Military bases have been making news over the last several years, but not for military maneuvers or deployments. Instead, many bases around the world have been feeling the direct impacts of climate change in the form of powerful storms and weather systems.

Now a group of former top military leaders and national security experts have created a sweeping plan of action to protect our nation from “these unprecedented security risks urgently and comprehensively.”

Military Bases Brace for Impact of Climate Change

The Climate Security Plan for America was issued by the Center for Climate a Security, a DC-based think tank, along with the Elliott School of International Affairs at George Washington University.

“The Climate Security Plan for America is a call for Presidential leadership to prioritize this challenge and take action to protect our national security in the face of the coming storm,” said John Conger, director of the Center for Climate and Security.

The plan has been endorsed by 64 leaders in the US military and national security, including Gen. Larry Welch (R), former chief of staff of the U.S. Air Force; Adm. Samuel Locklear (R), former commander of U.S. Pacific Command; and Gen. Anthony Zinni (R), former commander of U.S. Central Command.

Majority of Bases at Major Risk Due to Climate Change

This proposal, while limited to managing future risks rather than slowing or reserving climate change immediately, follows closely on the heels of a major Pentagon report discussing the projected impact of severe weather related to our changing climate.

Released in June 2018, the DoD-commissioned report found that about half of all US military bases, CONUS and OCONUS, are at risk for flooding due to climate change-related severe weather. Other risks reported at over 50% of military bases due to climate change included wildfires, storm surge, high winds and drought.

Many bases are already feeling the impacts of increased severe weather patterns. MCB Camp Lejeune, AFB Tyndall, MCAS Cherry Point and AFB Offutt have experienced devastating weather patterns, including hurricanes, between August 2018 and August 2019. Tyndall is still trying to recover after being virtually destroyed. In addition, Okinawa, a major hub for US military forces of all branches in the Pacific, has been experiencing multiple major typhoon systems during the 2019 season.

Weather-Related Destruction Impacts Military Missions

While military families feel the impact of severe weather on the homefront, it also complicates the national security and defense missions the troops are tasked with carrying out daily.

As of late May, the Air Force was still struggling to repair the massive damages at AFB Tyndall. Virtually every single structure was damaged or completely destroyed as a result of Hurrican Michael in 2018.

One year later, the Air Force was still waiting for Congress to pass an aid bill that would allow this base to rebuild.

MCB Camp Lejeune was also waiting for funding from this same $19 billion bill in order to continue repairing damages from Hurricane Florence in September 2018. Estimates in December 2018 put the cost to rebuild and repair at $3.6 billion.

Without this funding, the Air Force, as of May 2019, was looking at cutting thousands of hours of training flights. With multiple Air Force bases severely damaged by storms over the last year, the budget has been stretched thin in order to cover the massive cost to repair the destruction.

At Lejeune, military families have already seen how Hurricane Florence has hit their Marines’ missions. As of November 2018, incoming families were told to look for housing off-base due to hurricane damage.

Addressing the Present Climate Change Danger

The proposal from the Center for Climate and Security focuses on risk management for climate-related impacts on the military mission. However, it does not propose strategies or solutions that will stop or reverse climate change.

Some bases have taken steps on their own to address energy and resource in a way that minimizes the impact on the environment. Fort Hood currently receives 40% of its energy from renewable sources, including solar and wind power. Eventually, base leadership would like to create a microgrid that can sustain the base in the event the larger power systems fail.

“(M)ilitary planners don’t have the luxury of playing politics on the issue. They know that they have to do what’s required to ensure our country is kept secure and safe,” Maj. Gen. Rick Devereaux (R), former director of operational planning, policy and strategy for the U.S. Air Force, explained to Yale Climate Connections.

Has your duty station felt the impact of climate change-related weather? Share your experiences in the comments.

We all know that just getting in to see the doctor can be a hassle. But when you’re trying to navigate the healthcare system with a child who has medical complications, it can be downright scary.

Tricare Issues for Military Kids

All kids might face issues and concerns with the Tricare system though. And you deserve to know what you’re facing.

Referrals to Specialists

Need to see a (fill in the medical specialist here)? Oh, that’ll be a 6-12 month wait! That’s if they’re in-network and accepting new clients.

Sure, sometimes you get lucky and can get in ASAP, but often there’s at least some waiting involved.

On Tricare Prime and USFHP, beneficiaries are required to get a referral from their PCM in order to see a specialist. While Prime and USFHP offer no or very low-cost co-pays for all services and referrals, finding and getting into a provider can be difficult.

Select beneficiaries can select their own in-network specialists without a referral, but getting in to the correct person can still mean they’ll be waiting.

Often, on-base specialty clinics are full or limited to active duty personnel. Other times, finding a specialist who is in-network, accepting new patients and within a reasonable driving distance is a struggle.

Help! I Need Advice!

Perfect! That’s what the Nurse Advice Line is designed for! You can call 1-800-TRICARE (874-2273)—Option 1 to speak to a registered nurse about your concern.

The nurse you speak to can listen to your child’s symptoms and the progression of the illness/injury. Then, they’ll provide the next best steps in terms of seeking treatment or providing care at home. The nurses can even help you locate an ER or urgent care clinic.

Where Do I Go If…?

For military families, knowing where to get medical care in the event of an urgent or emergent medical issue is vital. Emergencies never seem to happen when you’re safely tucked into your familiar hometown. No, your child is sure to get into something dangerous or spike a terrible fever when you’re somewhere completely new. Of course.

What do you do then?

