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.