So I have to say that one of my favorite benefits of this military life is the medical insurance aka Tricare. Care aside, because that varies by provider, it’s an absolutely amazing deal as an active duty family. Most companies charge far more for family members to be covered by insurance than we do as an Army family (we only pay for dental and that’s a very low price), so it’s a great benefit! But it can be tricky to manage aka what makes it not so great as the dependent. I have had some ups and downs with Tricare and I wanted to share what I’ve learned in these few years in hopes that it can help you!
Tricare Prime is the one where they assign you a doctor and you need referrals. The names Tricare Prime and Tricare Standard have always been super confusing to me. But alas, the one that most families seem to have is Tricare Prime. Your insurance provider (they vary by region) will assign you a doctor – likely on the military installation. For any specialty care you need a referral from your primary doctor, also known as your Primary Care Manager (PCM). It can be difficult to get a referral depending on what it is for and the availability on the base. For example, I wanted to see a dermatologist when we lived in WA and it took 3-4 visits to the doctor trying different remedies/prescriptions for me to give up. Well give up isn’t the right word, the last prescription helped more than anything else so I stopped asking for the referral. Under Tricare Standard, you can see a specialist without a referral, and pick who you want to see as your PCM as long as they are in network. You will have to pay a co-pay for a lot of your care (mainly specialists) but those are usually fairly low.
You can request a specific doctor with Tricare Prime. When we moved to Texas we lived far enough off-base that I was assigned a civilian doctor near my house but not far enough away to be on Tricare Prime Remote. Fortunately they were accepting new patients and I liked them. I have a few friends who were assigned doctors not taking new patients, only worked in hospitals, or specialized in patients 55 or older. When asked, Tricare said that it is up to the provider to update that information, but you can only imagine how frustrating that process was for my friends. What they ended up doing is researching in-network providers online (available online), reaching out to those offices to ensure they were taking new patients, and calling back to request to be assigned to them. Yes it is extra work on their end, but they were able to make a decision about their care. Additionally, if you don’t like who you are assigned to, including a base clinic, you can request a change in provider. I did that in WA and was so happy that I did. My new provider was great and I got the care that was best for me.
To enroll in Tricare Prime or Standard (or to switch between the two), CALL TRICARE DIRECTLY. I recently switched to Tricare Standard and online they say that to enroll you must fill out and mail in a form or log into a DOD secure website. So I filled out a form, put it in the mail, and waited. Well I needed to see a provider sooner rather than later so called to confirm how long that normally takes, as I couldn’t make an appointment without knowing if I was on Standard or not, and that’s when the customer service rep told me that they can do it all over the phone. And the same is true if you’re enrolling for the first time. So, save the paper and the stamps, and give Tricare a call. They will help you – it’s an easy process. Just you have your sponsor’s (aka spouse’s) information ready and voila! DONE.
When you move – also call Tricare. When we moved I wasn’t sure how long it would take for my husband to do all of his in processing and get my information updated on his end with the Army so that I could make appointments as needed, so I called. I was able to switch to our new region that day and was assigned (I was still on Prime) a new PCM. It took a few minutes on the phone and was painless. This ensured that my care was uninterrupted and I wasn’t waiting on the long paperwork trail that is in processing.
No matter what, be your own advocate. Whether you have Tricare or another insurance, ALWAYS be your own advocate. If something doesn’t seem right or if you aren’t happy – speak up. I have switched Primary Care Managers and even insurance plans to be sure that I get the care that is best for me. Only you know what that means for you. So SPEAK UP! It is not bad or frowned upon to do that. Fill out the ICE cards if you’re on base and experience an issue – I have done that a few times recently and while issues aren’t resolved overnight, they are read and considered. Every base has a Patient Advocate – if something is seriously wrong and needs attention ASAP – seek them out, they are there for you. I’ve even gone in to ask a basic question, they are helpful.
What are your tips and tricks for managing your Tricare benefits? Anything I’ve missed?