First, you no longer need pre-authorization to seek treatment at an urgent care center near you. However, there’s a catch: your urgent care center must be in-network. In some cases, that could mean driving long distances to be seen somewhere in-network even though there is a perfectly good clinic within 5 minutes.

After you’re seen, just call Tricare’s regional call center to let them know about your visit. If you’ve gone out of network, be prepared to pay point-of-service co-pays.

Second, you can be seen at any ER anywhere. If you’re on Prime, be sure to call Tricare to let them know about your visit or if you’ve been admitted.

Getting the Records Straight

Moving every three years doesn’t make it easy to keep records, even digital ones. Ensuring that your child’s medical files are complete and accurate can be a full-time job, especially when they run to the hundreds of pages – as is the case for many medically complicated children.

With each move and every new report generated, there is more to keep track of and pass along between providers.

Making sure that the most important details, like a deadly allergy or surgical records, be communicated is extremely important.

If you’re working with off-base, civilian offices, getting the records for your records can be costly. Many medical offices charge a fee per page copied but will transfer your records digitally or via fax to another doctor’s office for free.

Getting Coverage

Can you see that provider or get that needed supply now? That’s a strong maybe!

Not all medical care needs fit into neat little boxes. What is needed for one child to thrive may be excluded under current Tricare policy.

For example, dyslexia treatment is not allowed, but ABA therapy is covered as long as your child is enrolled in a special Tricare program.

Figuring out which much-needed providers will be covered by insurance or should be added to your already tight budget can be an extreme balancing act!

Do We Need ECHO?

The Extended Care Health Option (ECHO) is available to support military families with medical needs that might go beyond standard Tricare coverage. These can include home nursing and some supplies, like diapers.

ECHO offers a lifeline for many military families, at a low cost-share, who are struggling to meet the needs of a medically complicated child while also being financially smart.

Hospice Care Now Covered

No one wants to consider this scenario, but it’s comforting to know that hospice care is now an option for military dependents and troops. Hospice is designed for people who have a life expectancy of fewer than 6 months. Care will focus on comfort and daily living rather than a treatment plan in hopes of a cure.

However, military families have to choose between hospice and treatment. You cannot have both services operating concurrently.

What are your experiences navigating Tricare with your child – medically complex or typically developing? We’d love to hear your stories!

New parents connected to the military have relied on Tricare’s breastfeeding support programs for years. Moms have received breast pumps and supplies for free. Now, parents of some infants may also qualify for donor breast milk, too!

Expanding safe feeding options that allow parents a variety of solutions that fit the business of military life is always a good thing. But all this good also comes with a few hiccups.

New Moms Face Snags with Tricare Breastfeeding Changes

While donor milk coverage has been added, the notoriously generous breast pump program has been slapped with new restrictions.

$16 Million Breast Pump Overspend Leads to Major Changes

During a 2018 Inspector General audit, over $16 million in overspending on breast pumps and associated supplies was discovered. In one case, a breast pump that normally cost $200 at major retailers was billed at $1400 to Tricare.

These inflated bills were caused by beneficiaries purchasing a pump directly from a medical supply company, which would then bill Tricare. Another option was to purchase a pump from other retailers on their own, submitting their receipt for reimbursement later.

Now, Tricare is instituting a reimbursement cap and streamlining the process for filing a claim.

Here’s what you need to know now:

• Tricare will reimburse qualified beneficiaries up to $312.84 (CONUS) or $500.55 (OCONUS) during 2019
• There are no restrictions on where beneficiaries may purchase their pump
• Deluxe models are no longer allowed; contact your Tricare call center for specifics
• To get reimbursed for a pump, you must have or obtain a prescription from your PCM or another in-network provider
• Initiate your claim for DD-2642; attach your prescription and a copy of your receipt when submitting the claim
• There are limits on milk collections containers, replacement parts and other associated supplies
• You are limited to one pump per birth event

For questions regarding the specifics of your coverage, please contact your Tricare regional office. You can call Tricare East at 1-800-444-5445 or Tricare West at 1-844-866-9378. Members stationed OCONUS should also call their regional call center.

Canceled Orders, Big Debts

With the major changes to how Tricare handles breast pumps, many beneficiaries have been left up in the air.

As of July, over 5,000 claims were pending at Pumping Essentials. The CA-based company also canceled all current and future orders of pumps and supplies for Tricare beneficiaries.

Pumping Essentials has also officially cut ties, for the time being, with the Pentagon due to outstanding debts owed on already ordered pumps and supplies. In July, the DoD owed Pumping Essentials over $1 million for past orders and claims. Pumping Essentials, in a prepared statement, claims that contractors like Humana and HealthNet were negligent in paying bills on time.

“[The contractors] have drastically mismanaged the handling of these claims, resulting in significant amounts of unpaid claims to Pumping Essentials and many other providers. … At this time, the volume of unpaid claims has put our company in a position where we can no longer sustain the debt that is accruing,” wrote Pumping Essentials officials.

New Benefit, Zero Instructions

Parents of infants with certain medical concerns can now access milk banks with limited or zero cost. But the implementation of this new benefit has been anything but smooth.

Donated milk is used to help totally feed or provide a supplemental food source for infants who meet one or more medically complicating conditions:

• very low birth weight, often due to extreme premature birth
• disorder or surgery that impacts the GI tract
• failure-to-thrive diagnosis
• unable to drink formula, causing weight loss or failure to thrive
• low blood sugar
• heart disease
• organ transplant
• when maternal milk isn’t available and the infant has a serious health concern
• other serious health conditions, at the discretion of the PCM or specialists

Milk banks are located around the country and world, but the extremely high cost has limited or prevented access for many. Donated milk can cost as much as $5 per ounce, with daily bills costing upwards of $150 during peak consumption periods.

