When I married into the military, I wasn’t thinking about the perks. Mostly, I was thinking about the challenges, such as long separations and frequent moves. However, there are benefits to being a military dependent.
I totally married my husband for the 10 percent discount at Lowe’s.
(Actually, I do get a lot of happiness out of a military discount. There are quite a few local restaurants that offer them, and it makes me feel less guilty about being too lazy to cook.) But I digress.
Tricare is the military health insurance provider. Now, there are different Tricare plans, but I am mostly going to talk about Tricare Prime, as that’s the one my family has, and the one I am most familiar with. Besides, apparently come January 1, the other plans are changing names and rules.
For the civilians reading this, Tricare Prime is the default plan. You pay zero dollars for it.
No, nothing is deducted from the paycheck, either monthly or annually. There are no copays when you visit doctors or specialists. The only time I ever pay for anything is if I opt to use a local civilian pharmacy (as opposed to the one on the military base) to fill prescriptions. Since we live 40 minutes or so from the base, with some prescriptions it is easier to pay the (whopping!) $10 copay and save myself the trip. I also get one of my daughter’s prescriptions filled by the mail-order pharmacy, which happens to be free for this specific medication. (I checked on another one of my prescriptions and there was a copay, so that’s not always the case.)
I didn’t really think too much about health insurance as a young adult. When we first got married, I was paying a few hundred dollars a month for a private health insurance plan through my job and had copays for prescriptions and doctor visits. However, it was never a big burden to me. (College was a different story. My plan covered $50 per year towards prescriptions. The balance was on me. Talk about bare bones.)
I never truly appreciated Tricare until we had our daughter. A few months after she was born, it was apparent that she was behind on hitting milestones. We started physical therapy twice a week with a local provider, which Tricare covered completely. As time went on, we started seeing specialists — a developmental pediatrician, a gastroenterologist, a neurologist, and an ophthalmologist. Late, we added an orthotist and nutritionist. We also had one consult with an ear, nose and throat doctor. We didn’t pay a cent.
We have received medical supplies: feeding tubes and syringes, a pump for the feeding tube, formula to put through the tube, two sets of SMOs (supra malleolar orthosis, or ankle braces), and most recently, diapers (which are after a certain age and with an appropriate diagnosis.)
She has had two brain MRIs, one CT scan, a few X-rays, a GI scope, multiple blood draws, and three rounds of genetic testing.
I have never paid anything for any of the above.
(Side note, I also didn’t pay anything when I gave birth to her. I have heard of friends leaving the hospital with $30,000 in bills.)
Each month we receive an explanation of benefits listing all of the claims Tricare has paid on behalf of my daughter. Given that she had over 200 appointments in 2016, (yes I kept count, with an old-fashioned hanging wall calendar) that adds up. Each month it typically varies between $1500-$2500, give or take. It was higher when she had the feeding tube (that is out now) as those supplies were pricey. But she still typically has five or six therapy sessions per week and sees a specialist or two each month for follow-up appointments.
You can understand how many families with children with special needs end up in debt. I can’t imagine if we had to pay a copay for 200 appointments, or if our insurance didn’t cover the prescribed (expensive) feeding tube fuel. SMOs are in the ballpark of $1000 per pair.
This is why I love Tricare Prime.
The only headaches I have to deal with are referrals and authorizations. Nothing happens with Tricare without prior approval. I have spent plenty of time on the phone obtaining/changing/confirming these authorizations, but I don’t complain (too much) because in the end, it always works out. Besides, this challenge is not unique to Tricare; most parents who need additional medical care for their children (or need it themselves) have the phone number to their insurance company saved.
I will admit I have heard that it’s not always 100 percent consistent in what people are able to get covered. I know the doctors have to use the right diagnosis or code to ensure that Tricare approves an authorization.
There is a supplement to Tricare called ECHO, or Extended Care Health Option, available to patients with higher medical needs/specific diagnoses. My daughter was recently approved for this, but we haven’t taken advantage of it yet. While there is a monthly copay based on rank, I have heard of families getting more expensive medical supplies such as wheelchairs under ECHO, and that is also who handles ABA (Applied Behavioral Analysis) therapy for children with Autism Spectrum Disorder. There seems to be even more variation in what ECHO will or will not cover.
Is Tricare perfect?
No, certainly not. I’m sure not everyone only has nice things to say about it. I know it can be a pain to get referrals and authorizations for some people. Depending on where you live, you may face the challenge of finding a provider who takes Tricare and has availability. But those are challenges anyone with health insurance faces. We didn’t have to wait six months to see the geneticist only because we have Tricare; that’s par for the course.
My husband plans to do 20+ years, so we have a while before I have to stress about health insurance. Even then, we will be eligible for Tricare Prime Retired, which (as of now, this is due to change in some ways) only requires a nominal annual enrollment fee and copays. While the copays would hurt, once she is in public school full-time, she will be eligible to receive many therapies at school.
In the meantime, Tricare is one of the benefits of being a military family that I will never take for granted.
I feel frustrated and sad for the families out there who are struggling to get adequate or affordable care for themselves and their children, and I realize how lucky we are. I think this is one of the things that the military does right when taking care of its families.
Do you have strong feelings about Tricare one way or the other?