I am going to truly try to be just the facts here, but in the event that I fail miserably… which I probably will: The views in this blog post are mine and mine alone and not representative of Tricare, the Army, the Department of Defense, or anyone else with way better lawyers than I can afford.
Let’s get straight to it. Tricare Select is the best kept secret of the Army. It’s open enrollment season until December 9th and I want you to know what that means for you and your family. I haven’t written a persuasive essay since at least 7th grade, but I’m about to dust-off my old skills and tell you all about why Tricare Select is my favorite thing about the Army and why I will never go back to Prime.
In case you’re wondering what the fresh hell Tricare select is- lemme explain. Tricare Select is the alternative Military Healthcare plan to Tricare Prime (what you’re automatically enrolled in) that allows you to see ANY in-network provider. That means you are seen “on the economy” and not at a Military Treatment Facility (MTF). You do not require referral prior-authorization for specialty care. You also don’t need to see your general practitioner at all for a referral in some cases. For instance: I thought I probably needed to see an allergist. I called one, asked if they took Tricare Select, made an appointment, and went.
Tricare Select is available to active duty family members with no enrollment fee. It’s open to other folks too, but I’m going to concentrate on the active duty family member beneficiary competent because that’s what I know.
Now that you know what Tricare Select is, let’s talk about that money, honey.
First. You do not have an additional monthly insurance payment like you would with Blue Cross Blue Shield or some other healthcare plan. In other words, the only extra cost you are acquiring by switching to Tricare Select is deductibles and co-pays. To further drill down this point: If you don’t go to the Dr/Urgent Care/ER/Receive treatment, you don’t pay anything that month.
On to co-pays and deductibles and catastrophic caps, oh my.
I’m not trying to insult you here, but I had to call Tricare and get a serious refresher course from my girl Margarita at TriWEST on how this all worked. So… here is a graphic explaining what you pay when.
I am going to say this here, say it later, and I might even clap about it in a bit again. ON TRICARE SELECT, YOU WILL NEVER PAY MORE THAN $1000 IN A YEAR FOR YOUR ENTIRE FAMILY’S MEDICAL CARE.
You’ve seen the graphic, now you might want to know what a deductible is and why you gotta pay it. Deductibles are basically a cost share for your care. Tricare pays their portion and then you pay the rest. Sounds ‘spensive, but it isn’t. Each person on my plan has a deductible of $150 with a family deductible of $300. An example: the year that Jack had 2 wrist surgeries and had to be seen at the Children’s hospital for 6 months to ensure his broken bone didn’t curve and he would end up with a T-Rex arm, we still never paid more than $150 in deductibles for allllllaaaa that.
Once you max out on your personal deductible or collectively you’ve all hit the family deductible (even if your individual one isn’t met), you start paying co-pays. Co-pay is a standard amount that is agreed upon between Tricare and the provider that you pay based on who you saw and whether it was specialized care, primary care, or emergency care. Here is a chart of the co-pays that Tricare Select charges. I’ll explain more in a second.
If you are on Tricare Prime, you usually are seen at an MTF. You stroll in, wait your turn, see the Dr, stroll out. No payments needed. Tricare Select requires a co-pay after the deductibles are met. Me, Meagan, just me- I have never paid at an actual appointment. I am always billed after the fact. The last bills I’ve gotten have all been $21 for primary care outpatient visits- re: taking my kids to the pediatrician or going to the general practitioner. There are 5 of us on the plan in my family. An example: I took all 4 of my kids in for a strep appointment last month. It wasn’t $21 total- it was $21 PER kid, per appointment for a total of $84.
You will pay co-pays until you hit your catastrophic cap for the year- if you even do. The catastrophic cap is $1000 for your family. $1000. for. the. entire. year. for. your. family.
Here’s a little perspective for you: the average MONTHLY cost just to have insurance (premiums) for a family of 4 is $910. That does NOT include deductibles or co-pays. On Tricare Select, all you will ever pay for your whole family is $1000 per year. Yes, even if you are capsized on the Titantic II, cryogenically frozen on top of a door in the middle of the ocean, and brought back to life. You still only pay $1000 for the year. If you decide the door is big enough for 2 people, unlike Rose, and your spouse gets frozen and brought back to life too- IT”S STILL ONLY $1000.
I should mention for the people who might be thinking that once they’ve hit $1000, they’re gonna run out and get Botox for those crow’s feet or maybe some plastic surgery to get a Kardashian booty. It doesn’t work like that. The only thing Tricare Select pays 100% for after the $1000 cap is stuff they would normally cover.
Tricare’s Open Enrollment Season is RIGHT NOW. If you enroll in Tricare Select now, you’ll be eligible to start receiving care “on the economy” 1/1/2020. I encourage you to call them if you don’t believe me about all of this or to clarify. They’ll answer your questions and walk you through the process.
Here’s the stuff they won’t tell you:
My oldest daughter, Clara, has sleep apnea. One Friday night, I went to check on her and she was blue. I got her awake and back to sleep with me watching her like a hawk. I called my civilian Dr on her cellphone on a Saturday morning at 6am. Clara had an initial appointment on Tuesday with the BEST ENT we had reasonable geographical access to and her tonsils and adenoids out the following Thursday. I didn’t have to make one single phone call to ask anyone if they would cover it and wait for approval. It was just done. Then, she went to the children’s hospital at Stanford for her sleep study where she was seen by some of the most experienced sleep disorder specialists in the WORLD.
The Army PCSed us when I was 38 weeks pregnant with my 3rd. I called one single OB 2 months before I was moving and scheduled an appointment for when I arrived. I filled out my paperwork, handed them my ID card, and was given excellent care.
When I was applying to West Point, I found out I had Wolff-Parkinson-White syndrome and had to have surgery. It’s genetic. My kids have to be tested with a pediatric cardiologist at 1, 5, and 15. Guess how many phone calls I’ve had to make to Tricare to get their tests approved? ZERO.
Now. I know a LOT of really fantastic Army doctors. I know they’re capable and brilliant, but they’re also tied up in Army bureaucracy and have little to no say over the appointment/referral process. As for me? I’ll leave the cream of the crop Army medical professionals to the active duty Army folk.
Tricare Select is a blessing to me and my family. I will never, under my own will, go back.