Tricare For Life- question

[braumeister]

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Originally Posted by friar1610 Point taken. Not sure if you're retired military or a non-retiree vet. I'm the former and between Medicare and TFL I'm more than adequately covered.

I'm retired military as well.
Like you, I am quite happy with Medicare/TFL, but it just seems prudent to avail myself of an alternate source of healthcare. As long as you're eligible for VA coverage, why not? I've found it to be good care, and they assure me I'm not using resources that should go to someone more deserving or needy.

[jimnjana]

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Originally Posted by mickeyd ... receive care directly from a military clinic, no papers arrive at all any more. I assume that the military and Medicare work it out between them.

Are you required to use the MTF or is it your decision? DW is counting the days til she reaches medicare eligibility so she can have a civilian doctor. We live very close to a Military base and a few years back we directed to use the MTF and lost our civilian primary care doctor.

[ExFlyBoy5]

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Originally Posted by jimnjana Are you required to use the MTF or is it your decision? DW is counting the days til she reaches medicare eligibility so she can have a civilian doctor. We live very close to a Military base and a few years back we directed to use the MTF and lost our civilian primary care doctor.

You *should* be able to see a civilian PCM. Best way to find out for sure is to go on the tricare.mil site and do a provider search...should take less than 5 minutes and you aren't required to log on.

Sent via mobile device. Please excuse any grammatical errors.

[Huston55]

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Originally Posted by jimnjana Are you required to use the MTF or is it your decision? DW is counting the days til she reaches medicare eligibility so she can have a civilian doctor. We live very close to a Military base and a few years back we directed to use the MTF and lost our civilian primary care doctor.

Jim&Jana-I'm guessing you're close to Patrick AFB, FL.

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Originally Posted by ExFlyBoy5 You *should* be able to see a civilian PCM. Best way to find out for sure is to go on the tricare.mil site and do a provider search...should take less than 5 minutes and you aren't required to log on.

If you don't get the answer you want on the Tricare.mil site, you could always switch to Tricare Standard/Extra. It's different than Tricare Prime (has a co-pay) BUT, no premiums & you choose your primary care doctor...and pretty much every other specialist you want as well.

[nash031]

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Originally Posted by Huston55 Jim&Jana-I'm guessing you're close to Patrick AFB, FL. If you don't get the answer you want on the Tricare.mil site, you could always switch to Tricare Standard/Extra. It's different than Tricare Prime (has a co-pay) BUT, no premiums & you choose your primary care doctor...and pretty much every other specialist you want as well.

Standard is definitely the way to go for provider choice, and what you pay out of pocket is really limited. I doubt we will ever use Prime. The counselor we spoke to basically said Prime is for folks who can't cover several hundred dollars in an unplanned expense. Standard is more choice if you don't mind covering up to $1000 in a year. Was a no brainier for us.

[Huston55]

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Originally Posted by nash031 Standard is definitely the way to go for provider choice, and what you pay out of pocket is really limited. I doubt we will ever use Prime. The counselor we spoke to basically said Prime is for folks who can't cover several hundred dollars in an unplanned expense. Standard is more choice if you don't mind covering up to $1000 in a year. Was a no brainier for us.

+1

Standard has worked very well for us too. It's better than our civilian company insurance when I was working full time.

[ExFlyBoy5]

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Originally Posted by nash031 Standard is definitely the way to go for provider choice, and what you pay out of pocket is really limited. I doubt we will ever use Prime. The counselor we spoke to basically said Prime is for folks who can't cover several hundred dollars in an unplanned expense. Standard is more choice if you don't mind covering up to $1000 in a year. Was a no brainier for us.

This is a VERY broad and generalized assumption. It is different for different people and it is different depending on locale. I would NOT get rid of Prime where we are. We have PCMs that we trust our lives to, and in my DW's case of a spinal tumor, she was able to be treated by the BEST specialist in the south; and he wasn't "in-network." But, because of the medical necessity and the lack of expertise, the approval to use him (and the hospital that ALSO isn't in-network) was quick and simple. AND...we can *always* use the POS option as a fall back *if* there is an issue with Prime providers. As for the counselor saying that Prime is "for people who can't cover several hundred dollars of expenses"...yeah, he/she can kiss my arse with that boneheaded assumption.

[friar1610]

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Originally Posted by nash031 Standard is definitely the way to go for provider choice, and what you pay out of pocket is really limited. I doubt we will ever use Prime. The counselor we spoke to basically said Prime is for folks who can't cover several hundred dollars in an unplanned expense. Standard is more choice if you don't mind covering up to $1000 in a year. Was a no brainier for us.

