Enrolling in TRICARE - Has it been good for you!!

I just turned 60 and have started drawing my Naval Reserve retirement pay. I also retired as a government employee and have had FEHB for over 30 years (BC/BS). I had not planned to shift to TRICARE because it appears to be an HMO type plan versus the BC/BS PPO. I could not overlook the cost savings though. Save about $4,000 per year in premium fees. $9 per 90 day supply of brand name drugs versus the new BC/BS rate of $65. The hardest thing will be changing doctors after 15 years or so. A friend who shifted a couple years ago said the only hassle has been getting the same quality of specialists for his wife. Does anyone else in TUG land have the military TRICARE? Is it working OK for you?

Charlie D.

I do not have first hand knowledge of retirement Tri-care however, my mother does have have two insurance coverage, one being Tri-Care. She is also retired from a quasi-governmental agency.

What I know: she did not have to give up her current doctor. All she had to do is provide her current doctors billing agent with Tri-Care billing section. The billing agent must be made aware that Tri-Care is a secondary payer. Tri-Care is always secondary regardless of what your primary health insurance is (including medi-care). Her primary insurance pays first minus the co-share payment. The co-share payment goes to Tri-Care. 99.9% Tri-Care will not question the co-share payment. She has been doing this for about 7 years.

Also medication is free if you pick it up from a military hospital pharmacy. However, they will only give you a 30 day supply at a time. Online pharmacy, you can get up to 90 days for one low cost of $9.00 deductible. If a generic brand is available but you want the name brand or your doctor prescribes the name brand you will have to pay a higher deductible. I think it is $24 for 90 day supply.

I know she doesn't pay an annual premium, but I think this is due to the fact that my Dad was in the Navy back in the early 1960 when lifetime free health care was promised to service member if they retired. (It was a Recruiting Tool)

When I retire in 5 years, I have to pay an annual premium if I want to keep Tri-Care as my health insurance. However, I was told it is still much cheaper than a business provided health care, especially if you live next to a military Hospital. (Like Triple Hospital in HI) Don't quote me on this but I think the annual premium is $400 for the whole family. No co-pay if I use the military hospital.

The best thing to do is talk to a Tri-Care counselor at your local military hospital. They are more that willing to talk to you about different option.

Hope this helps,
DEROS

Tri-Care

Both hubby and I are retired Federal Employees and hubby is retired military. While we were Federal Employees, we did not use TriCare, but once we retired and moved to an area where our federal HMO was not, we switched to Tricare. We are now both 65, and on TriCare for Life. (Medicare is primary, Tricare secondary.) We have no complaints with Tricare. Our local military hospital is overloaded, so they will NOT see either of us once we turned 65.

The only downside for me, is I don't qualify for Social Security, so I have to pay for my Medicare. I have it taken out of my federal retirement pay. After reaching 65, you don't have to pay for Tricare.

Since going on Tricare, my husband has had many medical problems and Tricare has handled and paid for them all except for one thing that was an optional/trial type procedure.

You can't have 2 types of Federal Insurance. If you take Tricare, you have to drop your other (BC) insurance. Yearly, I get a letter asking if I want to resign up for Federal Health insurance.

Hope this helps some. If you have more specific questions, I'll try to answer them.

Nancy

My elderly father is retired Navy and has TriCare for Life. He's always talked about how wonderful it is, and with his recent health problems, I can see why.

Tricare

I am retired from service and use primarily the VA. Recommend you at least look into them. They can be good for routine stuff. In 2007 I had an operation and went outside VA system and used TRICARE. Importantly, TRICARE has an annual cap of $4K (I think - maybe $3K?) which you have to pay if you use the proper facilities/doctors. If you don't use the ones who agree to accept TRICARE payments, it will cost you more. I had to go back in after my operation for a few more days and still did not come near my cap. The medical center/doctors I used billed almost $40K.

Good luck ... Uncle Davey

Charlie D. said:

I just turned 60 and have started drawing my Naval Reserve retirement pay. I also retired as a government employee and have had FEHB for over 30 years (BC/BS). I had not planned to shift to TRICARE because it appears to be an HMO type plan versus the BC/BS PPO. I could not overlook the cost savings though. Save about $4,000 per year in premium fees. $9 per 90 day supply of brand name drugs versus the new BC/BS rate of $65. The hardest thing will be changing doctors after 15 years or so. A friend who shifted a couple years ago said the only hassle has been getting the same quality of specialists for his wife. Does anyone else in TUG land have the military TRICARE? Is it working OK for you?

