Tag Archives: TRICARE

TRICARE Prime: Why I Wish I Ditched it Sooner

I did it. I finally switched from TRICARE Prime to TRICARE Standard. I’ve been a military spouse for ten years, and I never really considered Standard to be an option for my family . . . until now.

Don’t get me wrong, I LOVE TRICARE Prime. I loved knowing that when I take my children to the doctor, I wouldn’t get a bill. If I had to call an ambulance and bring them to the hospital, there wouldn’t be a bill. If someone needed a surgery, or was diagnosed with some scary medical problem, there wouldn’t be a bill.

I thought I couldn’t afford a bill.


Today, I’ve realized that it’s not the bill I should be worried about. I can no longer afford the care we’ve received at our Military Treatment Facility (MTF). As a working mom, I can’t afford to wait three hours at the pharmacy for prescriptions. As a mother of four, I can’t afford not being able to get my child into the doctor when they have an ear infection, or heaven forbid, pink eye, which left untreated will spread to ALL of my children.

I can’t afford to ignore my own health issues any longer, either. I can’t afford the time it takes to fight for referrals, or wait the three months until there is an opening at the specialist, or wait the six months the MTF told me it would take to get my child a referral for a mental health evaluation.

My family is in crisis; I can’t afford to ignore red flags any longer.

What I CAN afford is the co-pay for TRICARE Standard.

We switched to Standard two weeks ago, and let me tell you what happened:

I got online, and found doctors within the network. I found and called the specialists we needed and made an appointment, no referrals needed. In a half hour, I was able to schedule four appointments with a pediatrician, one appointment with a family practice doctor, a neuropsych evaluation, and an appointment with a specialist I have been asking to see for the last year. All of the appointments were scheduled for the next two weeks.

When I walked into my appointment at the specialist, I met a physician who listened to my symptoms, and immediately scheduled further testing…for the next day. During that test, he discovered a problem that will need surgery very quickly. This diagnosis explains all the symptoms I had been complaining about to the doctors at the MTF and military emergency rooms for the past year. I believe I could have (and should have) had this surgery a year ago, if one of the Primary Care Manager (PCM) I saw at the MTF (because I never did see the same PCM twice) had given me the referral I had asked for, by name, again and again.

Two weeks is all it took for me to get every last person in my family the medical care they need and deserve.

So what will it cost me? Every last penny I will spend on our healthcare this year is worth it. For my family of six, I will pay a $300 deductible before the coverage kicks in. We have already paid this within the first two weeks–we needed a lot of testing, procedures, appointments, and prescriptions! After I pay that deductible, we will continue to pay co-pays up until we hit a $1000 dollar catastrophic cap. My family will likely hit that cap, due to the special needs and health issues we are dealing with. Once we hit that amount, I will pay nothing else, until the following year.

There were times my family could not have afforded to pay a thousand dollars a year for health insurance, and during those times, and I am grateful my husbands service earned us TRICARE Prime healthcare coverage.

3-9 Tricare Standard Pinterest PIN

I know I’m not alone with the decision to switch to TRICARE Standard because my family couldn’t get the care they needed, when they needed it. Remember Sequestration? Remember when MTF’s were closed for a number of days each week and no one could get care? My problems, and others’, isn’t the fault of the doctors and PCM’s, in most cases, it’s the policymakers who can fix this for military families. My family deserves the best care, no matter which plan we’re on. So does yours.

The National Military Family Association continues to fight for military families like yours and mine by asking Congress to end Sequestration and the unfair burden it puts on military families. And this year, NMFA is putting a heavy focus on TRICARE reform and the health proposals in the Fiscal Year 2017 budget.

Right now, I can’t afford to NOT to pay the thousand dollars for my family’s healthcare. I am kicking myself for not transitioning to Standard sooner. I could have gotten my son the evaluations, help, and services he needed sooner. I could have received the preventative care I needed sooner. I could have saved myself so much stress and time spent waiting on referrals and prescriptions, and time spent sitting in the waiting room at the ER when appointments were unavailable at the MTF.

I could have saved so much, had I switched sooner.

Did your family switch from TRICARE Prime to TRICARE Standard? What would you tell Congress about your experience?

HeatherPosted by Heather Aliano, Social Media Manager

Reading the Defense Budget’s Fine Print: Is Your Military Family a Priority?

