Tricare Insurance vs. Private

[Anonymous]

I have a private insurance through my employer. It's very good coverage and decently priced. My fiancé is on Tricare. We are trying to decide what to do with insurance for me after we are married: I could either stay on my employer's insurance or move onto Tricare.

Going to Tricare would save us the cost I currently pay for my coverage, and I feel like it may be easier if we are on the same insurance plan when we have a baby. Also, being military, if we move to a new area where I cannot continue my employment and need to have coverage (at least until I get a new employer) if I had already switched over to Tricare, I would be covered and it wouldn't be a concern.

My hesitation is whether switching is worth it for the convenience factor. With my current private coverage I simply find a provider in my network, schedule an appointment and go. No referrals needed or lengthy wait times. With Tricare, I understand that I'd have to always get a referral to a different provider, and that there are sometimes lengthy wait times for appointments. I also think (but don't know for sure, we are just starting to compare the two now) that I would have to have all of my appointments at a military base medical center, which is extremely not convenient as we don't live on base.

Does anyone here have experience with Tricare and any advice to offer? On Tricare could I choose my own doctors or, when we want to have a baby, the hospital I'd like to deliver at? Or would I be stuck doing everything on base, which depending on where the bases are and where we are living, may be kind of subpar to what is available in a non-military network?

[Anonymous]

My boyfriend has Tricare and I also have private insurance. We have talked about getting married and I would not get on his Tricare plan. It is always SO difficult for him to get appointments, even routine checkups, and forget about getting a specialist appointment that works with your schedule or is remotely on a normal kind of timeline. We only live 15-20 minutes from Ft. Belvoir, so it's not the distance thing that is a dealbreaker for me.

[Anonymous]

There are two different versions of Tricare -- the one PP is referring to is like the HMO version (where you have to use a military provider and that may be inconvenient or require you to give birth at a military hospital rather than your local hospital like Inova or Shady Grove or whatever). That version is WAY cheap. You pay a fee of like $400/yr. and then just small co-pays along the way. If you have a lot of medical issues, that kind of Tricare will save you a lot of $, but you will have to work within the military provider system.

The other kind of Tricare is "Tricare Standard" -- it is basically like Blue Cross or some other insurance where you can go to any doctor, any hospital, any provider with almost no pre-approvals. You decide when/where/what you need for medical services. The downside is that it will probably cost more than $400/yr for a family. Each person in the family pays a deductible of $150/year (starting Oct. 1). So, typically, the first time you go to a standard doctor visit after Oct. 1, you will pay the full amount up to $150. After you have paid the deductible for any medical services, then you pay 25% of any medical expenses you have for the rest of the calendar year. (That's based on the approved rate for a service, not what the doctor bills.... for example, a tetanus shot may be billed at $75 to an insurance company, but the approved rate is $28. You will have to pay the doctor 25% of the $28 and Tricare Standard will pay 75% of the $28 (i.e. you pay $7 and Tricare pays $21). If you are in the hospital, you will pay 25% of the approved charges. So, for me to have abdominal surgery -- the full bill was something like $6k, but I paid around $1500. If you did it under the first Tricare version I mentioned, you'd probably have $100 co-pay for a hospitalization -- but you'd have to use a military doctor and military hospital. For my surgery, under Tricare Standard, I chose the doctor I wanted to use, and I went to a civilian hospital.

It's a matter of choice. The first Tricare version will be cheapest, but it comes with little choice. Tricare-Standard comes with all the choice you want, but there is a price to pay... although it's not an unreasonable price.

[Anonymous]

PP is correct. Tricare Prime is essentially an HMO. Tricare Standard is a PPO. Even Standard is still far cheaper than any private health insurance that I'm aware of.

We have been on Standard for the past 5yrs and I've had no problems seeing any civilian provider I ever wanted. Before you move, though, I'd check the number of providers in the region who accept it. Around here that number is pretty high since it's a heavy military area. I don't know that it would work as well in, say, Des Moines or someplace else without a concentration of military personnel.

[Anonymous]

I switched to tricare prime. It not perfect but far better than the private and cheaper. If you do not like the provider you change. Not a big deal. Sometimes it is hard to get an appt but you can get referred out or Er is free. It is best if your child has any special needs. They pay for lots of services most insurance will not. Try it before you rule it out.

[Anonymous]

OP here. This is extremely helpful information. Thank you.

[Anonymous]

OP, if you tell us how much you pay for your private insurance, it would be helpful to help you decide.

I think TRICARE standard is much easier because it functions a lot like a PPO-you don't need referrals, more doctors take TRICARE standard vs. Prime, etc. A few years ago when I thought about putting the whole family on TRICARE standard, the maximum out of pocket expense at that time was $1,000/year so that was worth it. However, because DH's private insurance only cost us $200/month for the entire family, we decided to stay with the private insurance because almost all the providers we've seen are in network. It's sometimes tough to find primary care providers who take TRICARE Standard although a lot of specialists seem to be in network for TRICARE standard.

Also keep in mind if you are TRICARE standard, you cannot go to a military treatment facility. That's only for PRIME. If you live in Maryland, definitely check out the U.S. Family Health Plan through TRICARE.

[Anonymous]

Well if you stay on your private insurance you can have standard as secondary at no additional cost- you might actually save as they may cover more.

There is a lot of misinformation above. Go to the websites and get the correct info.

[Anonymous]

Some good info above.

Definitely look here: http://www.tricare.mil/Plans/ComparePlans.aspx

With either plan there is a $1000 fiscal yr out of pocket cap for active duty. $3000 for retirees. Both plans also have same exact pharmacy benefits.

As a long time Tricare Standard User I love the control. I have never had to file my own paperwork although it is the most popular "threat" against Standard. I aim for in-network Providers and pay 15% of allowable, which as illustrated above can be minimal. I have to have trouble finding doctors but then again the Navy sends us to big areas.

In past years I also used Tricare as a secondary to my employer's coverage giving me very little out of pocket annually especially since that was back when my employer paid the employee premium 100%.

For all the bitching and moaning I've heard over the years I've realized a couple of things. Most comes from those using Prime and routed through the military clinics and hospitals which are understandably busy and crowded. The other is that those who come to this plan directly off their parents' don't yet realize that others pay hundreds per month in premiums for the same appointment waits, diagnostic frustrations and questionable practicioners. That's just our healthcare "system".

[Anonymous]

Tricare Standard is the way to go if you value choice. The out of pocket costs aren't that bad.

If you want free, then Prime.

Either way, they're usually cheaper and just as good as a private plan.