Charlie D.

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There are THREE different levels of TRICARE. I have Standard, as I can choose my Doc, but it costs more out of pocket. Because I am not Prime, the Naval Hospital will not give me any appointments although I can still use the pharmacy.


TRICARE is the Department of Defense’s worldwide health care program for uniformed service members and their families. TRICARE has several health plan options to meet the needs of it’s beneficiary population.
TRICARE Prime
TRICARE Prime is a managed care option offered throughout the United States in areas known as Prime Service Areas—these are usually areas near a military treatment facility (MTF) or where a high concentration of TRICARE beneficiaries are living. Active duty service members are required to enroll, while all other beneficiaries (active duty family members, retired service members and their families and all others) may choose to enroll in TRICARE Prime or use TRICARE’s other health plan options. Some beneficiaries (other than active duty service members and their families) must pay an annual enrollment fee to participate.
When enrolled in TRICARE Prime, you receive most of your care from your assigned primary care manager (PCM)—either from an MTF or TRICARE network. Your PCM refers you to a specialist (military or TRICARE network) for any care he or she cannot provide.
When enrolled in TRICARE Prime, you pay minimal out-of-pocket costs. A point of service (POS) option is also available for care received without a referral, but using the POS option results in higher out of pocket costs.
Learn more about TRICARE Prime.
TRICARE Prime Options
Because service members may be stationed anywhere in the world, additional Prime options are available. Generally, the same Prime rules and features apply to these Prime options:
TRICARE Prime Remote
TRICARE Prime Remote (TPR) is available to active duty service members who live and work more than 50 miles or an hour’s drive to an MTF. Service members must enroll in TPR if they live in a designated TPR ZIP code area. Active duty family members who reside with their TPR-enrolled sponsors may also enroll in TRICARE Prime Remote for Active Duty Family Members.
Learn more about TRICARE Prime Remote.
TRICARE Prime Overseas
TRICARE Prime Overseas is available active duty service members and their command-sponsored family members who in overseas areas.
Learn more about TRICARE Prime Overseas.
TRICARE Global Remote Overseas
TRICARE Global Remote Overseas (TGRO) offers the Prime benefit in overseas remote locations to active duty service members and their command-sponsored family members.
Learn more about TGRO.
TRICARE Standard and Extra
TRICARE Standard and Extra are available to beneficiaries who elect or are not able to enroll in TRICARE Prime. Active duty service members may not use TRICARE Standard and Extra—they must enroll in of the Prime options described above.
Enrollment is not required to participate in TRICARE Standard and Extra—with these options you manage your own care. Beneficiaries may visit any TRICARE-authorized provider, however the type of provider you see, network or non-network determines which option you’re using and how much you pay out pocket.
When you visit a network provider, you’re using the TRICARE Extra option. Your provider will file claims on your behalf and you’ll pay less out of pocket. When you see a non-network provider, you’re using the TRICARE Standard option. You may have to file your own claims and you’ll pay more out of pocket than when you visit a network provider. You can use the options interchangeably, but you’ll need to keep track of the type of provider you’re seeing.
Learn more about TRICARE Standard and Extra.
TRICARE Standard Overseas
TRICARE Standard Overseas offers the TRICARE Standard option to beneficiaries living overseas who elect not or are unable to enroll in one of the overseas Prime options. TRICARE Standard Overseas is essentially the same program overseas as TRICARE Standard and Extra except that network providers are not available overseas so the Extra option is not available.
Learn more about TRICARE Standard Overseas.
TRICARE For Life
TRICARE beneficiaries, regardless of age, who are entitled to premium-free Medicare Part A and who have Medicare Part B coverage may use TRICARE For Life (TFL). With TFL, Medicare is your primary insurance, and TRICARE acts as your secondary payer minimizing your out-of-pocket expenses. TRICARE benefits include covering Medicare's coinsurance and deductible.
If you use a Medicare provider, he or she will file your claims with Medicare. Medicare pays its portion and electronically forwards the claim to the TFL claims processor. TFL pays the provider directly for TRICARE-covered services.