What’s the advice every financial counselor gives you before you sign a contract for a car loan, an apartment, or a service agreement for your new big screen TV? Read the fine print! It’s important to understand, legalese buried in a sub-clause might end up costing you if you don’t do what it says. It’s also important to know what protections for you weren’t included in the contract so you can fight for them—things like a military clause in a rental agreement to keep from being penalized for a sudden PCS move. 


Our Government Relations team has certainly been reading the fine print on the budget proposal submitted by the Department of Defense (DoD) for the next fiscal year (FY17). I’m testifying before the Senate Armed Services Personnel Subcommittee, on behalf of our Association, about how that proposal will affect military families. We’re asking Congress to read the fine print and consider:

  • Pay raises: In their budget presentations, DoD officials have been quick to highlight that the proposed 2017 pay raise of 1.6% is the largest basic pay raise in four years. In the fine print, they admit this figure is smaller than the 2.1% increase in private sector raises, which is the standard currently in law. If the 1.6% pay raise is approved by Congress, 2017 will mark the fourth year in a row military pay raises lagged behind pay increases in the private sector.
  • TRICARE Reform: Although its primary mission is keeping our troops healthy and strong when in harm’s way, the military health system also has an obligation to deliver high quality care to military families, retirees and their families, and survivors. Too often, as military families tell us, DoD has failed to meet this obligation. Any discussion of TRICARE Reform must start with how DoD can fix the problems it knows exist in order to improve military families’ satisfaction with their access to care and the quality of that care.

In its FY17 budget proposal, DoD did acknowledge many of the issues military families face in accessing health care: the shortage of same-day and urgent care appointments, the time-consuming and cumbersome referral process. But, it stopped short of committing to specific improvements.

Instead, DoD chose to focus first on controlling costs. They propose eliminating TRICARE Prime, Standard and Extra and replacing them with two new plans: TRICARE Select (a managed-care option that sounds a lot like Prime but with higher out of pocket costs, particularly for retirees) and TRICARE Choice, a preferred provider option that would allow families to choose their providers. What’s in the fine print? Increased costs for Choice users across the board, including higher catastrophic caps and co-pays for out-of-network care, as well as a new annual participation fee for retiree families—but no expansion of the network or improved benefits.

  • Force of the Future: Lots of good ideas in what’s been released thus far: good ideas that will help many military families. But, will these enhancements and recognition of some of the demands military life places on families be enough to offset the constant budget threats to pay and support programs, downsizing, more missions to be performed with a smaller force? Where in the fine print are those things mentioned?

When I testify on Capitol Hill today, I will talk about what’s important to today’s military families. How does the Department’s proposed budget address their needs? Does it make a mom feel her sick child’s health is a priority? Does it ease fears about downsizing? Does it ensure support will be available for a family during their service member’s deployment, whether it’s the first or the fifth? Does it support a spouse eager for a career? Does it promote smooth transitions, whether to a new duty station or life after the military? Does it support families financially? Does it keep our military families strong?

I want to thank all the military families who share their stories with us, complete our surveys, and comment on our web and social media posts. You help us tell your story to people who not only want to hear, but who are in a position to address your concerns. Our message is stronger because of your trust in us. Together we’re stronger.

Watch the hearing today at 2:30pm ET and hear our full testimony on behalf of our nation’s military families.

joycePosted by Joyce Wessel-Raezer, Executive Director

How the “Talking Doctor” Helped my Military Kids Cope with Deployment

My in-laws have a fantasy with how  they view my family.

Their assumption is we have the perfect family. We only enjoy the benefits that the military offers dependents. We get to travel. We visit exotic cities like Norfolk, VA. Our medical care is almost free and we save money shopping at the commissary. It seems we literally have the best quality of life.

Recently, they visited us. We showed them where the kids go to school and where their ballet studio is located. We showed them our local library, where the girls check out their books and attend story time. We also pointed out their pediatrician’s office, and where they attend sessions with their “talking doctor.”


“What’s a talking doctor?” My in-laws were deeply puzzled.

I explained to them that once a month, my children attend therapy with a licensed child psychologist. My in-laws were horrified to realize their granddaughters attend therapy on a monthly basis, and without reservation.

“Why? What horrible thing has happened to them that they need to see a psychologist?” they demanded to know.

I politely explained that my children have rarely seen their father in the last four years. He’s unwillingly missed four consecutive birthdays of both children. He has missed big holidays like Christmas, Easter and New Year’s Eve. Worst, he was never able to send them to school on their first day, attend parent-teacher conferences, and wasn’t home to congratulate them when they finished the school year. He has been on two consecutive deployments, several underway missions, and works long hours, since he has been on his department-head tour.