Military families have gone deeply into debt trying to care for their new baby. With Tricare’s new policy, retroactive to January 2019, military families will bear less of a financial burden in an already stressful situation.

However, Tricare and the Defense Health Agency announced this new policy without creating or communicating a complete plan of action to providers and associated agencies.

There are questions about what is covered and who is responsible for different elements of using donor milk.

Lactation specialist Pauline Sakamoto said that Mothers’ Milk Bank in San Jose, CA was overwhelmed with calls after the new policy was introduced.

“There continue to be questions as to what the benefit is and what the families are responsible for paying,” Sakamoto said. “For example, shipping costs. Is that part of Tricare coverage or not? And to some extent, Tricare has a co-pay, but we aren’t seeing that families are getting requests. There are a lot of issues right now swarming around this coverage.”

Getting Your Baby Banked Milk

Right now, parents who are interested in exploring how donor milk may benefit their baby should speak to their PCM or medical care team. A prescription is required.

Your child’s doctor should be actively monitoring your baby’s case and writing a new prescription every 30 days. Babies may consume donated breast milk, covered with a prescription, until 12 months of age as long as it is deemed medically necessary.

Parents may need to pay for the donor milk upfront, submitting a claim to Tricare for reimbursement after the fact. With all claims, parents should submit an active prescription and their bill from the milk bank.

In case of confusion, call your Tricare regional call center stateside or overseas. Customer service representatives should be able to help you navigate the billing and reimbursement loopholes.

Have you used either the new breast pump or donor milk benefit? We’d love to hear about your experiences!

EFMP or the Exceptional Family Member Program. It’s supposed to be a program to help military dependents access care, find advocates and only PCS to locations that can really, truly serve their needs.

Except it doesn’t always work that way.

Military spouses hear from commands and MTFs that EFMP will totally help them! It’ll be so much easier to ensure access to the right health care providers, additional support services and education programs (for kids) at wherever they’re stationed.

They hear that it’s “mandatory” to be enrolled.

And then they hear the horror stories from other families, detailing all the things that have gone wrong, promises left unfulfilled and careers derailed.

So what’s the truth about military spouses and EFMP? We went straight to the source – military spouses with EFMP experience that run the gamut.

Digging into Real EFMP Stories from MilSpouses Who’ve Been There

Enrolling in EFMP is supposed to be simple, just some paperwork. Paperwork that you should be able to grab right at your on-base PCM. And your PCM should be helping to determine if you or your children are eligible to begin with.

That’s not always the case, as some military spouses have discovered. Air Force Spouse, Susan R., was given some faulty information

“I should have been enrolled years before, but was told some inaccurate information about EFMP and the population the program serves,” she said. “I was informed by my PCM in 2008, that EFMP was a pediatric program and that adult specialty medical care could always be found. Sadly, that’s not entirely accurate.”

Adults are, in fact, eligible for enrollment in EFMP. But this might not always be clear to your PCM, military or civilian.

Other spouses, like USMC spouse Melissa, were surprised with their EFMP status.

“I had a temporary condition that I did not know qualified me for EFMP, and I was enrolled in EFMP without anyone contacting me or contacting my active-duty spouse,” she explained. “I believe I was enrolled for about two years. When it came time to PCS, we suddenly found out that I was in EFMP, since it came up on the checklists. That was a surprise!”

Unlike Melissa, Susan found enrollment challenging, contrary to the “easy process” touted by the military powers that be.

“Enrolling in EFMP seems to be an easy process, too,” Susan shared. “Fill out a form, get the PCM to fill it out, sign it and that’s it. Sadly, that’s not it. Depending on the diagnosis there could be many physicians and specialists involved needing to fill out and sign paperwork. That process can be long and drawn out.”

Once in “the system,” many military spouses felt let down by the support and services they experienced.

Melissa felt completely ignored by the whole process. Not only was she not informed of her enrollment, she was barely involved in the process to get out.

“I saw a distinct lack of communication from the EFMP service at the base where we were, Melissa said. “I could not believe I’d been signed up and no one from the office contacted me. (It) took him three tries to get to someone who knew what forms we needed to get me out of the program. Then, the final in-person interview we needed to attend was only scheduled through my spouse, not me. He called and asked if I could attend the meeting time. No one from EFMP reached out to me then, either.”

Even though getting into EFMP, and apparently getting out as well, might be a challenge, there are some positives to this program.

“The base we were at had good programs for EFMP members, in terms of regular gatherings and events for both kids and adults,” Melissa said. “I think it was a good program for those who knew they were in it.”

Susan, an Army kid turned Air Force spouse, remembers the days pre-EFMP. In her eyes, the positives come close to balancing out the negatives.

“The positives of EFMP means that families with medical needs are being considered when the service member is up for an assignment,” she said. “I was an Army kid and I remember life as EFMP was being rolled out by the Army. We had families getting stationed in places where their medical, educational and family support needs were never considered. The stress on families was overwhelming. In some cases, rare cases, family members would get very sick and not have the medical care they needed.”

Good & Bad of EFMP

USMC Spouse Jen C. has seen both sides of EFMP. Both Jen and her children are enrolled in EFMP.

