Typically when I hear people talk about how much they hate Tricare or how much of a pain in the butt it is to deal with Tricare, they are referring to Tricare Prime. There are stories of having to wait a week for an appointment to open up at the Military Treatment Facility (MTF). Stories of incompetent physicians misdiagnosing. The notorious wait at the MTF pharmacy for prescriptions. In other words, you may be sacrificing your health by being on Prime.
As a spouse of nearly 10 years, I am living proof that Tricare Prime and Prime Remote have not caused me to sacrifice my health care. I can’t even fathom the thought of switching to Standard. I see no need. Plus, I don’t want to pay for something when I don’t have to. I don’t know about you, but being a one income family with a new baby, I can’t really afford to pay the out of pocket costs that come with Standard.
So let’s take a deeper look at Tricare Prime…
1. You are not “stuck” with a provider
There is often a feeling that physicians at the MTFs haven’t even let the ink dry on their diploma before they see patients. Sure, there are some young guns out there – but hey – every doctor has to start new at some point! Or you come across that old salty doctor who will provide Motrin for everything. They exist in the civilian world too! With Prime you are assigned a physician at the MTF and could very likely encounter a less than stellar physician, but you aren’t stuck with them.
There are other physicians that you can be assigned to. Called for an appointment because you have a fever and can’t be seen right away by your physician? They can cross schedule you with another physician. Believe it or not there are some really fabulous physicians at the MTFs. After just moving back to base from recruiting duty, I was afraid our 2 month old’s physician would not be as awesome as our civilian physician. Apparently I had no reason to worry because our base physician is just as nice and took her time with us. She answered my questions and put any fears that I had at ease. If worse comes to worse, fill out an ICE form so you can let someone know that you are less than impressed with the care you are receiving.
2. Free prescriptions
Okay, there is only so much defending I can do about the MTF pharmacy situation. I have waited and waited AND WAITED at the Camp Lejeune pharmacy. But it’s free. And believe it or not, there is a system to the madness in how they take care of filling prescriptions: active duty patients, emergency room patients, then everyone else.
Did you know there are pharmacies at some Exchanges? You can cut down on the wait time a bit there. If you want to save even more time you can use the refill line so you can just stop by and pick up your prescription or use the mail order system. Seriously, I don’t know why you wouldn’t use the mail system for your routine refills! It’s free, you get 3 months instead of 1 month at a time, and you can have it refill automatically so you don’t even have to remember to do it! I love it!
3. Referrals ain’t no big deal
Seriously, it’s not a big deal to get a referral for a specialist. You just have to see your regular doctor and they’ll put in the request for you. Some doctors don’t even require you to come in if the referral is for something you’ve previously discussed. When I was on Prime Remote and found out I was pregnant, I just called up my doctor and asked for an OB referral. It was done in just a few days.
And guess what? If you had any other HMO type insurance (which is what most companies offer their employees) you would need a referral for specialty care. You can check your referral status online and you’ll also get the referral in the mail. Then it’s still free for you to see a specialist where if you had any other insurance you typically pay a higher copay and out of pocket costs.
4. Tricare Prime travels with you
Traveling is something that Milfams do frequently: PCSing, visiting family, house hunting, training…the list goes on. If your luck is like mine, something always happens when you travel. You can go the whole year without incident and the moment you travel, someone gets sick or hurt. So you make a trip to urgent care. To have the visit covered, all you have to do is call!
At MCAS Cherry Point, there is a specific referral line to call where you have to leave the usual information for a referral: when, where, why, et cetera. It’s that simple! Just make sure you know what number to call or call your provider’s office when they are open to get the correct info.
The caveat? If you are in town and go to urgent care during MTF operating hours and your doctor had open appointments, they might not approve the referral. To me that just makes sense! Typically you would call your doctor first anyway. If it’s that urgent to where you don’t have time to call anyone, you’re usually on your way to the ER.
5. It’s FREE
Like I said at the beginning, why pay for something when you can get it for free? There are no co-pays, no splitting costs 80/20, and no deductible. Just make sure you have your ducks in a row with referrals when necessary and you’re squared away. When my daughter was born, they thought she had a serious heart murmur. She had to have an echocardiogram done in the hospital and another one a month later. Those two things combined cost more than $3500. Could you imagine paying 20% of that bill? I couldn’t…and didn’t! Prime covered it all. (And luckily, she doesn’t have the condition they thought she did.)
A note on Remote
Prime Remote operates much the same as regular Prime. There is a form to fill out to switch to Prime and you can search for providers in your area online. When you fill out the form, you can either write down your physician preference or let Tricare assign you. Some areas do have more of a selection than others, it just depends on where you are. I asked my neighbors and new friends about the doctors in the area and the ones who came highly recommended accepted Prime (a few of the doctors where even former military). Referrals and urgent care referrals work the same as if you were on regular Prime. Prescriptions are slightly different. You get to use a regular retail pharmacy but there is a copay, which can vary. For routine refills you can use my favorite option – the mail! And your care is still FREE!
Tricare Prime has provided my family with quality care within the Tricare access standards and has taken care of our prescription needs at little or no cost to us. Why would I pay when I receive the same quality of care for free?
*Please note that the above information applies to Tricare Prime and Prime Remote for active duty families. Retirees and their families have different costs.