Just reading the above title that included the “T” word might have been enough to trigger subconscious impatience and perhaps even a little sweat. Visions of time spent idly on the phone, doodling your afternoon away as you wait for a Tricare representative might also have suddenly come to mind.
Despite all your preconceived notions about the hassle of insurance, we all have to admit, it is literally — and figuratively — a lifesaver. However, when researching the different Tricare plans, how do you choose the right one?
We’re digging into the options and taking a good look at the differences between Tricare plans to help you choose the best fit for your military family.
In total, there are 15 different Tricare plans, ranging from retired military options to unique plans geared toward those in the National Guard, reserves, and those overseas. Stripping the plans down to the basics, however, leaves two main plans for CONUS military families: Prime and Select. Let’s break them down.
With Tricare Prime, family members are usually seen on the installation. It’s considered a managed care option and offers the most affordable and comprehensive coverage:
- Enhanced vision coverage and preventive services
- Most care received from your primary care manager (PCM), who is a military or network provider
- Specialist referrals, if necessary
- No enrollment fee for active-duty families
- No claims to file
- Few, if any, out-of-pocket costs
With Tricare Select, family members can see their preferred provider, as long as it is within the approved network. This plan offers families the most freedom of choice and flexibility:
- You can receive care from any Tricare-authorized provider. (There are two types of Tricare-authorized providers: network and non-network.)
- Referrals are not required, but some care can need authorization.
- You may have to pay for services up front and potentially file your own claims for reimbursement.
To strictly compare costs between the two plans, visit the Tricare website to find an easy-to-read table.
Facts don’t tell the whole story, though. Each plan has pros and cons, and your family’s medical needs may be different from your neighbor’s. Three military spouses shared their experiences and some of the factors that impacted their decisions.
One spouse admits that her choice to stick with Prime was mostly based on the free factor. “I’m not really one to go to the doctor, and part of that is because of the cost,” Violet said. “So, because I have Prime, I don’t have to worry about paying for my appointment with a copay or for prescriptions.”
As spouse stationed at Camp Pendleton, Violet added that the base hospital has every type of doctor to cover her needs, including therapy, surgery, and counseling. “I honestly love my doctor, and I’ve had really great service with Prime,” Violet said. “But I think it depends on the base you’re stationed at.”
Katie, a spouse stationed on the East Coast, also appreciates Prime’s ease on her wallet and is content with her current plan, saying, “I can be my own advocate if that’s needed.” However, she also states that when she and her husband begin adding to their family, she will likely switch to Tricare Select in order to get the highest-rated care with the best resources in her area.
There is something to be said about consistency. Military spouses who require specific, more detailed care tend to turn to Tricare Select.
Sarah, the wife of a USMC pilot, was diagnosed with an auto-immune disease that requires home treatments. “I have not had to jump through any hoops in order to get approval or coverage for my autoimmune treatments,” Sarah said. “They are easy to get a hold of if there is a problem and will always solve the issue before ending a call with you.”
Now that you’ve educated yourself, it’s time to give yourself a little pep talk and get on the phone. While Tricare’s website is an incredibly helpful tool that offers a myriad of resourceful information, you will not feel a peace of mind about what you have chosen until you have spoken to a representative. As much flack as those charming people might get, they are there to help.
So, pep talk given, confidence boosted, get to the Tricare website, navigate through the time-saving Phone Wizard (which directs you to the exact phone number you will require for your specific need) and start feeling a lot more covered.
Think it might be time to talk to your provider about stress? Learn the Physical Symptoms of Stress so you can discuss them with your doctor.
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