“I have been enrolled as EFMP member since 2003. I also am a disabled vet and have physical limitations,” Jen explained. “I had my oldest May 2005. I was given respite. I used respite with the CDC on base. I was given I believe 16 or 20 hours of respite a month. It actually helped our family since my husband was an e-5 and I only had a 10% service connected disability rating at the time.”

Respite care, available to EFMP-enrolled adults to care for their children as well as for EFMP-enrolled children, provides a qualified sitter or care providers. Families then apply for reimbursement at a set rate and for a particular number of hours.

However, after 2009, Jen saw EFMP change – and not for the better in her estimation.

“After 2009 things changed drastically because of the sequestration,” she said. “EFMP respite was than non-existent for EFMP adults.”

Will It Impact the Military Career?

Career issues top the list of why military families try to stay off of EFMP rosters. But if you’re talking to military powers that be, negative career effects are basically non-existent. But what’s the truth?

Actually, it seems like it’s both.

EFMP basically ensures that military families are not moved to locations without the correct services and supports. At least, it’s supposed to prevent that.

In reality, EFMP status can limit duty station options and lead to unaccompanied tours.

Army spouse Megan H. has experienced two unaccompanied tours and denial of tours, all due to EFMP-enrolled dependents. There are multiple EFMP-qualifying individuals in her household.

“(W)e were not just denied accompanied overseas assignments, but CONUS assignments as well,” Megan shared in her personal story. “(The) doctors, without understanding the process, not only ended up putting a wish list of services on each of my daughters’ forms (for now my three oldest all qualified to be enrolled) but they also enrolled me for about six or seven different diagnoses, some of which I didn’t really have, as well as listing approximately seven or eight providers that I needed to see either weekly or monthly for those diagnoses.”

Susan also saw impacts to her spouse’s career. While the personal impact is negative, she can also see the rationale behind the policy.

“(W)e were unable to move to a location that would have helped his career progression. The lack of medical care meant that my family was denied travel to that location. We ended up staying at a location for close to 8 years,” she explained. “I also believe that EFMP is supposed to impact the service member’s career. I’m sure this seems strange, but this is what I believe. If DoD didn’t have EFMP, then families who have children with autism, are diagnosed with cancer, have illnesses that require specialty medical care would move to duty stations and never be able to access the care and services needed.”

A new USMC study appears to show that there is little to no longterm impact on Marine’s careers.

“Not only did we find that career advancement was not distinguishably impacted by EFMP enrollment, we also learned that, on average, EFMP enrollees serve slightly longer than their non-EFMP active duty counterparts, achieve a slightly higher grade, and the majority achieve that high grade in the same or shorter amount of time than the average of their non-enrolled peers,”  said Jennifer Stewart, the EFMP Section Head for Marine and Family Programs.

What Happens If I Don’t Enroll?

If your EFMP-qualifying issue is mild or well-controlled, then this should be listed on your medical paperwork. Opting to avoid enrolling is a 100% personal decision that needs to be based on multiple factors.

However, before choosing to skip EFMP, it’s important to understand the implications.

• Moving to a duty station where limited or no services are provided via MTFs or in-network civilian medical providers
• Being located in a place with limited or no support services, like ABA therapy
• Moving to a location where routine, infrequent maintenance screenings or check-ups are unavailable

Basically, you could be in a place where the things you or your child needs to cope with your diagnosis are just not available. While some diagnoses or individuals might be able to manage, others may not. And you just won’t know what’s there until you get there.

Susan appreciates the fact that her family’s duty station options are more limited.

“My husband and I are good with not being able to move to a location that doesn’t have the medical care to support our family,” she shared. “Our family is the most important thing which means having access to medical care that we need.”

However, Jen found that the system failed her family,

“We had serious waitlist issues in FL,” she explained. “I even called USMC EFMP HQ in Quantico because I asked why they sent me somewhere where there are no services.”

What has been your experience with EFMP? Sound off in the comments!

Here is a recent CNN Headline: “Citizenship will no longer be automatic for children of some US military members living overseas”. Reading this headline; I immediately think, if I am stationed outside the U.S. and have a child are they a U.S. citizen?

All this confusion comes from a Policy Alert, dated August 28, 2019 from the U.S. Citizenship and Immigration Services. Basically it is policy guidance to clarify requirements for residence in statutory provisions related to citizenship regarding children of U.S. government employees and members of the U.S. Armed Forces employed or stationed outside the United States. In layman’s terms, it affects a small number of children who are born to naturalized U.S. citizens who have not lived in the United States for a required period of time.

After realizing this new policy doesn’t affect the majority of military service members and their families who are stationed overseas it did make me wonder how the process works if you have a child while stationed outside the county. There are three ways you can become a U.S. citizen: naturalization which is becoming a citizen after birth, born on U.S. soil or birth to parents who are U.S. citizens. A few things you need to know if having a child outside the country.

• Contrary to popular belief, a U.S. military base outside the country is not considered U.S. soil for citizenship purposes.
• The only way a child born outside of the U.S. can become a citizen is through their parents.
• If your child is born in a military hospital overseas or in a foreign hospital, you will receive a birth certificate but these are not valid for obtaining a U.S. passport.
• It is important that you register the birth with the U.S. embassy or consulate in the country you are stationed in. This requires an application and documents proving the parents’ citizenship as well as the paperwork from the military or foreign hospital recording the birth. You will receive a Consular Report of Birth Abroad which proves your child’s citizenship and is valid for obtaining a U.S. passport

You may wonder if there are any benefits to making your child a dual citizen of the foreign country you are stationed in. This is something that should be carefully considered. Many countries have mandatory military service or income tax that you would not want to inflict on your child. It may make sense if one of the parents were from a foreign country. In these circumstances it would be worth it to speak to an immigration attorney.

