Married to the Military by Meredith Leyva

Author:Meredith Leyva
Language: eng
Format: epub
Publisher: Simon and Schuster
Published: 2009-07-15T00:00:00+00:00

How Tricare’s Coverage Rates

Having spent 10 years in and out of different HMOs paid for by my civilian employers, I can attest that Tricare appears to have the same caliber of health care coverage—and often better. Government health benefits usually are. Those who complain about Tricare typically have unusual circumstances or don’t understand and aren’t willing to deal with the HMO system. HMOs are here to stay, folks, and Tricare is one of the better ones.

The key to obtaining coverage of your specific health care needs is the term “medically necessary.” Tricare has a list of what ailments are or are not covered, but if a doctor says you need coverage, Tricare gener ally will give it. Military doctors and civilians who do a lot of work with Tricare understand this, and they will work with you to make sure your expenses are covered. Yet another reason to establish a good relationship with your PCM!

To my knowledge, Tricare Prime is the only HMO plan in the world where it costs nothing to have a baby, from your prenatal vitamins to your postpartum checkup. Well-baby, well-child, and well-woman visits also are covered, as are visits for mental health care, obesity, infertility, birth control, and genetic testing. There are some exceptions to coverage, such as artificial insemination and abortion (unless the mother’s health is at risk), but much of it is left to the discretion of your doctor.

Maternity care is particularly generous and generally hassle-free under Tricare. If you want to go to a civilian physician for your OB care and there is an MTF available, you’ll have to change to Tricare Standard and pay a copay. If you wish to use alternative methods, such as a birthing facility instead of a hospital, you have the option to do so, but with costs being shared. The only outstanding item not covered is “lay” midwives (as opposed to the medically trained and licensed superhero nurse midwives), but no insurance covers such minimally trained, nonlicensed caregivers. Doulas are welcome to attend births at MTFs.

On a final note, be sure to verify your Tricare coverage and DEERS report every year or every time you move. These guys process up to 25 million claims each year and are known for occasionally “dropping” beneficiaries out of the system. This comes as a shock when the purported beneficiary is either denied care or receives a whopping bill for health services. A once-per-year verification is worth the trouble of a phone call compared to a bureaucratic nightmare of a dropped beneficiary.

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