• For Medicare and TRICARE-covered services, Medicare pays first and TFL pays your remaining coinsurance for TRICARE-covered services.
• For services covered by TRICARE but not by Medicare, such as care received overseas, TFL pays first and Medicare pays nothing. You must pay the TRICARE fiscal year deductible and cost shares.
• For services covered by Medicare but not by TRICARE, such as chiropractic services, Medicare pays first and TFL pays nothing. You must pay the Medicare deductible and coinsurance.
• For services not covered by Medicare or TRICARE, such as cosmetic surgery, Medicare and TRICARE pay nothing and you must pay the entire bill.

Other than Medicare Part B monthly premiums, you’ll have minimal out-of-pocket costs when using TFL.
Learn more about TRICARE For Life.
US Family Health Plan
The US Family Health Plan is an additional TRICARE Prime-like option available through networks of community-based, not-for-profit health care systems in six areas of the United States.

• Brighton Marine Health Center
  Serving Massachusetts (including Cape Cod), northern Connecticut, southern New Hampshire and Rhode Island
• CHRISTUS Health
  Serving southeast Texas and southwest Louisiana
• Johns Hopkins Medicine
  Serving central Maryland, Washington DC and parts of Pennsylvania, Virginia and West Virginia
• Martin's Point Health Care
  Serving Maine, Vermont, New Hampshire and northeastern New York
• PacMed Clinics
  Serving the Puget Sound area of Washington State
• Saint Vincent Catholic Medical Centers
  Serving parts of New York, all of New Jersey, eastern Pennsylvania and southern Connecticut.

Learn more about the US Family Health Plan.

My husband is a retired military Navy pilot. At 60 or so we decided to change from employer insurance to Tricare because there were no premiums and the cap for out of pocket is $3,000 per year. That is less than we were paying for annual premiums! Because of Tricare qand other reasons, we decided on early retirement (no annual premiums) and have been very please with the care we have received. We are snowbirds, so we have a family practice MD that we see in FL. and one when we are up North. The physician we had in MN. for 25 years, took Tricare pts. but he also tacked on a 20% to the office visit( that is allowable). His office visits became $120. and Tricare paid much less than that. So, we had alot of out of pocket to pay him. Fortunately, we have been very healthy and usually only have annual physicals and an occassional yearly cold.
By the way, we got angry with our northern MD because of his cost and the 5 minute visit you MIGHT get with him, so we found someone else that gives us atleast 15-20 minutes and charges less! We also use Express Scripts and that is a great deal! Much cheaper than any previous insurance we had. There are quite a few MD's that don't take Tricare because their payments are around medicare payments and MD's think it is too low.

Many doctors willl not take Tricare prime because they do not get paid. Duke University Hospital accepted my Tricare Standard but will not take the Prime.
None of my ten doctors take prime. I have the same doctors I had when I had insurance through work before retirement. Check what your doctors will accept before making a choice.

Thank you for all the very informative posts. My current doctor is not enrolled in TRICARE. If his current policy does not change, I can go back to him when I get 65 and using Medicare and TRICARE for life. I have one more visit set up with him and then he will transfer all my records to my new doctor. TRICARE is effective 12/01 and I will suspend FEHB effective same date. If not satisfied with TRICARE I can go back during an open season. My new MD has a wife who is also an MD and I selected her as my wife’s PCM.

All those two-week annual trainings and weekends away from my family are starting to pay dividends. I got to see a big portion of the US and a pretty good chunk of the world. Come to think of it, kind of like a timeshare except that I got paid for being there and the military was picking up the maintenance fees.

Charlie D.

Charlie,
As a wife with children at home in the 80's, I was never very happy with those weekends and 2 week reserve duty, but now....It was all worth it as we get that nice check each month and medical benefits! My husband did 8 yrs. active and 14yrs Reserves. He was out of the Navy for 5 years and then decided to go back and fly in the Reserves. What a great idea!

Charlie D. said:

I just turned 60 and have started drawing my Naval Reserve retirement pay. I also retired as a government employee and have had FEHB for over 30 years (BC/BS). I had not planned to shift to TRICARE because it appears to be an HMO type plan versus the BC/BS PPO. I could not overlook the cost savings though. Save about $4,000 per year in premium fees. $9 per 90 day supply of brand name drugs versus the new BC/BS rate of $65. The hardest thing will be changing doctors after 15 years or so. A friend who shifted a couple years ago said the only hassle has been getting the same quality of specialists for his wife. Does anyone else in TUG land have the military TRICARE? Is it working OK for you?

Charlie D.

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Tricare for life... yes.