An an interesting note this topic came up during the last election regarding whether Sen. Ted Cruz, was eligible to become President because he was born in Canada to a U.S. citizen Mom and a Father who was born in Cuba. He gained citizenship through his Mother and is consider a “natural born” citizen meaning he held citizenship from birth which is the requirement to become President.

Marguerite Cleveland is a freelance writer who specializes in human interest and travel stories. She is a military brat, a veteran and now a military spouse.  Her military experience is vast as the daughter of a Navy man who served as an enlisted sailor and then Naval Officer. She served as an enlisted soldier in the reserves and on active duty, then as an Army Officer. She currently serves as a military spouse. She lives in the Pacific Northwest with her husband and two sons. Visit her website www.WanderWordsWine.com

Are you outraged that $3.6 Billion from the Pentagon Budget is going to be diverted to pay for the border wall?

The news has been filled with headlines like this one from a CNN opinion piece “Trump is hurting the military for his own political benefit”. According to the September 3, 2019, DOD Briefing on Use of 2808 MILCON Funds for Construction of the Border Wall, $3.6 billion dollars from the military construction budget will be reallocated to help fund the border wall. I found myself pretty angry for a variety of reasons. One of the listed projects is near where I live affecting one of our military bases and the local economy. The second reason is that budgeting falls under Congress and I didn’t like the use of Executive Orders with President Obama and I don’t like this use with President Trump. It violates our constitution and the separation of powers between the Executive, Legislative and Judicial Branches of the government.

Background. (compiled from the Sept 3, DOD Briefing)

So how can this happen? The president declared a national emergency at the border between Mexico and the United States under the use of Title 10, U.S. Code, Section 2808. The Defense Department then evaluated whether military construction projects (the wall) on the border would support the use of Armed Forces deployed to the border. The chairman of the Joint Chiefs of Staff, Gen. Joseph Dunford concurred that such projects support the use of armed forces. So after all the analysis, Secretary of Defense Esper determined these construction projects are necessary and that the DOD will take on 11 border barrier military construction projects on the border.

Next the DOD identified which construction projects could be deferred with the goal of minimizing the impact within the United States and its territories. They also did not include housing for both troops and families or those that were awarded for 2019.  Approximately $1.8 billion will come from projects outside the U.S. and about $1.8 billion from with the U.S. and its territories.

According to a Military Times article, “Here’s everything the Pentagon is putting on hold to concentrate on building the border wall,” dated Sept. 4. It is quite a few. “In total, the list included 43 projects in 23 states ― two of which had been slated for cancellation ― along with 21 in three U.S. territories and another 63 in 20 partner nations abroad. Now, they are all delayed in favor of 11 new projects that will make up 175 miles of new or reinforced border barriers.”

Where the politics come in – now the DOD is going back to Congress to request these funds that were reallocated to the wall be returned to the Pentagon budget.  In regards to the 63 projects occurring in partner nations, it seems the goal is to ask them to pay for the projects as part of President Trump’s plan to make allies pay a fair share of defense expenses.

Current headlines about money being pulled from the Defense Department to pay for the wall made me very angry. Some even stated that the military would be less safe because of the reduced funding. I found that many of these headlines are very inflammatory and really designed to elicit the response I had. After reviewing all the information I could find and going to the source (Department of Defense briefing about this issue) I realized that the Pentagon has worked to choose construction projects which will have the least impact if they are delayed and I don’t believe any directly affect the safety of our military service members. So, I am still angry that Pentagon money is still going to pay for the wall but it is not a damaging as the headlines would have you believe.

What do you think about this issue? When you see inflammatory headlines do you take them at face value or do you delve into the story a little deeper to find the facts?

Marguerite Cleveland is a freelance writer who specializes in human interest and travel stories. She is a military brat, a veteran and now a military spouse.  Her military experience is vast as the daughter of a Navy man who served as an enlisted sailor and then Naval Officer. She served as an enlisted soldier in the reserves and on active duty, then as an Army Officer. She currently serves as a military spouse. She lives in the Pacific Northwest with her husband and two sons. Visit her website www.WanderWordsWine.com

In every single military spouse group, members are constantly discussing Tricare. The ups, the downs and the best tips to make it work for you.

What’s the Deal with Tricare? Common Issues that Every Military Family Might See

Almost every family will run into the same common issues if you spend any time at all dealing with Tricare, MTFs and even civilian in-network providers.

Which Plan Do I Pick?

The first question every military spouse and family encounters is about which plan is best for them.

• Prime: the entirely free (yes, free) plan requires families to default to on-base military treatment facilities (MTFs) and pharmacies, with off-base providers being used when on-base clinics are full. Off-base pharmacies can be used at your discretion, but with a co-pay for medications.
• Select: this works more like a traditional civilian insurance plan, with deductibles and co-pays. But you can see any in-network provider, usually without a referral! However, you may need to pay for services up-front and file a claim for reimbursement later.
• US Family Health Plan: only available in certain areas of the US. Operates like Prime, but with civilian providers. You are not able to access care or the pharmacy on-base, except in the case of an emergency. Referrals for specialty care is provided and there are co-pays for prescriptions and some specialty care.
• Prime Remote: the same exact plan as Prime, but offered to families who live 50 or more miles from an MTF. You’ll see civilian doctors at little to no cost to you.
• Prime Overseas: it’s Prime, but overseas! Get your care on your local military base and grab prescriptions from the military pharmacy. You won’t notice any changes in care, other than your physical location!
• Select Overseas: it’s Select, just overseas! You’ll be able to see providers of your choice, with co-pays and without referrals. Be prepared to pay for services up-front and file claims later. These will be local providers, so there may be a language barrier.
• Prime Remote Overseas: for families located OCONUS but far from an MTF, Prime Remote Overseas is for you! Your care will be managed and coordinated via the contractor’s regional call center.

