Posted on 06/25/2016 1:39:56 PM PDT by M.K. Borders
Excellent summary.
My Mom, who has Tricare for Life due to my Dad’s military service, has better care than any other health plan I know of. She has a Medicare supplement as well. They completely covered weeks in rehab, twice, after falls due to post-polio and other issues. Don’t know how long it will be this good, but it sure has been good for her. Get it while you can would be my advice.
I was a ‘grey area’ retiree. I was able to start Tricare-standard when I turned 60. I only carried Tricare from that date until I turned 65. I didn’t see much need for a supplement as Tricare-standard. I had been BC/BS Civil Service for years and the co-pays and cost shares weren’t all that much different between Tricare-standard and BC/BS and tricare was much, much, cheaper.
Every time I told a healthcare provider I had tricare, they would make a face and ask Prime or Standard. The face turned to a smile when I said Standard. The providers really don’t like Prime. I asked a couple what they thought about Standard and they said that they really liked Standard, that it paid well, and paid promptly.
In this area, Humana administers Tricare. The Humana reps strongly recommend Standard over Prime and all the complaints I’ve heard are about Prime, not Standard.
I’ve had Medicare for five years now so I’m on Tricare for Life. When I qualified for Medicare, I started receiving all this stuff about supplemental insurance. I called Humana and Humana told me they would be happy to sell me supplemental coverage but that I wouldn’t need it. They told me that I had the best supplemental insurance through Tricare for Life.
The best thing about Medicare and Tricare for life is this. You will have to pay a fee for medicare but the combination of medicare and life is great. If it’s covered under medicare, you’ll pay 20%. Tricare will pay the rest. Some times tricare will pay for things that medicare doesn’t. A friend needed some special surgical techniques that medicare wouldn’t cover. Tricare covered it 100%.
About two years ago, I severed all four tendons in the back of my right hand. (Walking my dog, long story.) I was in therapy for 10 weeks following the surgery. I saw one bill that was over 20K. I would guess that the total cost was around 50K. I paid five bucks for some pain pills. That was it total. I could have filed for the five bucks but it wasn’t worth it. I had one of the best hand surgeons in this area. Surgery was successful and I can play golf and touch type again.
I’ve never found a provider that would not take Tricare Standard or Tricare for Life. I have found some who would not take medicare.
I retired about 20 years ago and thought the TriCare Supplements were the way to go - - then I did the math. I switched to TriCare Prime and will stick with it till I have to go with TriCare for Life.
I believe the major factors in determining which is best for you is the old adage, location / location / location...Depending on where you live, your proximity to a Military base (with Clinic or a Full-fledged Hospital) and if you have “special medial needs” all come in to play.
In other words, there is no one best answer - - it depends.
As you probably know, there are two versions of Tricare you should currently be eligible for. Tricare Standard and Tricare Prime.
Tricare Standard is what I used for 25 years but you need a supplement in order to cover 100% of the costs. Supplements are available from numerous military-affiliated orgs.
Tricare Prime is like an HMO, if i’m not mistaken. I never used it, but I’ve known friends that have and they were very happy with it.
The third, which you’ll be eligible for when you turn 65 is Tricare for Life. Tricare for Life serves as a supplement to Medicare Parts A&B. Tricare also supports prescription medications under Express Scripts. (Express Scripts works under Tricare Standard too. Not sure about Tricare Prime, but I assume it does.)
I miss my days on Tricare Reserve Select. Low premiums and a $3k cap. By comparison, my “Cadillac” coverage with the federal government has $500 a month premiums and $10k cap which has doubled in the last 8 years.
For my family of 4 it would have cost over $2000. Since the cap is $3000 we rilled the dice. Last year our out of pocket was around $1200, which included a rather extensive workup by a subspecialist. We clearly came out ahead.
I have tricare standard and love it, no problems, small deductible, good program.
I have Tricare Prime and they have done extremely well taking care of my family and I. Granted, we have to pay a monthly fee but it is not that of Obamacare and we actually get great medical care. I recently had to have both of my knees replaced and Tricare Prime allowed me a wonderful surgeon and the copay was almost that of a standard doctor’s visit.
So you probably be forced to keep your wife's insurance as primary.
The main problem with Tricare is Express Scripts.
They are next to impossible to deal with.
Other then that Tricare is as good as most insurance.
I live in the sticks. Closest Mil hospital/clinic is over 100 miles away. Tri-care standard covers us well. Only hit the cap one year out of the last 10. That was the only year we would have been better off with a supplement.
Stay healthy! Avoid doctors and the places they frequent!!
The wife has more patience than I. If you can get Express Scripts set up and running its a money saver, but , YES, it seems to be the most challenging part.
You know the catastrophic cap is only $3000? You would be ensuring $3000 if you get supplemental. Not worth it in my opinion unless I’m missing something. I’ve never had a problem with Tricare standard and just started using Expressscipts which seems to be okay.
Fun with math....
TriCare has a $3,000 catastrophic max (catmax)
If you buy a supplement and it cost you $250 per month - you will pay $3,000 a year in premiums - thus it can only cost you more, never less than the $3,000 TriCare would have charged you if you reached your max.
Prime is not much different price wise... I pay an annual fee, but I find it lets me in at the best doctors in the area (Johns Hopkins, UMMS, etc...)with little out of pocket expenses.
I see no value in ever buying a TriCare Supplement. The annual premium equals the CatMax - - so they 9the insurance company) pockets the difference, and you lose. (Suckers bet) IMHO
Thank you for your service.
I’ve had Tricare now for 26 years - standard until I was eligible for Tricare for Life. I’m 130 miles from the nearest facility and have never had a problem with using local medical facilities. But then again it’s a relatively rural area to begin with and I suspect a large portion of their income comes from medicare, medicaid, and other similar programs. I don’t talk much about it to friends and neighbors as I watch them struggle.
TriCare is an excellent secondary/tertiery insurance. Whatever my primary doesn’t cover, TriCare picks up the difference.
I am completely satisfied with TriCare (USAF 20 year vet)
“The main problem with Tricare is Express Scripts.
They are next to impossible to deal with.”
Interesting you would say that.
I’ve had the exact opposite experience. They have been prompt and accurate in all my dealings with them. . .
BINGO. Couple it with Tricare Life and many docs don’t want to see you. What docs forget is that if they take Medicare they have to take Tricare Life. It is automatically filed by Medicare.
We are Tricare Life as hubby Ret. SCPO 20 yr career Navy, so can’t answer for current Prime to long out of that system.
You are to young for Medicare, you will have to have a supplemental plan if all it covers is 20% like Tricare Life does.
And you are under DOD MANDATES on daily meds. Base filled or Express Scripts, which is known for fraud and subbing generics for DAW scripts over docs orders. Generics are RANDOM, not set meds. So if there is a med reaction issue, there is a problem waiting to happen. Just shoved in your mail box UNSIGNED for. Long cumbersome process, NEVER give them your credit card write a check. Base will fill what they have according to size of nearest base, but refills come for us out of Pensacola. 5 day wait. ES is a month to fill, 2 weeks to refill.
Tricare Life is not doc restricted. You are free to chose who you want. Not all test or blood work is covered or covered as frequently as needed. They have moved many to 2 year intervals.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.