Category Archives: TRICARE

Back to School: TRICARE options for college students

collegeboyYou’ve spent the summer months searching for the perfect dorm room essentials: mini-fridge, extra-long twin sheets, and the perfect papasan chair. But what are your college student’s TRICARE options?

Dependent children are eligible for regular TRICARE benefits while in college full time until their 23 birthday or until graduation, whichever comes first. After that, children may qualify to purchase TRICARE Young Adult.

The service member must update the dependent child’s “student status” in the Defense Enrollment Eligibility Reporting System (DEERS) to maintain the student’s TRICARE eligibility past age 21.

Before sending a son or daughter to college, it is important for military families to review their child’s health care options because some TRICARE options will work better than others. Here are some tips to consider:

Location. Where is the school located? Is it in a Prime Service Area? Contact the regional contractor for the TRICARE region where the school is located to determine if the school is in a Prime Service Area.

Transportation. Will your son or daughter have a car at school? Will your child be able to get to his or her assigned Primary Care Manager (PCM)? If enrolled in Prime, your child will need to see his or her PCM or additional fees will apply.

Cost. TRICARE plans have different cost sharing components and your student may need a split-enrollment in order to receive care while at college. A split enrollment allows some members of the family to be enrolled under one plan and other members of the family to be enrolled under another type of plan. For example, the family may be enrolled in TRICARE Prime, but the college-age student may be enrolled in TRICARE Standard. Or the college student may disenroll from Prime at his or her home location and re-enroll for Prime at the school location. Please review disenrollment options carefully. Students may be subject to a one-year lock-out if disenrolling from Prime and will not be able to re-enroll in Prime at their home location when returning for the summer. Families should check with their TRICARE contractor for more details.

On Campus Options. Many colleges and universities offer student health plans. Student health plans are considered other insurance, so TRICARE will be the secondary payer to any student health plan. TRICARE Standard and Extra work best with student health plans.

Visit our website for additional information about TRICARE options for college age kids.

KatiePosted by Katie Savant, Government Relations Information Manager

TRICARE Standard: Is it right for you?

flag-stethoscopeAs a new spouse, or even a seasoned spouse, the difference between TRICARE Standard and TRICARE Prime can be somewhat confusing. I remember how overwhelming it felt when I was faced with the decision on whether I wanted “Prime” or “Standard”. After reading through the literature available, as well as on TRICARE’s website, I decided TRICARE Standard was the best for me. If you are considering TRICARE Standard for your family, here are some points to consider:

TRICARE Standard is an option which allows you to choose your own doctor. You are able to see any type of doctor, from a specialist to a primary care physician. To search for the type of doctor you need, go to TRICARE’s “Find a Doctor” feature. If you choose a network provider, you end up paying less of a cost share . The cost share depends on what care you get at that particular appointment, whether or not you use a network or non-network doctor, or whether you are an active duty family member, retiree, or retiree family member.

The “in network” doctors file the TRICARE claims for you so you do not have to deal with the paperwork of filing the claim yourself. Using a network doctor is called TRICARE Extra . Also, there is no pre-authorization required when you need lab work or testing done. Each fiscal year you have an annual deductible to meet, which varies based on your service member’s status. As an active duty spouse, I pay only 20% of any allowable charges after I have paid my deductible for the year. There is also a $1000 “catastrophic cap” for active duty families. This means your out of pocket expense will not exceed that cap.

TRICARE patients have the option to choose which pharmacy they would like to use. Using TRICARE retail pharmacies are especially convenient for patients using TRICARE Standard, but are the most expensive option. Major drug store chains such as RiteAid, CVS, Target, and Walmart are in-network pharmacies. By using an in-network pharmacy, you are responsible for a $5.00 copay for generic medications and a $17.00 copay for brand name medications. You can save money if you use the TRICARE Pharmacy Home Delivery to have your prescriptions mailed right to your home.

A common misconception of TRICARE Standard is the idea that patients are not able to use the military pharmacy because they are not seeing a doctor at a Military Treatment Facility (MTF). As a TRICARE Standard user, you have the option to use the MTF pharmacies, which may be the best value if the MTF stock your drugs. Personally, I have never used a MTF Pharmacy because they were not as convenient for me because I did not live on the Army Post. However, if you want to save money, using the MTF pharmacy is a great option because both generic and formulary drugs have no copay!

TRICARE Standard has been the best choice for me because I enjoy choosing my provider instead of being assigned one. I also enjoy the flexibility of changing providers if I am not happy with my current doctor. Unlike TRICARE Prime, TRICARE Standard does not require a referral to see a specialist. Because of these choices, I don’t mind paying to see a doctor when I am ill and can’t survive another day without an appointment! I feel I am in control of my healthcare experience with TRICARE Standard. I encourage you to read about the other differences between Prime and Standard in order to make the best decision for your family. I hope that by shedding some light on the sometimes confusing and often-misunderstood TRICARE Standard, your decision may come a little easier.