All plans require enrollment. You can compare the plans before you make your selection.

How Do I Find a Doctor on Prime or USFHP?

Before you enroll, you can check to see where the in-network providers are located. You can read reviews and compare practice specialties.

Pick your PCM (primary care manager) based on your own criteria!

Once you’re enrolled, start seeing the doctor of your choice by coordinating with the Tricare representative and the office.

Where Do I Go In an Emergency?

For something that simply cannot wait, go to the closest ER. Even if it’s not an MTF or in-network provider, just go. Call Tricare or your plan provider network to notify them of your location. This will help them to process any resulting claims.

For anything that is not emergent, you can visit an urgent care clinic. Check the “find a doctor” options available specific to your plan.

Ugh, My Doctor Spends Zero Time with Me

Got a doc who’s in and out ASAP? Make the most of your time and come prepared to get to the heart of the matter.

Bring a list of your top questions and concerns with you. Then go down the list. Having your stuff prioritized means that you can make every second count.

If the limited time is impacting your care or you feel like you’re not being listened to, send a complaint. This helps the powers that be track and address issues within their system. Another option is to ICE the actual facility or doctor you’re working with. This is usually available on your MTFs website.

I Don’t Love My Care Provider

Good news, you can switch providers at any time. Send the request through the Tricare system or call to speak to an operator. You don’t need to give an explanation either.

What If I Want to Switch Plans?

You can change your plan once a year, during the enrollment period in the fall. All other times are off-limits, unless you experience a qualifying life event.

Waiting for Meds Takes Forever

If you’re using the military’s pharmacy, the wait for medication can be long. That’s because active duty troops in uniform get first priority. And because the meds are free, many pharmacies get swamped with prescriptions.

If you’d like to keep using the free pharmacy, go early. There is typically a shorter wait time first thing in the morning. Or scope out your location by visiting and doing recon at different times of the day.

Another choice is to take your prescriptions to an off-base, in-network pharmacy. You’ll be paying a co-pay, but also not waiting.

Finally, you can go mail order. For a co-pay, your routine medication will arrive at your door on a regular schedule.

I’m Not Getting the Care I Need

First, request that second opinion. Then file all the grievances and ICE complaints possible. Let them know you’re upset and detail the reasons why.

Follow up your complaints with in-person visits to the hospital/MTF administrator or care manager. Be ready to explain your concerns calmly and detail the optimal resolution(s).

Remember, you can always switch your PCM at any time. Try that and see if your level of care changes.

Keep requesting to see any specialists you think you need to get a handle on your issue.

And when the next enrollment period swings around, don’t be afraid to change plans entirely.

Mostly, just keep sharing your concerns and be ready to take action in order to get the care you deserve.

How Do I Make Sure My Doctors Follow My Wishes?

Good news, you’re not supposed to get care or treatments without your consent. If you have concerns or questions about a medication, vaccine or procedure, call a halt and start asking your questions!

Ask about alternatives to the initial proposal and why these may or may not be recommended.

While the doctors and nurses are the professionals, you’re the expert in yourself and your kids. Don’t be afraid to take a stand when it matters!

What Are My Recourse Options If Things Go Really Wrong?

First, there is the complaint and grievance procedure. Start there and see where you get.

If they’re not budging, push harder. While the Feres Doctrine bars active duty troops from suing the federal government over medical malpractice, it doesn’t appear to extend to military dependents. Bringing a lawsuit is always a possibility, albeit a very expensive option.

What are your thoughts about Tricare or other military healthcare plans? Sound off in the comments!

I get the intent behind the rank-based limitations on MyCAA, the program that helps underwrite college courses, as well as certification and licensure programs. Truly, I do.

But it still kind of, sort of bothers me. There’s an implication of resources here that just isn’t right.

Why Can’t Senior Spouses Access MyCAA?

Again, I get it. MyCAA is meant to help military spouses of junior enlisted and newly commissioned troops access higher education. I’m totally behind this! I remember what those early days were like and just how tight money really was at the time. And while we are not rich by any stretch, honestly, we had it better than many of our peers financially.

Still, as a new(er) spouse, MyCAA was attractive. I just barely qualified based on my husband’s rank. Like by the skin of my teeth qualified. I was so pumped.

Then the plug was (temporarily) pulled as financing and bureaucratic issues were finagled behind the scenes. So my account was there, I just couldn’t do anything with the money. By the time everything was active again, my spouse had moved up and I no longer qualified.

Higher Rank Doesn’t Always Mean More Financial Resources

I’m sure the intent behind limiting MyCAA to spouses associated with certain ranks was well-intentioned. After all, money doesn’t grow on trees and MyCAA certainly doesn’t have enough funds to cover $4000 for every single active duty military spouse out there.

But limiting this program based on rank instead of true financial need implies that mid to senior level troops and families always have their accounts in order. Experience tells me that this is often not the case. Senior enlisted personnel and officers are vulnerable to financial missteps and issues, just like those lower on the totem pole.

Money issues could have been cleverly disguised through carefully balanced credit card juggling or other smoke-and-mirrors deception. You would never know, unless you’re in it, that the house load of new furniture was purchased using an almost maxed-out credit card. Or that a senior level family is living paycheck to paycheck.

