TriCare Health Care

[VAmookie]

Can anyone tell me what their thoughts are on TriCare. I will soon be enrolling my wife in TriCare, and their website is less than helpful. It says that it is an HMO, but i am concerned about the type of care my family may be receiving. In the event that my wife or kids contract a dibilitating disease or an autoimmune disorder, can i count on triCare to put out when necessary? Also, what is the company going to expect from me (Co-pay, etc. ??)?

I ask because her family has a history of medical issues. THanks

 

[bennett4362]

well, it's a very large "orgnaization" to sum up in a post, but essentially you can enroll in either tricare standard or tricare prime.

if you enroll in tricare prime, you receive treatment at military facilities, from military doctors, have very, very little say in who and where, but there is absolutely no cost to you.

tricare standard is more like your typical hmo. you choose your provider from a list of participating doctors and there are associated copays.

i'm enrolled in tricare prime, and what i've learned (with several medical issues myself) is that you have to have a very proactive approach; do your own research as much as possible, and go into your provider informed, with questions, and ready to take a stance on issues, if necessary. if you know your stuff, they're likely to do what you want.

each military treatment facility is different, each tricare prime clinic is different, and of course, each doctor is different. i had a primary care physician in va beach that i would've rather died before i went and saw; however, my primary care physician here in whidbey is better than any civilian doctor i would've chosen myself, and i will be very, very sorry when i have to move away from him.

a couple of general things to keep in mind are the "standard" exams you get free every year; eye exam, dental exam and cleaning, and woman's exam, all of which you can self-refer to (meaning you can choose any participating doctor to perform these exams, whether you're enrolled in tricare standard or prime). a lot of spouses aren't aware of these benefits.

as far as prescriptions, again i'm speaking as someone on tricare prime, they come at no cost to you, so long as the military pharmacy carries it. if the military pharmacy doesn't carry it, you pay $3 for a generic brand or $9 for a name brand at an outside pharmacy.

tricare is a huge "monster" with so much to know. before i enrolled, i went to a tricare service facility and had a caseworker explain the ins and outs to me as best she could. it was very, very helpful for me. even if you're not around a navy base, they have the tricare service centers at all military bases (i went to an army one), so i recommend your wife, and you, if you can/desire, go in and talk to someone in the service center.

good luck

 

[crysmc]

I'm enrolled in Tricare Prime and I've had nothing but wonderful experiences with it. The Naval facilities and Dr's have really been excellent. If the military medical facility in your area does not have a particular specialist that you need (gynecologist/obstetrician, emergency room, etc), you can go to approved civilian specialists in your area. I had a lot of civilian specialists to choose from. One of the best perks so far has been prescription coverage... that's saved me a lot of money. If you have other questions, please feel free to PM me.

 

[feddoc]

Both my wife and oldest son are handicapped. We have tricare prime and have never had a problem in obtaining proper medical care for any condition. My son's conditions were pre-existing as he was born 3 months early with a multitued of problems...and he is - technically - my step-son. Never a problem with any coverage.

I suggest you contact your tricare rep again and ask what happens if you and your provided doctor do not agree, get along, etc. I *think* that you have the right of refusal...but, if that is true, there may be some stipulations attached.

 

[KBayDog]

The particular Tricare program you choose is based on your family's situation, but for the most part, you will not have any problems. Like any HMO-type organization, though, Tricare has its quirks. Make sure you take the time to read all of the regulations, and ask (preferably in person) any questions you may have. My wife is young and healthy, so Prime works best for us. She's seen at a military treatment facility and is referred "out in town" for anything that is beyond the scope of the military docs. (They generally aren't "stingy" about getting an outside referral, either.) Prescriptions are free at a military facility, and subject to a $3 or $9 co-pay if you get your prescriptions elsewhere. If an true emergency arises, SEEK MEDICAL CARE FIRST - then call Tricare within 24 hours so they can handle the billing.

Remember that Tricare has a separate dental plan through United Concordia (dependants are not seen on base). It's a hair over $10 a month for that coverage, but as with all Tricare services, standard checkups/cleanings/etc. are included. Other procedures are subject to small co-pays.

Finally, remember that in ANY military town, Tricare contracts mean good business for the local docs/dentists. Therefore, there are no shortages of good doctors - on base or off - to choose from wherever you go.

 

[VAmookie]

I thank you all for your input, especially those who are willing to share even when it may be a private issue. Again, I welcome any more input that people are willing to share. Thanks