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How would you improve TRICARE?
TRICARE is the military medical care program. There are several different versions of TRICARE, which are made available to active duty, military retirees, members of the Reserve Component, and the family members of these respective groups. TRICARE has several different plans that cover the different groups of military members. You can learn more about these individual programs, including eligibility and coverage, in this TRICARE overview.
In today’s article podcast, we’re doing a roundtable discussion about TRICARE – the good, the bad, and areas where TRICARE can be improved. In this episode, we primarily focus on TRICARE Prime and TRICARE Reserve Select, as those are the plans we have direct experience with. We cover a lot of ground, including some areas where TRICARE shines, some of the issues we’ve experienced, and some of the areas where we would like to see improvements.
Overall, TRICARE is substantially more affordable and offers greater coverage than many other health care programs that can be purchased in the civilian market place. TRICARE is a great benefit, but it does have some downfalls. Join us, as we explore this topic and discuss the value of TRICARE, some issues we’ve had, and some ways to improve TRICARE.
No longer eligible for TRICARE? Learn about health care options available to you after leaving the military.
TRICARE Roundtable Discussion Panel Members
Our panel today features 3 TRICARE participants, one active duty retiree, one active duty spouse, and a member of the Reserve Component:
Ryan Guina, Air National Guard member, and TRICARE Reserve Select participant. Founder of this website, and host of The Military Wallet Podcast.
Doug Nordman, a retired Navy officer, and TRICARE Prime member. Doug is the founder of The Military Guide and the author of The Military Guide to Financial Independence and Retirement (a recommended book about building wealth while serving in the military).
Kate Horrell, spouse of an active duty Navy servicemember. Kate writes at KateHorrell.com, and Paycheck Chronicles @ Military.com.
TRICARE Roundtable Podcast Overview
In this podcast, we discussed several different aspects of TRICARE, including some of the areas where TRICARE shines, some of the issues we’ve had, and some of the areas we believe TRICARE can improve.
TRICARE Eligibility
All Military Members Are Covered. TRICARE is available to all active duty military members and their families, retirees and their families, and members of the Reserve Component (including retired Guard and Reserve members). Plan eligibility and pricing depends on which group you fall into. But coverage can be had for anyone who belongs to one of those groups.
The more popular TRICARE programs are:
Click on the above links to learn more about each plan, including eligibility, coverage, monthly premiums or out of pocket expenses (if any), and other details.
Where TRICARE Shines
In general, we all seem to agree that TRICARE does a very good job overall. There are areas for improvement, but that is to be expected with any large organization.
Personal Anecdotes About Positive TRICARE Experiences:
In the podcast, Doug shared his experience with a recent bout of appendicitis, in which he ended up in emergency surgery. Everything turned out well from a medical perspective. And in regard to TRICARE, Doug never saw a bill or had any issues. Score one for the system!
I had a similar experience when I had knee surgeries while I was on active duty. Our base had a clinic, but not a hospital. So I received an off-base referral. My base doctors and med techs handled the referrals and scheduling, and TRICARE took care of all the bills. I never had to worry about anything.
Kate mentioned her experiences with US Family Health Plan, a little-known TRICARE option available to TRICARE members in certain geographic areas. Kate and her family are able to receive medical care through Johns Hopkins, a top-tier medical facility on the East Coast.
Kate has also PCS’d several times, which presents issues. Each time you PCS, there can be a learning curve. Thankfully, Kate has found that TRICARE is forgiving when it comes to allowing retroactive claims when the individuals were being transitioned into a new TRICARE region, or for similar issues.
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Difficulties with TRICARE
Any large organization will have issues, and TRICARE is no exception. While I’m sure there are some horror stories out there, most issues turn out to be major inconveniences or huge time sucks while correcting the issue.
Because of this, it’s extremely important to stay on top of things and work closely with your provider and billing to make sure everything is taken care of correctly. Mistakes can and do happen. If you experience any issues, you should seek out a TRICARE case manager, or TRICARE ombudsman to assist with your problem. When all else fails, you can file a grievance, which, as Doug mentions in the podcast, is like bringing a nuclear weapon to a gunfight. It gets customer service’s attention very quickly.
Doug mentioned several issues he has had:
- Billing – Doug had a billing issue that dragged on for 6-8 months until he filed a grievance with TRICARE (use this link to file). You can read about Doug’s experiences with TRICARE errors.
- TRICARE Regions – Doug also had issues when his daughter was covered by TRICARE, but attended college in a different region than he was in. You can read more about this experience here.
Kate’s Negative Experiences:
- TRICARE Regions & Billing Problems – Like Doug, Kate had a similar bad “out of region” billing experience with TRICARE. One of her family members had to receive an emergency treatment while they were PCS’ing, and were in a different TRICARE region. Unfortunately, the bill was never paid correctly, even though Kate explicitly informed the billing clerk she was in a different region. She wasn’t aware of this until she was closing on a mortgage two years later – and saw there was a pending collection affecting her credit score. (Here is how you can check your credit score for free and potentially catch similar credit errors).
My Negative Experiences:
- TRICARE Reserve Select to TRICARE Prime and Back. I was activated last year for two months of training. During that time I was automatically moved to TRICARE Prime and my TRICARE Reserve Select membership was paused. The TRS participation was scheduled to resume immediately upon the ending of my orders, but I had a last-minute change to my orders, and they ended a few days early. There was a problem with getting the new orders submitted, and it took TRICARE Reserve two months to get me back in the program. The good news is they agreed to make the coverage retroactive to the date my active duty orders ended. Thankfully, we didn’t need any health care during that time, as it would have needlessly complicated things, and it’s possible I may not have been able to receive care without having the coverage actively in place at the time.