Many senior enlisted personnel and officers do live this way.

But the implication of MyCAA is that they shouldn’t need extra financial help. They should be totally fine floating the cash or taking out a loan for the non-serving spouse’s higher education, licensure or certification.

Higher Rank Doesn’t Always Mean Advanced Careers or Degrees

The other troubling implication is that senior spouses should have already achieved the types of credentialing, licensure or education MyCAA supports. On the flip side, by targeting junior spouses it could also imply that this community is not as educated.

Neither implication is 100% true, but that niggling feeling of a nugget of truth is still there.

It feels like, as a senior spouse, I should absolutely have achieved XYZ degree, certification or licensure by now. And if I haven’t done so, I should have the financial flexibility to pay or borrow for it.

Just like being married to a PFC doesn’t mean a lack of higher education, being married to a Gunny or a Major doesn’t mean that it’s been achieved.

Limiting access to MyCAA based on rank makes it seem as though the community of senior spouses ought to have put this check in the box. “You’re senior, therefore you don’t need help to achieve your next career step.”

Limiting MyCAA Limits MilSpouse Dreams

Again, I get the intent: help the spouses of junior personnel who are more likely to have less financial resources and fewer opportunities to access higher education or career programs.

Totally, 100% back this train of thought. It’s great and totally altruistic and super helpful.

But what about the spouse who married their service member later in life? What about the mid-level officer spouse who has tried to make finances work on just one salary, when more is expected of the service member at work?

Limiting MyCAA based on rank instead of (or leaving out) true financial need is hindering military spouses from achieving their dreams. That mid-career spouse might be desperately needing to go back to school, to get a certification or license, in order to help boost the family financially. Yeah, looking at the service member’s rank might make it seem like they’ve got it all in the bag: money, career, family, life. But that rank might be hiding the money troubles or desire to start a career.

Having MyCAA open, in a limited fashion, to spouses of higher ranking troops might go a long way to fixing or alleviating the well-known spouse unemployment issues. More spouses would be able to access needed funds, based on true financial need, in order to help their military family get ahead.

And helping military spouses get ahead in their own careers is supposed to be the entire point of MyCAA. Except that it’s missing a major chunk of spouses in need.

Do you think MyCAA could use a few tweaks or changes? Sound off in the comments!

It’s over. Done. Finito. Now, it’s just about getting the whole family together again, finally. All that’s left is the hugs and kisses. But who gets that first homecoming hug?

Honestly, this is a huge topic of controversy for military families, especially parents and spouses. Everyone seems to want that “first” contact after deployment is finished, but there can only be one.

Deciding Who Gets the First Homecoming Hug

There are some serious familial politics at play. No matter what, it seems like someone might walk away with hurt feelings.

Let’s break it on down to make your next homecoming super simple! All these scenarios assume that parents and/or extended family will be present along with the service member’s significant other and kids.

Single Service Member

This one is a no-brainer: parents get the first hug! When a service member arrives back from deployment, they might be the only ones there to provide a welcome.

After parents, if necessary, move down through siblings to extended family, then friends.

A single service member coming with no significant other is so simple.

Dating or Engaged Service Member

This is where the family politics come into play, with parents often butting head with significant others. Which means that everyone is going to need to communicate clearly, openly and honestly. Mostly, it comes down to service member preference: parents or significant other.

If Mom and Dad get the first hug, the significant other should obviously get the second. And vice versa.

That said, if the service member is in a long term serious committed relationship or is engaged, the significant other should take preference. they’ve moved into the “spouse” role (see below).

Either way, talk as a family and a couple before homecoming to be super clear about what’s happening and why.

There are no losers here: the service member is home.

Married Service Member, No Kids

Hey parents, in this case, back off the first hug urge. I get that this is your baby, coming home after months away. But you’ve also been somewhat removed from the stress of this deployment.

Your grown child’s spouse has been holding it down at home, dealing with the absence of their loved one for months on end. They’ve done the bills, handled household emergencies and been super involved with the FRG.

Mom and Dad, grab that second hug and savor it!

Married Service Member, Kids

Everyone hold on, because the kids get first dibs here! Their world has been rocked by their parent’s absence. Plus, they probably look pretty sweet in those special homecoming outfits.

Get out of their way, they’re getting their parent!

After the kids get scooped up, the spouse should be next in line for a hug and kiss. There might be a big family hug worked in here, too.

If anyone else is around, work down the line: parents, grandparents, aunts and uncles, cousins and then friends.

Why Are We Even Talking About This?

Okay, yes, it might seem pretty basic. There’s an order and preference for who gets that first hug that should be pretty intuitive: kids, spouse/significant other, parents, others.

But we wouldn’t be having this discussion if there weren’t pretty widespread issues around homecomings. Especially when it comes to a mom wanting the first hug over anyone and everyone else, including the kids.

There have been cases of parents literally racing a spouse to get the first hug. Other reports of parents, especially mothers, hugging and not letting go have also trickled down through the ranks.

Let’s be clear: unless the service member says otherwise or they simply aren’t in the picture, homecoming first hugs are for spouses and kids. Mom, sorry, this isn’t your show anymore. Your child is grown, even if it’s hard to imagine. Their spouse and their kids have born the brunt of this deployment and they get first dibs on hugs or kisses.

Other Homecoming Related Concerns & Issues

Homecoming seems to be a topic of much discussion and lots of stress. And it mostly falls on the military spouse to handle the load of planning, inviting and prepping for this glorious day.