I told my in-laws that despite sending them cute pictures of us smiling, we experienced many sleepless nights with the girls crying for their dad. There were many school nights where the girls refused to do their homework because they missed their dad. And there have been many times when we all went to emergency room, spending several hours waiting for medical care because one of us was sick, and I didn’t have a sitter or a friend to help me watch the other.


Life for the military dependent is down right hard, but for many of us, we refuse to give up the mission. And we won’t give up hope and help provided to us.

I tried, on my own, to make our daughters lives a little brighter. After many trials and errors, I built a community where I thought my kids felt welcomed. When my daughters didn’t feel like they fit in at their school, I looked for options to transfer them to an institution where they felt they could learn in a supportive environment.

No matter how many people I forced to visit us, how many friends we forged, or how many expensive places I took the girls, none of it mattered. They still missed their father.

Despite all my efforts, I realized my daughters’ anxieties were multiplying. I finally scheduled an appointment with a therapist. It took a while but we found the right therapist that understood our complicated plight.


Our typical military dependent plight:

“Dad is still married to Mom and loves her. Mom loves Dad. Dad loves the girls and works very hard to support the family financially but Dad is not physically seen or present.”

In the civilian world, at least the breadwinner has some flexibility in his or her working hours, but it’s not the same in the military. My in-laws encouraged us not to tell many people that we see a psychologist. They lectured us that people might take it that something is severely wrong with us. I told them there is no shame in receiving help, especially when it comes to my children’s health.

Since we have seen a therapist, my daughters are much happier. They needed to hear from a medical professional that their daddy is safe. The work he does will not necessarily kill him. We also discussed how to manage situations that are out of our control. We learned to how to effectively communicate as a family. I learned that just because I can handle the deployment, doesn’t mean my kids will follow my lead as their mother.

I thank TRICARE for allowing us to utilize resources, like our therapist, to help us understand each other and how to control our fears and loneliness. The girls learned in therapy that even though “deployment” means Dad might enter a war zone, it doesn’t mean he’s actually going to war or will have to shoot guns at anyone. It was a huge revelation for all of us; I think my girls know about modern-day politics and the constant possible wars we are engaging.

Therapy has been heaven-sent, helping us relieve the heavy burden we were all carrying mentally.

Have you ever done something rewarding for your family that others didn’t agree with? How did you handle it?

Posted by Katie M., Military Spouse and Mother

TRICARE’s Breastfeeding Policy: A New Mom’s Experience

Recently, TRICARE implemented a new breastfeeding support policy including coverage for breast pumps. Our Association is generally pleased with this new policy because it gives families flexibility in terms of when, where, and how to purchase breast pumps and supplies.

But we wondered how this policy is panning out in military communities as families try to use it. So we asked Jaclyn, a Fort Benning Army Spouse, while she was expecting her first baby. Jaclyn had just purchased a breast pump.


I heard about TRICARE’s new breast pump policy from an online moms group.  I called TRICARE even before the policy went into effect and they were able to answer some of my questions.  They were at least aware that the policy would go into effect on July 1.

Back in August, I started to think about buying a pump again, so I needed to learn about the process for getting a pump covered by the new policy. At that point I was only seeing my midwife once a month for appointments.  I wasn’t sure if I would need to get a prescription before buying the pump. I checked my online Army Moms group and saw a post about how to buy a pump at Target so I decided to give that a try.

I called the 800 number for the Target breast pump program. They collected some basic information about me and my TRICARE coverage and then they took it from there. They sent me an email with three choices of pumps that would be fully covered by TRICARE. They also provided some options where I would have to pay part of the cost out of pocket. I chose the Medela In Style Advance (retail price approximately $200 at Target.)

It turns out that I didn’t even need a hardcopy prescription – Target followed up with my midwife directly to get the prescription. Target emailed me with a list of locations where I could pick up the Medela pump. I chose one and went to the store. I stopped by the Target customer service desk and the pump was there waiting for me.  I didn’t have to pay anything given the pump I selected!

My experience was pretty easy, but my friends on TRICARE Prime seem to be having a more difficult time. Some of them are having trouble getting a prescription from their OBs. It seems like Pediatricians are more aware of the policy and will provide a prescription without a problem. 

How does Jaclyn’s experience compare to yours? What worked well and what did not? Share your story with us in the comments section below.

And don’t forget about lactation counseling! We talked with Jaclyn while she was still expecting, so her story doesn’t touch on breastfeeding counseling. Have you tried to use TRICARE’s new coverage for lactation counseling?