A couple more benefits you may qualify for:

When doc prescribes tests or xrays, we get them done at military facility.
Diabetis treatments... Hearing aids...

Check out Space-A flights for your travels... Also, see if you can stay over in military accommodations.

DEROS said:

The billing agent must be made aware that Tri-Care is a secondary payer. Tri-Care is always secondary regardless of what your primary health insurance is (including medi-care).

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I don't believe that's true. If you're under 65 and not eligible for Medicare, then Tricare is indeed the primary insurance. Once you become Medicare eligible at age 65, then Medicare becomes primary and Tricare for Life becomes secondary.

Tricare is widely accepted in Hawaii b/c the other big private insurance company here pays similar to Medicare rates, so there's no real reason not to take Tricare as a physician. That's not necessarily true in other parts of the country where private insurers have more competition and pay substantially better than Medicare or Tricare. It all depends what part of the country you're in.

"When doc prescribes tests or xrays, we get them done at military facility.
Diabetis treatments... Hearing aids..."

This depends in the military facitily. Here in DC area in VA, you are basically out of military when eligible for Tricare for Life. Hubby always did INR at Ft Belvoir and they let him go until he had a problem (less than a year) and then told him they couldn't do it anymore and should not have been doing it after he turned 65.

Nancy

Patty said:

Many doctors willl not take Tricare prime because they do not get paid. Duke University Hospital accepted my Tricare Standard but will not take the Prime.
None of my ten doctors take prime. I have the same doctors I had when I had insurance through work before retirement. Check what your doctors will accept before making a choice.

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TRICARE Prime is managed care, no independent doctor can/will take it unless your military provider refers you out, fat chance.

Nancy said:

"When doc prescribes tests or xrays, we get them done at military facility.
Diabetis treatments... Hearing aids..."

This depends in the military facitily. Here in DC area in VA, you are basically out of military when eligible for Tricare for Life. Hubby always did INR at Ft Belvoir and they let him go until he had a problem (less than a year) and then told him they couldn't do it anymore and should not have been doing it after he turned 65. Nancy

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Exactly, most will not see you if you're not on Prime.

Clemson Fan said:

I don't believe that's true. If you're under 65 and not eligible for Medicare, then Tricare is indeed the primary insurance. Once you become Medicare eligible at age 65, then Medicare becomes primary and Tricare for Life becomes secondary.

Tricare is widely accepted in Hawaii b/c the other big private insurance company here pays similar to Medicare rates, so there's no real reason not to take Tricare as a physician. That's not necessarily true in other parts of the country where private insurers have more competition and pay substantially better than Medicare or Tricare. It all depends what part of the country you're in.

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Did you hear that the library burned down at Clemson last weekend?





I recently had minor surgery. TRICARE 'allowed' the Surgery Center about $700 of their $6K bill, the surgeon about $700 of their $4.5K bill, the anethesiologist about $250 of their $800 bill. Could explain why many doctors in my area will not accept TRICARE. Now that doesn't mean you can't use them, they will normally still file the paperwork but you get what TRICARE pays and then you have to pay the full doctor bill. Although many doctors will 'work with you' on the bills.

It is true that Tricare pays about the same as Medicare and so many Dr.'s don't want to take Tricare. However, for those that do, they write off a portion of the bill and remember, you only pay a total of $3,000. out of pocket a year for all your medical expenses. After you have paid that amount, Tricare pays the remainder. So, as I understand it, you will never have to pay more than $3,000 per year out of your own pocket. Someone please correct me if I have incorrect information.......
For us, we paid nearly $6.000.00 annually for my husband's company medical/dental insurance coverage (his company paid a similiar amt.) and we still had deductibles and copays!
So this is much better for us!

JoeMid,

Thanks for posting the detailed info about TriCare and additional links. I didn't realize it had the various levels.

Richard

I'm retired Navy, and am in Tricare Prime. I've had no trouble getting treatment for routine things, and my recent knee surgery (cost me all of $25) was done at a facility of my choice. I can choose my own providers, and have had no problem getting the coverages I want. If I have an objection to Tricare Prime, it's that there is a list of things it doesn't cover.

An interesting side note: I work for a large Medical Center, that offers a pretty good medical benefit to employees/ Tricare is actually better. I declined coverage from my employer, since it would have made Tricare secondary coverage, and would have cost me more money out of pocket for less service. In my case, Tricare was a better fit for me.

Hope this helps,
Dave