So, in case you were wondering, here are some things you might want to think about as the service member, military parent or extended family.

Returning Service Member

Stick to the plan, no deviations. Seriously. Don’t need to run a quick errand real fast. There are no rides offered or shuttling services provided before, during or after your homecoming.

Don’t do it.

Your spouse, kids and/or parents just want to get you home.

Remember that your spouse and/or parents have likely spent some time getting the house spotless for your return. Dropping your gear in a messy pile in the living room might ruffle some feathers. Definitely find a drop-spot, but keep things out of the way until you can sort them properly.

Other than this, it’s your day! Take a nap, pop a cold one and chow down!

Out-of-Town Visitors

This is sensitive. You want to welcome your hero home, but also want to avoid stepping on any toes. Which means that you need to wait for an invite, preferably from the spouse.

Don’t invite yourself. There might be other factors at play here which would make your presence intrusive.

By all means, come if you’re invited though. But rent a car and get a hotel. your loved one and his/her spouse. If you opt to stay with them, things might get awkward. After all, it’s been a long deployment.

How do you handle homecoming politics? We’d love to get your best advice!

We’ve entered, or maybe have been in for a while, a unique space for military families, spouses specifically. It’s the land of discounts, freebies and entitlements.

Yup, it’s time for us to talk about all the stuff we get for free. But more than that, it’s long overdue that our community talks about just how much this system of “for free” has impacted us overall.

Don’t You Offer a Military Discount or Freebie?

Now, look, I’m the very last person you’ll hear complain about military discounts, included benefits or support programs. I’ve happily used TriCare insurance and military treatment facilities for over a decade. Saving those few dollars on shoes or Disney tickets is kind of sweet, too. Plus, it’s a boon to our community that there are support programs, like EFMP or MFLC, available to us.

Because, let’s face it, no service member is in this life to get rich – quick or otherwise. There are sacrifices to be made, and we all make them regularly and willingly.

I appreciate all of the amazing benefits, like those discounts and that healthcare and all the support organizations, because I use them regularly. I’m not, 100% not ever, suggesting that we get rid of them. They’re needed, deeply truly needed, by our community.

But we’re not entitled to them. We don’t just get them because of our affiliation with the DoD.

We Need to Check Our Entitlement to More

So, in case you’re unaware, part of military spouse life in this generation is being pretty active on social media. Yup, I’m talking about Facebook and Twitter.

Inside of those social spaces, various groups have sprung up over the years. Some are for the military community generally and others are just for military spouses. There are even some that are branch, rank or base-specific. Guess what? I’m in a fair few of them.

And sometimes, what I’m seeing from our community bugs me.

“They don’t offer a military discount or upgrade”

Again, let me say, I get that the budget is tight and every little bit counts. But come on, guys, it’s getting a bit extreme.

Did you know, the other week, I saw a rant, a full-on diatribe, about how suchandsuch an airline wasn’t extending no-fee baggage for active military to the non-serving spouse? Yeah, no, that’s a thing I saw. And it’s not even the first time. Try more like the thousandth time for that particular rant.

There are folks who get all up in arms about stores or tourist attractions who have certain rules about applying military discounts. I’ve even seen small business owners, members of the military spouse community, told that they ought to be giving away their products or services for free.

Why? Great question.

“Because you’re one of us and you need to support your own.”

Yeah. Okay. I don’t think giving away homemade soaps or hours of tutoring pays the bills, Brenda.

What’s grinding my gears is the notion, clearly not held by every military member or spouse, that discounts and freebies should be happening no matter what. That the non-serving spouse should get that free baggage for a pleasure trip to Las Vegas just the same as the AD service member on orders. Or that a military spouse who tutors should be providing free services to her neighbors just because “military discount.”

When did we get so entitled? Why are we expecting to get discounts and freebies from everyone and everything?

And why, oh why, are we getting mad about instances when those things aren’t happening?

Are We Insulated & Entitled?

Everyone walks their own roads, fights their own battles and gets through the day the best they can. Honestly, I get that.

But what else am I to think when I see people throwing virtual (and sometimes in real life) fits about not getting their “deserved” discount? What am I to think when I read (and sometimes have to listen to in real life) rants about suchandsuch business should be ashamed because of their lack of or minimal military discount?

Really, stop and think about it.

We are entitled to nothing from no one. Not one single business has to offer military troops or families a discount. Just like they don’t need to offer one to first responders or teachers or accountants or doctors or lawyers or the general public.

But our families generally get a discount.

We get cheaper tickets to Disney parks in the US. Sometimes our bags get checked free or we can board first. Some places, like SeaWorld, even offer completely free admission a few times a year.

We get discounts, big and small, at many retailers and tourist attractions around the country. No other group of people, on the basis of their association with an employer, gets this privilege. Not one other group on this scale.

So when I see a military community member go off on yet another rant about being “denied” a military discount, I just shake my head. It reads as entitled to grouch about that sort of stuff. Can you see that, too?

Instead of putting on our grownup pants and just getting on with our day, discount or not, you’re grumbling about this “denial.” Oh, poor you, not getting another thing for free or cheaper.

Listen, you’re not entitled to get cheaper goods or upgraded services because of who pays you or who you married. Sure, it’s a great perk and one I fully admit to enjoying as just that – a pleasant and unexpected bonus, the cherry on top of a sundae.

I’m not due anything for free or cheaper. And neither are you.

Do you think that the expectation for military discounts has gotten out of control? Sound off in the comments!