major nuke. We could no longer use the provider we liked for years, the premiums tripled and the out of pocket went to the moon. Even their mail-order pharmacy is a joke.

John,

Try this link to the DOD's info on TRICARE : http://www.tricare.mil/
 

Paul & Nan

Well-known member
For sure check out Tricare Prime-that is what we had. Never considered anything less, even though we have few medical needs, you never know. Now Tricare for Life covers what Medicare does not. Just watch out and help be active in preventing what BIG BROTHER keeps trying to take away, never mind it was promised so many years ago.
 

Joe Isuzu

Member
My wife and I are not quite old enough for Tricare for Life (Medicare primary, Tricare secondary) but we have been using Tricare Standard for almost twenty years now. The choice of Tricare Standard and Tricare Prime is yours but I actually find that Tricare Prime may or may not be cheaper but is much more restrictive. We live in Texas and also find that if you choose Humana Military is also a good choice.

Tricare Standard does not require you to use an "in network" physician but does require a twenty five percent copay after your $150.00 per person or $300.00 per family deductible is met. The twenty five percent copay is not what you may think it means. It is twenty five percent of what Tricare allows the physician or medical facility. If the physician bills Tricare $200.00 but Tricare only allows $50.00 for the visit or procedure your copay is only $12.50 after your initial deductible is met. The key is to make sure that you physician/facility accepts Tricare. I have no problem finding excellent physicians/facilities that accept Tricare. Tricare billing has improved immensely over the years so doctors don't have to wait long for their fees, much quicker than Medicare.

We use no supplemental insurance because in my calculations it is not cost effective. Tricare has a catastrophic cap of $3000 annually per family so if your Tricare Prime or supplemental insurance costs you more than $250 per month you are probably spinning your wheels. My work insurance is too expensive now so we don't even take it.

In a nutshell Tricare Standard can cost you no more than $3000 annually, does not require you to select an "in network primary care physician" (you can choose anyone / anytime you select - make sure they accept Tricare), and does not require a referral to see a specialist. If you want to see a cardiologist - find one and go see him/her, if you want to see a neurologist - find one and go. I find it as simple as that. Tricare Prime is much more restrictive - requires you to select an in network primary care physician and also requires referrals for specialists. Do your homework on the internet and select what fits you. This data is correct as far as I know but again, verify for yourself. Your mileage may vary.

Tricare Standard has served us well for almost twenty years now. Also, ExpressScripts which is part of the Tricare systems is wonderful. Ninety day prescription for the price of thirty day by mail. Three dollar for most generic.

Good luck in your choices and thanks for serving!
 

JJnLilly

Well-known member
Before we turned 65 we went with TriCare Prime, at the time it was less than $500 a year for the two of us. As we are both pretty healthy and the specialist I did see was on the list it was worth it. DW is 15 months behind me in hitting Medicare eligibility so I just continued it for her. Now that we are both on Medicare, TFL handles the deductibles and any co-pays. Be sure to stick with express-scripts - no need for any Medicare drug coverage.
 

JohnDar

Prolifically Gabby Member
My wife and I are not quite old enough for Tricare for Life (Medicare primary, Tricare secondary) but we have been using Tricare Standard for almost twenty years now. The choice of Tricare Standard and Tricare Prime is yours but I actually find that Tricare Prime may or may not be cheaper but is much more restrictive. We live in Texas and also find that if you choose Humana Military is also a good choice.

Tricare Standard does not require you to use an "in network" physician but does require a twenty five percent copay after your $150.00 per person or $300.00 per family deductible is met. The twenty five percent copay is not what you may think it means. It is twenty five percent of what Tricare allows the physician or medical facility. If the physician bills Tricare $200.00 but Tricare only allows $50.00 for the visit or procedure your copay is only $12.50 after your initial deductible is met. The key is to make sure that you physician/facility accepts Tricare. I have no problem finding excellent physicians/facilities that accept Tricare. Tricare billing has improved immensely over the years so doctors don't have to wait long for their fees, much quicker than Medicare.