Your stories will help us understand if TRICARE’S new breastfeeding supplies and support policy is working as intended.  Thank you for helping us advocate for military families!

karenPosted by Karen Ruedisueli, Government Relations Deputy Director

Do White Coats Make You Nervous?

doctors_black and white photo-550Do white coats make you nervous?! Because they sure make me anxious! I’ll be honest with you: just the prospect of going to the doctor’s office makes me sweat. And don’t even get me started on the dentist. No, I am not scared of shots. But I am scared that whatever help I need, I won’t get. And that is a very real fear!

As military dependents, we don’t have the luxury of picking medical providers. Under the best conditions, we can ask other military dependents who they recommend, and under the worst, we are flying blind. So, the question becomes: How do you get the care you deserve and need with a practitioner you don’t know? The answer is: advocate for yourself and partner with your healthcare provider!

Here are some things you can do to help get your medical needs met!

  • List your concerns and the needs you want met. Make sure they are prioritized. This sets the stage for your exam, for both you and the provider. Don’t make them hunt down the reason for your visit; if you are there for a run of the mill check-up mention it, if you are there for specific reasons tell them.
  • Negotiate with the provider what issues can be addressed today, and if you will need another visit to address the rest. This way the two of you will have realistic expectations about what can be completed today. You don’t want to leave your appointment and feel like nothing was accomplished. Nor do you want to rush through! Be aware that different appointments are allocated different amounts of time. A first time visit to a new primary care provider may be a 45 min slot at one practice. While an appointment for a specific problem may be a 15 min slot.
  • Prompt your healthcare provider! Ask them what they think about your symptoms, what else it could be, and what tests they will run. This will pull your healthcare provider out of his or her tunnel vision. You want to inspire them to think outside the box. Just in case!
  • If they prescribe medication: What is the medicine for? What are the side effects? When should you take it? Will it interact with any of the medications you are presently on? And will it interfere with your daily life at all? The last thing you want is to go home with a medication that you don’t fully understand!
    If you aren’t happy, say so. Fill out a patient satisfaction survey. Let someone know. Nothing is going to change unless you say something!

Now, if you are reading this and you are saying to yourself, “I can’t be that assertive with my provider,” then bring a friend. Bring someone, anyone, who will advocate for you or just be there for you emotionally so that you can feel supported.

Recently, I heard a talk by August Fortin, an MD who specializes in patient centered care, and he acknowledged that “being a patient is amazingly disempowering.” We all know that feeling, especially when seeing a healthcare provider you don’t know about an issue you might be really nervous or uncomfortable about. But you can take that power back. You should get the care you deserve!

What experiences have you had with a new provider? What tips and tricks do you have to make it an easy transition?

katie-mccuskerPosted by Katie McCusker, NMFA Volunteer, US Coast Guard spouse, and ACNP student

Sick and Tired: Military Kids Need Better Access to Same-Day Care at MTF

Child-at-MTFRecently, when a military spouse at our Association told me she had to take her baby to the emergency room when there were no appointments at their Military Treatment Facility (MTF), I thought my head was going to explode.

I flashed back to one of many similar situations I faced when we were on TRICARE Prime, and my daughter, Kate, was in her ‘ear infection phase.’ On one memorable occasion, Kate started a fever on a Friday night (of course, after the MTF was closed for the weekend). By Saturday, the telltale ear tugging and crankiness were in full swing. I kept my fingers crossed that we could keep things under control with Motrin and Tylenol until the clinic reopened on Monday. Unfortunately, by Sunday she had a 104 degree fever, obvious signs of a ruptured ear drum (I’ll spare you the details), and was crying inconsolably.

I knew we couldn’t wait until Monday for an MTF appointment, so with a newborn crying to be fed and a 20 month old wailing in pain, I braced myself for an uphill battle to find medical care that TRICARE would cover.

I consulted the TRICARE website where it seemed like our only option was the emergency room. This concerned me; did a ruptured ear drum constitute a threat to life, limb, or eyesight? I was terrified of having to foot the bill for an ER visit.

Not willing to risk it, I called TRICARE. They told me to take Kate to a network urgent care and call our primary care manager (PCM) on Monday to request a referral.

I think you know where this story is going…

On Monday, I called our PCM, who refused to give me a referral because the appointment had already taken place. When I called TRICARE back, their hands were tied. Without a referral, they could not pay the urgent care provider. We were at an impasse, and eventually paid out of pocket for that visit.