Stephanie-OSullivanBy Stephanie O’Sullivan, National Military Family Association Volunteer, Fort Bragg, NC

Looking back at 2012

National Military Family Association: A look back at 2012Where does a year go? It’s amazing to see the months fly by, filled with memorable occasions like weddings, road trips, big moves, and deployments. 2012 was a year of change, new ideas, and growth for the military community, and for us as well! Here’s how we spent our year.

Sometimes it seems like if something can go wrong, it will. Or when it rains, it pours. Whichever idiom you want to apply, 2012 brought a few unexpected lemons for us to make into lemonade. From the close call of a government shutdown in April, threats to commissary benefits, and the fiscal cliff negotiations in December, we were proud to be  the place military families turned to understand the impact of these actions and find out what could be done in response. It’s nice to know that no matter what comes our way, our community always makes it to the other side of the issue infinitely stronger.

With almost everyone and their grandma (literally) having a smart phone or social media account, these days it seems like we are more connected than ever. Military families are no different, and this year we created a few new ways to provide resources and support via the most-used platforms. Although we are all part of the same community, each military family faces its own challenges going through the many different stages and phases of life. Whether a family is preparing to move, expecting a baby, or anticipating a deployment, our new app, MyMilitaryLife, brings our subject matter expertise and important resources when and where it’s most needed. We’ve had nearly 4,000 downloads from the iTunes and GooglePlay stores, and with six more life paths being added in 2013, we look forward to growing our presence on this new mobile platform.

We are committed to providing spouses and families with the resources and programs needed to make military life a bit easier. We awarded $448,000 in scholarship funds to military spouses beginning or continuing their education through our Joanne Holbrook Patton Military Spouse Scholarship Program. Our Operation Purple® program had another great season, sending 1,581 military kids to camp across the country. With so many service members returning from deployment, creating a network of support during this period of change and adjustment was more important than ever. We held six Family Retreats and four Healing Adventures for families with a wounded or returning service member who needed to ease into the reintegration process after a deployment.

It went by fast, but 2012 was a productive and fulfilling year. We’re excited to see where 2013 takes us—stay tuned for a companion post on the Association’s goals for the year.

Your turn: what would you like to see us focus on this year?

maranathaPosted by Maranatha Bivens, Communications Editor at the National Military Family Association

One toe over the edge: the Fiscal Cliff and military families

One toe over the ledge: the Fiscal Cliff and military familiesSo we’ve managed not to topple over the cliff, but it looks like we’ll be hanging on the ledge of uncertainty for a few more months. In the wee hours of the New Year, Congress passed a compromise bill to keep the country from heading over the edge. Like any compromise, the bill didn’t please everyone, but it did fix several issues important to military families, including a one-year extension of the Medicare/TRICARE doc fix, which will help protect families’ access to health care. The compromise legislation did not include an increase to the debt ceiling and the Treasury Department estimates it will run out of ways to stay within the current ceiling by late February or early March, right about the time sequestration is now set to start.

And what of those automatic cuts to federal spending, known as sequestration? The best the Congressional leaders and the President could do was to postpone it for two months. That might sound like a good thing, but this delay also means uncertainty about what will or could be cut for military installations, schools that educate military kids, defense contractors, and all other military and community agencies that support military families.

Other provisions included in the compromise bill would:

  • Create a permanent fix for the Alternative Minimum Tax to prevent taxpayers from moving into higher tax brackets simply because of inflation—this fix was needed immediately to keep taxpayers from paying higher taxes on their 2012 income.
  • Permanently extend the Bush-era tax rates for all families earning less than $450,000.
  • Increase the tax rate on capital gains and some estates.
  • Freeze Congressional pay.
  • Extend federal unemployment benefits for one year.
  • Extend provisions in the expiring farm bill by one year. (This means milk prices won’t skyrocket, as you may have seen in the news.)

The compromise bill did not extend the lower payroll tax rate of 4.2% in effect during the past two years through economic stimulus legislation. Therefore, the payroll tax workers pay to support Social Security will immediately return to 6.2%. Workers will see this change in their first paycheck of 2013. Experts estimate that the family earning an average of $50,000 per year will pay an additional $1,000 in payroll taxes this year.

While the New Year’s Congressional action gives the government and taxpayers some breathing room, we’re not out of the woods yet. The temporary delay of the sequestration cuts will combine with other pending budget events to continue the fiscal uncertainty facing our Nation.

The Association appreciates the actions by Congress and the President to provide the fix to Medicare and TRICARE doctors. We remain concerned about the failure to address the potentially devastating sequestration cuts to both civilian and military programs that could have a negative impact on military families. While the delay in sequestration will temporarily protect some needed support services, it also continues the uncertainty, and a military community at war needs certainty that the Nation supports its service. We call on our Nation’s leaders to forge a more permanent solution that will preserve the strength of our service members and their families.

How do you feel about the outcome of the compromise bill and the negotiations surrounding it?