In the years between the time I retired for good (age 58) and becoming Medicare-eligible, I found Tricare Standard to be the right answer for us. Whether fairly or not, I wanted to have more freedom of choice than Tricare Prime seemed to offer. I also had a MOAA-sponsored supplemental policy which rarely paid me anything but provided peace of mind in the event of an expensive hospital stay.

But, to be fair, a number of retired Guard guys that I knew from the Legion were more than happy with Prime.

[mickeyd]

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Originally Posted by jimnjana Are you required to use the MTF or is it your decision? DW is counting the days til she reaches medicare eligibility so she can have a civilian doctor. We live very close to a Military base and a few years back we directed to use the MTF and lost our civilian primary care doctor.

It's our decision. When I turned 65 a few years ago the MTF kick me out and said that I had to find a civilian doc. I did as instructed and he got paid Medicare/TFL for a few years, but I never liked the guy or how he practiced medicine.

About a year or so ago the MTF opened up a couple of new clinics out in the community (not on base) and opened it back up to retirees.We jumped back on the military option, as one of the clinics is about 15 minutes away. Best of both worlds.

[jimnjana]

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Originally Posted by ExFlyBoy5 You *should* be able to see a civilian PCM. Best way to find out for sure is to go on the tricare.mil site and do a provider search...should take less than 5 minutes and you aren't required to log on. Sent via mobile device. Please excuse any grammatical errors.

We used to have a civilian PCM then the local MTF Commander directed us to use the MTF.

[jimnjana]

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Originally Posted by mickeyd It's our decision. When I turned 65 a few years ago the MTF kick me out and said that I had to find a civilian doc. I did as instructed and he got paid Medicare/TFL for a few years, but I never liked the guy or how he practiced medicine. About a year or so ago the MTF opened up a couple of new clinics out in the community (not on base) and opened it back up to retirees.We jumped back on the military option, as one of the clinics is about 15 minutes away. Best of both worlds.

Good to know. I'm happy to keep the military option after age 65 which is over 10 yrs away. DW is not. She would prefer to see the same PCM each year vs the rotating doctors/PAs at the MTF.

[nash031]

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Originally Posted by ExFlyBoy5 This is a VERY broad and generalized assumption. It is different for different people and it is different depending on locale. I would NOT get rid of Prime where we are. We have PCMs that we trust our lives to, and in my DW's case of a spinal tumor, she was able to be treated by the BEST specialist in the south; and he wasn't "in-network." But, because of the medical necessity and the lack of expertise, the approval to use him (and the hospital that ALSO isn't in-network) was quick and simple. AND...we can *always* use the POS option as a fall back *if* there is an issue with Prime providers. As for the counselor saying that Prime is "for people who can't cover several hundred dollars of expenses"...yeah, he/she can kiss my arse with that boneheaded assumption.

So maybe that recommendation applies only in the fleet concentration area in which we live. You'll note that I qualified my comments talking specifically about patient choice. Here, we have all kinds of civilian options and that was most important to my wife. As to the rest, sure, I never think anyone in Prime is poor. I just know that the reason SOME people DON'T use standard is because they can't or don't want to cover unexpected copays, and that was more to the counselor's point.

[Nords]

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Originally Posted by Tailgate Now comes a question about an unforeseen medical event down the road. She is 87, healthy (no chronic ailments) and has survivor benefits from Tricare For Life. I'm just now beginning to get up to speed on these benefits. I understand that they kick in after Medicare pays and is very good at paying. Her finances are pretty tight and my question is what medical related expenses might we be on the hook for if something happens (fall, serious illness) beyond what Medicare and TFL would pay. The answer will tell me what she will be able to afford in housing. Has anyone had a similar experience with your DH or DW? Are we safe to use her assets for housing and not worry about major medical that is not covered? Thanks in advance for any advice.

Tailgate, the "worst" case is that you'll get a bunch of bills from ancillary medical providers for a hospital visit or a doctor's assessment. (This includes transportation services, lab reports, equipment, even dental care.) The bills might be mailed to her address or to yours... and if the bill gets lost in the mail, your first notification might be from a collection agency.

When those bills finally get delivered, you're the guy who spends the time on the phone with the various call centers to give them the info they need to correctly bill TFL.

