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I'm a little rusty on this whole business. I don't think you can actually drop Tricare--you just shift to Standard, right? Anyway, I think it is such a good deal that why even try to drop it? One reason that Tricare has been important to me and the wife is that Medicare (we're over 65) doesn't cover you outside the US. If you go over 65 you get onto Tricare For Life and/or Tricare Overseas. Then, since Medicare doesn't cover you, the Tricare goes from its "secondary" position to "primary" payer.
Now, I have another question---Primary Care Providers in a lot of areas are refusing to take NEW Medicare patients. Has anybody run into this problem and/or cases where the Doctors won't take Tricare?
Thanks.
Just came from a luncheon where we invited the Clinic commander to speak with us, so very appropriate topic...
As to reimbursements, the amount Tricare pays to physicians is related to the Medicare amount, and from what I heard, may actually be LESS than the Medicare reimbursement. Anyway, about the only way the reimbursement can be changed is by an act of Congress. So... write your Representative and Senators. You can also ask a physician if they will "accept assignment", which means they will accept the amount Tricare pays for you, but they do not have to be open for everyone.
Just came from a luncheon where we invited the Clinic commander to speak with us, so very appropriate topic...
As to reimbursements, the amount Tricare pays to physicians is related to the Medicare amount, and from what I heard, may actually be LESS than the Medicare reimbursement. Anyway, about the only way the reimbursement can be changed is by an act of Congress. So... write your Representative and Senators. You can also ask a physician if they will "accept assignment", which means they will accept the amount Tricare pays for you, but they do not have to be open for everyone.
onevthoki:
Thanks for the feetback. I notice that your address block indicates you are a Realtor. Do you know if the NAR has ever addressed this problem of lack of Primary Care Providers? I realize that there are a bunch of other problems out there in the real estate industry. But, with a bunch of "baby boomers" coming of retirement age and possibly wanting to relocate, this also has the potential of becoming a major problem.
Found out a few months ago we can get free scrips at the AFB.
That's even cheaper than mail order. Plus mail order leaves a bit to be desired, you know the meds are going to get outside their storage temperature range window going through USPS.
I can get my meds in a name brand vs. generic there. I could not get name brand from Tricare, it was get them at Walrus World for 40 bucks for 60 I think.
Varies by medication.
At any rate, the trip to the base every three months is definitely worth it.
onevthoki:
Thanks for the feetback. I notice that your address block indicates you are a Realtor. Do you know if the NAR has ever addressed this problem of lack of Primary Care Providers? I realize that there are a bunch of other problems out there in the real estate industry. But, with a bunch of "baby boomers" coming of retirement age and possibly wanting to relocate, this also has the potential of becoming a major problem.
To my knowledge the NAR has not addressed that issue. It is possible that local Boards have, but I seriously doubt it. That would be more of an issue to take up with through the local installation (such as AFAP), and possibly getting NMFA involved.
We used to get our scripts from onbase, when we lived near a base.
Now that base is far away.
I went to our closest base, and I was told that they are entirely over-whelmed by Active Duty. treating 10X more than they are staffed to treat. So retirees can not get in.
Out mail-order pharmacy charges us $3 per 3 month script.
We recently retired from civilian work and chose to use our Tricare. In reviewing the differences between Prime and Standard it appeared that Prime is an HMO type and therefore chose Standard. Additionally it appears with Prime you are limited to specific doctors and require a Tricare Primary. With husband's medical history, we prefer to continue with doctors who have treated him in the past. We also have a MOAA Mediplus supplement. The EOB's are confusing, Tricare refuses to pay for physicals, they have told one provider they are waiting for an EOB from Medicare, when in fact we are not old enough for Medicare.
My husband had lymphoma and was treated successfully in NJ. We want to continue with his followup care with the same doctors.
What do you suggest? We live in upstate New York. Any information would be appreciated.
Ellwood, I'm confused. You mention being recently retired from the civilian workforce, but are you retired military? Assuming yes, you are then saying you have already selected Tricare Standard? It is my understanding that if you are Standard you can go to any doctor you chose, you just will have a higher out-of-pocket expense.
Now, I don't know about Standard, but under Prime, if you receive more than 50% of your care from someone other than your PCM, you can request a Nurse Case Manager who can help you with all of your referrals. And definitely push continuity of care.
We chose prime because copays are more controlled. We had some problems finding a PCP when we first got here. The online list is WAY out of date. Big surprise.
Finally found an RN Practitioner (called FNP here, don't ask me I don't make the rules) and she has worked out pretty well. Her husband is a retired jarhead, so she has an understanding of the military issues.
Have to get a referral for any specialist but the copay is still 12 bucks.
Considering what Tricare costs, the only better deal I could find is get elected to congress and stay about 6 years. Not gonna happen.
I don't know what coverage would be if something major went down, I know there are supplemental policies available but so far we haven't invested in any.
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Tricare - Prime or Standard? HELP
