Retirees using Tricare Standard

[bruno]

Just curious how many folks who are eligible (ie... military retirees), living outside an area where there is a Tricare Prime network set up are using Tricare Standard as their primary Health Care Insurance? Do you find it timely? How much out of pocket are you routinely stuck with? Do you find a lot of providers not interested in dealing with Tricare?

I am looking at an enormous increase in Health care costs this year as my company has dropped the option that I (and most of my fellow employees) were using and are offering a plan with much higher deductibles and out of pocket expenses. I might just throw the whole thing over and finally use Tricare but a couple of friends who are physicians have warned me that their experiences with Tricare Standard have left them pretty unhappy. So- thoughts?? There are pretty much no MTFs or Tricare Clinics in Massachusetts that I know of so Prime is no option.

 

[kp2001]

One would think I would be more help here, but I can only provide a few thoughts:

It is true that it can be difficult to find providers who accept Tricare. The reason for this is that it usually reimburses less than Medicare and can at times be archaic in it's rules and regulations.

I believe the out of pocket expenses for Standard are quite low beyond the enrollment fees that are associated.

I would recommend getting in contact with a Tricare Rep who may be able to better answer your questions. You would fall under Tricare North

https://www.hnfs.net/bene/home

 

[Pima]

Bullet elected to carry both. The problem with Tri-Care is you will deal with referrals, on top of paying out of pocket. In our area the bases are not accepting retirees, thus, we are forced on the economy and can only use docs that accept tri-care, our "everyday illness" doc is now not accepting tri-care, luckily we have a better insurance program through Bullets employer, thus, we can stay with them. I have a knee issue, traumatic arthritis that was caused due to the doc that the military referred me to while he was AD. Tri-care for their share of the bill sent us a statement saying they would only authorize $15 for the visit. The bill was 800, and his private insurance picked up all of it, but the way the system works you have to give both insurers, thus, in the end Tri-Care was never billed, but told us they would have only paid 15. Why? Because this was not a "referral". If you are healthy and do not intend to use insurance except for the dire need or for shots then go tri-care. If you are like us and want to select your specialist, keep your private insurance. The cost is well worth it if you have great private.

Our private is very good, but we got hit this yr, we went from 135 a mo to 150. From 100% coverage for prescriptions (any) to 100% for generic and a $9 co-pay for "name" prescriptions. We also went from no co-pay to 10. In the end we have tri-care picking up the extra so we won't be hit. Our tri-care is 128/mo, it doesn't have vision or dental or orthodontic, our Aetna has all three, additionally we can select our docs. We pay tri-care for a safety reason ... catastrophic

I would suggest to look into tri-care for your area and the docs that accept it. If you have children with vision issues, like we do, the 100% coverage for exams and contacts/glasses the cost of contacts and exams for 1 yr would make up the difference. Same is true as their wisdom teeth are coming in...60% coverage on a 750 bill to remove them is better than 0%. Just in those 2 scenarios, our savings from carrying the 2nd paid for the premiums in one yr.

Look at your family needs, if you don't use docs except occasionally, then go tri-care...if you have specific medical needs or expect to within the yr...i.e. wisdom teeth, than don't.

 

[bruno]

Bullet elected to carry both. The problem with Tri-Care is you will deal with referrals, on top of paying out of pocket. In our area the bases are not accepting retirees, thus, we are forced on the economy and can only use docs that accept tri-care, our "everyday illness" doc is now not accepting tri-care, luckily we have a better insurance program through Bullets employer, thus, we can stay with them. I have a knee issue, traumatic arthritis that was caused due to the doc that the military referred me to while he was AD. Tri-care for their share of the bill sent us a statement saying they would only authorize $15 for the visit. The bill was 800, and his private insurance picked up all of it, but the way the system works you have to give both insurers, thus, in the end Tri-Care was never billed, but told us they would have only paid 15. Why? Because this was not a "referral". If you are healthy and do not intend to use insurance except for the dire need or for shots then go tri-care. If you are like us and want to select your specialist, keep your private insurance. The cost is well worth it if you have great private.