Over the last five years of handling my father's bills, I can't recall any biller who actually read their website "Contact us" notificaion from me or their e-mail. Even if I signed my Dad up for an account on their website and sent messages that way, they were routinely ignored. The only solution was a phone call.

During the phone call I was frequently lectured on HIPAA or powers of attorney or other "authorization" bureaucracy. My answer to those obstacles was "I'm the court-appointed conservator. I'm not trying to obtain any private information. I'm just the money guy who's going to help you get your bill paid. If you can't talk to me then I'd appreciate you forwarding me to a supervisor."

Once they had the correct TFL billing info in their system I rarely ever heard from them again. I took that as an indication that the bill was paid, and I'd usually see that status a month or two later on an EOB summary.

[Rustic23]

DW and I have been under TFL for about 8 years. The only bill we have ever had to pay was for my shingles shot, and a Vitamin D test for DW. Total billing for 8 year under $500. My FIL was a retired reservist. He and my MIL lived into their 90's and had what I would say are typical end of life illnesses. While I don't know their exact billing, I believe it was minimal. (MIL in and out of Hospital and skilled nursing for about 2 years)

[mickeyd]

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Originally Posted by jimnjana Good to know. I'm happy to keep the military option after age 65 which is over 10 yrs away. DW is not. She would prefer to see the same PCM each year vs the rotating doctors/PAs at the MTF.

Check with your local MTF. The program is called Tricare Plus and local conditions dictate it's availability. I don't think many folks know about it.

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TRICARE Plus is a primary care program offered at some military hospitals and clinics. Each hospital or clinic leader decides if TRICARE Plus is available. You must enroll to participate. Your enrollment is only for the hospital or clinic where you enrolled. Contact your local military hospital or clinic to see if they offer the program.

Special Programs - TRICARE Plus | TRICARE

[Old Microbiologist]

Good point. It is mostly useless overseas though. Living in Hungary which has very cheap medical costs for excellent service (not state of the art but very competent) with European MD/PhD level physicians. I did 28 years active and another 10 as a DA senior civilian, and another 5 as a contractor so am keenly aware of the real costs for this coverage.

Tricare Overseas is a managed coverage which you must pay your Medicare Part B (once you turn 65) and then meet the annual deductible of $150 per person. Then they cover roughly 75% of allowed costs. Medicare becomes non-functional and this ends up being your only coverage and it is done as a cash up front then file for reimbursement. This is where the trouble comes in. The contract was awarded to the Wisconsin Physicians Services Corp. and they of course, being the lowest bidder, pay minimum wages to untrained personnel. These claims processors, of course, cannot read Hungarian nor understand the types of things done in Europe such as commas instead of periods in numbers. Tricare just to complicate things (mostly to prevent fraud which is rampant in the Philippines) recently implemented a requirement that all medical payments be done by either check or credit card and that receipts are no longer acceptable. Checks are not used anywhere in Europe and they have no idea what they are at all. No medical system here in Hungary (hospitals or doctors) accept credit cards and all payments are made in cash (which is actually a difficult process as well as they have free National Medical coverage for citizens so payment is a nonsensical problem for them). Of course, you get eventually a receipt with lots of official stamps etc., but these are no longer accepted by Tricare. This is not unique to Hungary and is a symptom of the problems with health care in America and corruption in the medical systems in various countries, especially in the Philippines and Puerto Rico.

The first 4 years we lived here we had some substantial medical expenses but filing the claims with Tricare the error rate is over 400% (you must resubmit the claims at least 4 times before they manage to get it close to correct). This is extremely time consuming and our average payment was around 6 months after initial claim. Some took over 3 years. None were ever 100% correct.

What we found is that expenses here are almost ridiculously low. Major surgeries with weeks in the hospital come to under $1,000 cash. We have never spent more than $5,000 in a given year. Medicare Part B is now $121.80 a month per person or $2923.20 a year. Then we have to pay an additional $300 before it kicks in at all. That is $3223.20 out of pocket before we get any coverage and then we are only covered at a rate of 75% and even that is not payable as we have no acceptable proof of payment. So, for us cash is king and we stopped paying the Part B entirely which means we have lost Medicare and Tricare forever. A tough decision but we never plan to return to the US so for us it is an all-in situation. The funny thing is we saved up for years to have a very sizable emergency fund but do not need it. Our pensions are over $6k/month and we spend less than $2k/month here for living expenses. So, for us these medical expenses are more or less trivial and paying cash gets you to the front of the line every time. So, it is a win-win situation for us.