The reason this particular incident is burned into my memory is because it occurred while I was recovering from a c-section, and we were about a week away from PCSing. My husband’s new unit had orders to Iraq, but the departure date kept moving, causing second and third order effects… most notably on our temporary housing plans. Oh, and we had just learned (from CNN – surprise!) that Army deployments were being extended to 15 months.

Military families lead complicated lives full of uncertainty. Getting a sick child appropriate medical attention should NOT be complicated.

The National Military Family Association has advocated for years to fix this problem.

And, in fairness, things have improved.


At certain locations.

For instance, our old MTF in Virginia, the Woodbridge Clinic, is gone now. It’s replaced with the Dumfries Clinic, which has improved appointment access by adding Saturday hours.

Yet, we still hear of too many instances where families can’t get same-day appointments at the MTF, are refused referrals to urgent care, and are left with no option but the emergency room for their sick kids.

This is just wrong.

As the health care subject matter expert for our Association, this issue is not only my job, it’s personal. Now is the time to fix this problem once and for all. Military families deserve access to the best care, including same-day appointments for urgent issues.

Please help us by signing our petition and sharing your experience with access to same day appointments in the comments below.

karen-rPosted by Karen Ruedisueli, Government Relations Deputy Director

Since When Does MTF Mean ‘Might Take Forever?’


Did you know garlic is a powerful antibiotic?

I didn’t either, until I had lived in Germany on an Army post for a couple months.

One day, my daughter woke up with a fever. It was just high enough to have me worried, so I waited for the appointment line to open for the day, and called as soon as the clock rolled over to 7:30am.

We know how this goes, so of course, I had the number programmed in my phone. All the better to dial quickly. By 7:31am I had navigated (like a pro) through the menu options and found myself on hold, waiting to talk to a representative.

“There are seven calls ahead of you.”


My heart sank. Seven isn’t great. Seven means it’s likely that the appointments for the day will be filled before they get to me. But, being the optimist I am, I hung on the line.

After all, my baby daughter had a fever. She’s never sick, and even after being trained as a nurse, fevers in infants worry me. The hold music starts playing, and I pulled out the thermometer again. I held my breath and hoped.

Nope, the fever was still there. She’s was flushed, and clammy, and crying, again, because I just had to take her temperature one more time.

“There are four calls ahead of you.”

It’s now 7:45am and I am losing hope. I’m bouncing the baby and waiting.

Finally, a representative comes on the line, gets my husband’s social security number, and asks me to explain the problem. I do, and the baby screams, filling in the gaps of my story with her own frantic song.

“The earliest we can get you in is Friday. There is an appointment at two.”

Today is Monday, and we need seen now. Friday won’t work. On Friday, she’ll be fine. Or, as my overly worried Momma brain starts thinking, she’ll be dead.

The only other option is to take her to the emergency room. Germany doesn’t have an urgent care system, and other than the small clinic on post, there isn’t an American facility to go to. However, the German children’s hospital is amazing, if your child needs a hospital; if you have an infant with a fever, it’s really not that great. What I needed was antibiotics for an ear infection, and the reassurance that I was doing the best I could by hydrating and comforting my child at home. What I got was excessive testing in the German hospital, hours of waiting, the stress of not being unable to understand the system, and the flu (probably from the arm rests in the waiting room).

Unfortunately, this situation happened to me again, and again, for the three years we were stationed in Germany.

During our tour there, I was only seen ONE time for an urgent matter in the pediatrician’s office, and that was because I sat in the office and refused to leave until someone could help me.

I learned quickly the best I could do was attempt to help myself. I learned that garlic is a powerful antibiotic… in large doses. And believe me: you really haven’t lived until you’ve tried to get your five year old to swallow four cloves of fresh garlic to treat a suspected ear infection.

I learned Germany has an extensive alternative medicine culture, and in a pinch, I could go to a pharmacy off post and communicate my problems (in terrible German) to their pharmacists. I learned essential oils can help, and sometimes, you just have to suck it up and spend two nights in the German hospital for an issue American doctors would treat as urgent care, and send you home.

This has to change. Our military children deserve better. As wonderful as alternative medicine and emergency rooms are, we shouldn’t be forced to use them because there aren’t enough appointments, or doctors, to go around.

In the meantime, I’m stocking up on garlic.

Have you had problems making an MTF appointment for a sick family member? Please tell us about it and include the approximate time frame (we are most interested in recent situations to show this is a current problem). We will compile your stories and share with Congress and senior DoD leadership.

heatherPosted by Heather Aliano, Social Media Manager