Our private is very good, but we got hit this yr, we went from 135 a mo to 150. From 100% coverage for prescriptions (any) to 100% for generic and a $9 co-pay for "name" prescriptions. We also went from no co-pay to 10. In the end we have tri-care picking up the extra so we won't be hit. Our tri-care is 128/mo, it doesn't have vision or dental or orthodontic, our Aetna has all three, additionally we can select our docs. We pay tri-care for a safety reason ... catastrophic

I would suggest to look into tri-care for your area and the docs that accept it. If you have children with vision issues, like we do, the 100% coverage for exams and contacts/glasses the cost of contacts and exams for 1 yr would make up the difference. Same is true as their wisdom teeth are coming in...60% coverage on a 750 bill to remove them is better than 0%. Just in those 2 scenarios, our savings from carrying the 2nd paid for the premiums in one yr.

Look at your family needs, if you don't use docs except occasionally, then go tri-care...if you have specific medical needs or expect to within the yr...i.e. wisdom teeth, than don't.

Thanks for the feedback PIMA-lot's to think about. I have had very good though expensive coverage thru work - what they are offering this year is going down in monthly portion that I have to pay to carry but deductibles that I didn't have last year are going way up until you hit a catastrophic point. It's a drag having to go thru all this- If I were outside Ft Bragg or Norfolk or Tampa this would probably be an easy call as Tricare Prime looks like a pretty good system but outside Boston- it's Standard all the way. Probably going to bite the bullet continue with company offering and just start using my Tricare as a second provider for the deductibles- I have a late in life post Army retirement daughter who seems to have a propensity for Doctor's visits over Asthma and allergy related stuff. I will call Tricare North just to see what they tell me.

 

[Just_A_Mom]

Is a Health Savings Account offered through your employer? If so then you can deposit money in there and it will carry over from year to year - (tax free).
This is different from a 125 plan which is "use it or lose it".

If I were you I would lay out all your medical visits and expenses. Check with your physicians - if you or your dependents have any specialists they see on a regular basis - check that too. Check your local hosptal as well.

 

[Pima]

Bullet retired last October in the DC area, we have 7 military installations and not one accepted new retirees, the belief that if you were closer to a large installation is wrong. Even SJAFB is no longer accepting retirees. Retiree families are not eligible for VA, Bullet can go to any military hospital, the rest of us live and die by TRICARE.

If your child has a medical issue, it is best to bite the bullet because you are able to keep control. I am 44 and as I stated I have traumatic arthritis due to the referral doc through TRICARE prime as an AD dependent. Had it been diagnosed correctly 4 yrs ago by the TRICARE doc, I would not be looking at 2 or 3 knee replacements over the next 20-25 yrs. I have had to give up my career for health issues to prolong my replacement. I have bone spurs on my knee because the military forced me to go to their doc that accepted TRICARE. I also have hip issues because my body was trying to compensate for my knee. I had no option, because that was our only insurance. With Bullets new insurance I was able to go to the best of the best (ranked #1 in VA) and paid nothing. Through them, my health seems to be their priority.

FYI the doc for the TRICARE had a license plate that said "NE PD 4 IT"...tell you something?

I will also state I have a bitter taste in my mouth from Concordia for dental...it seems that every filling that was given to my kids failed and we had to get them re-done, but this time because of constraints it was out of pocket. Even our DD at 10 had to have an emergency root canal and TRICARE refused to pay since it was not in the time limit. Check out dental... panoramics are only covered 1 in 3 yrs, 2x a yr cleaning, fillings 20 a shot...our AETNA allows panoramics every yr, free cleanings and fillings. 60% co pay for major work...wisdom. root and bridges. The little costs add up.

We also keep Tri for our DS at college, he can go anywhere and place that claim by just showing his i.d. card

Finally call the national TRICARE number and they will give you the list of docs that accept them, luckily we are in FY10, which means they will accept until Sept 30 10 tricare