- Availability of Car Providers and More Limited Network. I personally use TRICARE Reserve Select for my health care needs. But my wife chose to purchase health care for herself and our daughters on the Affordable Care Act (ACA) exchanges because those plans offered greater choice in for doctors and networks. This is much more expensive than using TRS for our entire family. But there is something to be said about being comfortable with your medical care provider. I also have to drive twice as far as I would have had I remained on one of the ACA plans. I save money, but my network of medical providers is more limited, and further from my home. It’s important to note that the TRICARE network will vary by location. You will most likely have greater availability when you are closer to a military installation.
Handling a TRICARE Problem
Doug, Kate, and I have all had different issues with TRICARE, and for the most part, we’ve been able to work through the issues before they became major problems. Remember that you are your own best advocate. And that means it’s important to stay informed about your benefits. This includes reading the website, downloading the benefits guides and reading through the fine print, following up with your care providers, and following up with the TRICARE customer service providers.
In general, TRICARE customer service reps want to work with you to find a solution to the issue. So it’s important to treat any issues as though you are working toward a common goal, which is correcting the problem.
Persistence is important. Sometimes the first answer is always no. That doesn’t mean the final answer is no – just that there may be a process that needs to be followed before TRICARE will say yes. (This is the same at most insurance providers, by the way). Kate gave an example of how it can be difficult to get TRICARE to pay for specialized baby formula unless there is a documented need, and certain steps have been taken.
See our TRICARE Reference Guide for important numbers and contact information.
How to Improve TRICARE
TRICARE is a massive organization, so improvements aren’t always something that can happen at the drop of a hat. Their hands are also tied due to Congressional mandates, budgetary limits, and other factors. So our recommended improvements are focused on ease of use for participants, not asking for unreasonable or impossible solutions.
Kate’s Recommendations:
- In general, Kate is very happy with TRICARE and thinks they do a great job. To quote, Kate says, “TRICARE does a pretty amazing job, given what their mission is.” I’ll agree.
- That said, Kate’s primary wish is that TRICARE remains substantially the same. Her wish list is focused on preventing the erosion of benefits over time. Her concern is especially directed toward those who have been retired for some time and have counted on these benefits. As we all know, it’s not easy to come up with extra money when you are on a fixed income.
Doug’s Recommendations / Concerns:
- Financial Stability with TRICARE. Doug’s primary concern is how financially viable TRICARE Prime will be in the future, and whether it will be forced to move toward a system like TRICARE Select or Medicare, with increased premiums or increased co-pays based on a percentage of the expenses.
- Administrative Stability within TRICARE. Changes happen frequently, with regions and providers changing between service providers, prescription medicine fulfillment procedures changing, and similar issues. This can cause problems when the new providers change policies, the databases don’t communicate properly, and there are other unforeseen issues.
- Communication. Doug has had a few issues with his care providers changing without being notified, and he has been marked as inactive in the system because he rarely needs medical treatment. These issues can be prevented by simple emails or letters from TRICARE.
My Recommendations:
- Seamless Transitions from TRICARE Reserve Select to TRICARE Prime and Back. The temporary loss of TRICARE benefits during a transition from Reserve to Active Duty, and back to Reserves is a problem that can affect many members of the National Guard and Reserves. In theory, this is supposed to be a seamless transition. But in my case, I was without benefits for two months while my orders were being corrected and routed through the system. I would love to see this truly be a seamless transition as that would give Reserve Component members more confidence in their health care, and will prevent many future problems.
- Wider Network Access. TRICARE Reserve Select is a great deal for those who are eligible. But network access varies greatly by region. I would love to see wider acceptance of this plan, which would make it much easier for servicemembers to use. As it stands, we use a hybrid health care solution (I’m on TRS, while the rest of my family maintains separate health coverage).
Overall, I’m very happy with TRICARE. The price can’t be beaten, especially for those who use TRICARE Prime. Even TRICARE Reserve Select is a more affordable option than just about any health care plan you can find on the economy. I think Doug and Kate are in agreement on this and seem to be very happy with the overall quality and cost of their health care.
How Would You Improve TRICARE?
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S Rochen says
Dependant wife here, stuck in the hospital 8 days, able to be released 4 days ago. Holding on authorization for a wound pump from tricare to the supplier.. My hospital person has been trying since last Friday to get me out of here. I myself have talked to 3 different people.
1)
Said I wasn’t authorized to be here because I have other insurance ( I do not). Little late now, I’ve been here 7 days already. After emergency surgery. After talking to hospital insurance person while sitting right here in my room.
Said they would get it straightend out.
2)
This AM, said they’d not heard from anyone since decline of admitting last week. I stayed on the phone with her until she supposedly had it all worked out. Including wound vac. Hospital would be faxed to in 45 minutes. (approx 9am )
3)
3 hours later told me they had not heard from anyone since the week before. But I was now authorized to be in the hospital until 2 days before today’s date, so someone had done somewhere. That they’d not heard from anyone about anything.
So now I sit waiting.5 days since I could have been released. My sick husband home alone. My birthday passed. I’m so distraught, but can’t leave without the wound vac attached to the huge hole left behind from the surgery.
My anger and distress is form being on hold, being asked questions by a recording, I don’t have the answer for to ” be connected to the person I need to speak to”. Only to be again and again forwarded to a person that just reads off a screen, direct asked questions. No guidance on how to get the information you need, being left on the phone while they try to contact the person with the answers, that your not allowed to speak to. NO way to call back, someone that knows what’s going on. New person to drag on to, with the same story to drag on, to waste more time to get nowhere. My husband is alone and very sick, I’m another year older since I seen him.