We use no supplemental insurance because in my calculations it is not cost effective. Tricare has a catastrophic cap of $3000 annually per family so if your Tricare Prime or supplemental insurance costs you more than $250 per month you are probably spinning your wheels. My work insurance is too expensive now so we don't even take it.

In a nutshell Tricare Standard can cost you no more than $3000 annually, does not require you to select an "in network primary care physician" (you can choose anyone / anytime you select - make sure they accept Tricare), and does not require a referral to see a specialist. If you want to see a cardiologist - find one and go see him/her, if you want to see a neurologist - find one and go. I find it as simple as that. Tricare Prime is much more restrictive - requires you to select an in network primary care physician and also requires referrals for specialists. Do your homework on the internet and select what fits you. This data is correct as far as I know but again, verify for yourself. Your mileage may vary.

Tricare Standard has served us well for almost twenty years now. Also, ExpressScripts which is part of the Tricare systems is wonderful. Ninety day prescription for the price of thirty day by mail. Three dollar for most generic.

Good luck in your choices and thanks for serving!

Hey, Joe, thanks for all the details. That's pretty much the kind of information I was hoping for. The $3000 out of pocket is pretty much what we have now, but that's on top of the $1800 a year premiums we also have to pay...each. I know I should have seen a proctologist last year to get my head out of my arse about TriCare, but better late than never.

I've looked extensively at the Prime option, and in our area, it doesn't work. There are no military facilities other than the VA. And I don't like bull-pen medicine. I've already talked with our current primary care doctor (who we've been seeing for several years), and they are familiar with TriCare and bill to it, even though they are not part of the network. I'm going to work on her a bit to get them to join. There isn't much to it beside formally agreeing to accept what TriCare pays. I need to contact the local hospital and see what their take is on it. My idea of a supplemental insurance, or something like AFLAC, is to cover any differences between what they bill vs. what they accept from TriCare. Having seen some of the Statement of Benefits from our current plan, it's crazy. They bill $500, the BC/BS will allow $300, which I have to pay until I've met the $3000 out of pocket. Without the insurance, the provider could chase me for the $200 that the insurer doesn't allow. I kind of read that in the TriCare info, that that could be a possibility using an out-of-network provider.

I went online, looking for info on supplemental plans. Actually got a call from one agent who was a retired Master Chief. Told him what my "plan" was and he thought it was the way to go, even though he didn't have a supplement to sell me. I've got an inquiry in to AFLAC, and I think I'll check with our financial advisor for his input. Could be we forget the supplement and use our savings to handle any costs beyond the coverage.

I've got another 3 years before I qualify for TFL, and the wife's another six.

Again, thanks for all the inputs. I'll be sure to post what I finally come up with.
 

HappyKayakers

Well-known member
I'm currently on Tricare Prime because I've been stationary for awhile. If you're going to stay in one place most of the year, it's probably a good option. Previously, I was on Tricare Standard while traveling full time and had almost no problems. At each new place, I would look up participating hospitals and doctors and use those. The only real problem I had was a hospital in Amarillo TX which tried to overcharge me individually. They started talking about collections and credit ratings. I sent a letter to Tricare. They sent a letter to the hospital (cc me) telling them they were not in compliance with the Tricare agreement and to knock it off. Problem was resolved very quickly. I plan to go back to Tricare Standard next year when I start traveling fulltime again.
 

lcdrdean

Active Member
Tell me more about that supplemental coverage. I never thought about doing something like that as a back-up.

My understanding is that it pays what Tricare does not. I am still researching but think I will be going with MOAA's policy. You can search Tricare supplements on the web.
 

JohnDar

Prolifically Gabby Member
Just to follow up, I've "officially" called and cancelled our BC/BS enrollment to be effective 1 Jan 2011. TriCare Standard will be our sole coverage. I checked with the doctors we currently use, along with the hospitals and pharmacy, and it's all good. They are either in the system, or accept it without problem. For all of my research, the only thing we'll be giving up is the privilege of paying $300 a month in premiums and a capricious pharmacy co-pay schedule.
 
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