Joyce RaezerPosted by Joyce Raezer, Executive Director at the National Military Family Association

Here We Go Again! Cuts to Medicare/TRICARE Physician Payments Begin January 1 Unless Congress Acts

Here We Go Again! Cuts to Medicare/TRICARE Physician Payments Begin January 1 Unless Congress ActsAttention TRICARE beneficiaries! In two weeks, doctors will face a 26.5% payment cut for care they provide to Medicare and TRICARE patients. The National Military Family Association believes these impending cuts will directly affect military families’ access to timely care because physicians may decide to no longer care for their existing Medicare or TRICARE patients or accept new ones.

Getting a so-called “Doc Fix,” which would end scheduled cuts in Medicare reimbursement rates, is a recurring issue. Congress temporarily stopped the scheduled payment cuts in February 2012 as part of the Middle Class Tax Relief and Job Creation Act of 2012  (P.L. 112-96). Unfortunately, that fix is due to expire on January 1, 2013, which means that without further Congressional action the 26.5% physician payment cut will go into effect. The timing of the expiration also means the issue has been caught up in the negotiations over the pending fiscal cliff. This makes fixing it that more difficult.

By law, TRICARE reimbursement rates must follow the Medicare reimbursement rules. The law does permit TRICARE to make exceptions if necessary to ensure an adequate network of providers or to eliminate a situation of severely impaired access to care. But, the process of making those adjustments can take time and may happen only after TRICARE officials receive enough reports that military families aren’t finding the care they need.

Our research, Views from the Homefront, demonstrated the need for mental health services for military spouses and children. Our military families already experience difficulty gaining access to mental health care in many communities. We cannot afford to lose any mental health providers. After 11+ years of war, the military must be growing our access to mental health care rather than decreasing it.

We’ve been monitoring this issue and raising concerns about the impact not fixing the rates could have on military families. We encourage military families to contact Members of Congress (House and Senate) and tell them how these cuts can affect access to the health care they need. Ask Congress to implement a permanent fix.

What do you think about these potential cuts? Will your family be affected?

Joyce RaezerPosted by Joyce Raezer, Executive Director at the National Military Family Association

Discrimination by uniform: an update on TRICARE and ABA therapy

Discrimination by uniform: an update on TRICARE and ABA therapyFor the first time—ever—Congress is purposely excluding certain members of the Uniformed Services from receiving some health care benefits because of their Service affiliation. Shocked? So are we.

When I speak about who our Association serves, I say that we work to improve the lives of active duty, National Guard and Reserve, retired, and surviving families of members of all seven Uniformed Services. Then I ask the trivia question: “What are the seven Uniformed Services?” In most cases, people easily name the Army, Navy, Marine Corps, Air Force, and Coast Guard, but they’re often stumped on the other two: the Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA) and the Public Health Service (PHS).

Members of all seven Uniformed Services take the same oath to support our Nation, are paid using the same pay tables, go where our leaders send them, earn the same retirement benefits, and receive the same TRICARE health care coverage. But this equality in benefits for their service that is granted by law is now threatened by the very Congress we ask to protect us.

A little background. Many military families with an autistic child, as well as some with other disabilities, have seen improvement when the child has access to Applied Behavior Analysis (ABA) therapy. Because TRICARE has provided ABA therapy under the ECHO Program, which is open to active duty families only and has an annual cap on costs, many military families have asked Congress to make it a covered TRICARE benefit to remove the cap and be available to retirees as well. They’ve encountered resistance for several reasons, most notably the cost.

The House’s version

In May, the House of Representatives added a provision to its version of the Fiscal Year 2013 National Defense Authorization Act (NDAA) that would make ABA therapy a TRICARE benefit for patients with an Autism Spectrum Disorder diagnosis. Normally, when a benefit is added to TRICARE, it applies to everyone that qualifies medically. In this case, however, the House decided it was acceptable to specifically exclude all  families of three Uniformed Services: the Coast Guard, NOAA, and PHS—a first.

The Senate’s version

On December 4, the Senate approved its version of the NDAA, which also contains a provision adding ABA therapy as a TRICARE benefit. At the request of our Association and others, the Senate provision opens up the therapy to anyone whose doctor believes would be helped. In response to our concerns about the House excluding three of the seven Uniformed Services from the benefit, the Senate included coverage for all active duty Coast Guard, NOAA, and PHS family members. But, it still specifically excludes retiree families of those Service branches.

What’s Needed

I don’t want to diminish the importance of this new TRICARE benefit. I’m glad Members of Congress have recognized the burden military families with a child needing ABA therapy face in finding and paying for the treatment. However, our Association is deeply concerned about the precedent this action by both Houses of Congress sets—and thinks that every military family should be as well.

Members of Congress have a chance to fix this inequity as they meet to create the final version of the NDAA. They must ensure eligibility for TRICARE benefits is determined by the medical needs of the patient, not the type of uniform their service member wears or wore.

How do you feel about these exclusions in the proposed NDAA?

Joyce RaezerPosted by Joyce Raezer, Executive Director at the
National Military Family Association