Tricare has come a long way, there’s a lot of information and changes that have happened recently that can be confusing, but know that you do have options! It took me years to even understand my healthcare coverage and rights as a spouse when it came to my medical care.
If you are a Military Spouse and your service member is active duty and not overseas (and you are not on Medicare), then you have 2 -3 choices when it comes to your healthcare plan:
- Tricare Prime - With Prime you will be seen at the closest MTF (Medical Treatment Facility) and given a PCM (Primary Care Manager) you will need a referral for anything your PCM cannot fulfill. Sometimes, if they cannot accommodate you or you don’t live within certain distance of a MTF you will be assigned to a civilian physician within network and they become your PCM. The perk of this plan is there are 0 out of pocket expenses and no medical bills.
- Pros- No out of Pocket Costs, no Copays.
- Cons- Have to be seen at MTF unless told otherwise. You need referrals for everything. There can sometimes be long waits, and you don't get to pick who you get to see.
- Tricare Select (formerly known as Tricare Standard) - This plan gives you the flexibility to see civilian providers within network with no referral needed. You will however, pay a deductible and copays up until you reach your cap, which all depend on the rank, and what year your service member joined.
- This is the plan my kids and I have been on because of negative MTF experiences, living in the DC area with long drives and difficulty getting appointments we switched, and we budgeted it in to fit it into our yearly budget.
- Pros - Freedom to choose…You can pick any provider you like who is in network, no referrals needed.
- Cons - Copays, a deductible, and an annual catastrophic cap (max amount paid out per year).
- US Family Health Plan – This is a newer option and only if you live in certain areas of the United States. Basically, you find a provider through the list of private physicians affiliated under specific health care systems in your area. There are no costs or out of pocket expenses.
- Pros- No out of pocket expenses, seen by a civilian dr. of your choosing within the designated network.
- Cons- not everywhere, choices are limited and hard to get in.
With all plans, you must first enroll and no you cannot change plans freely like once before but have to enroll or dis-enroll between specific times. If you are unsure what plan you are on check out Tricare’s plan finder. Every plan is different and they all have their pros and cons and as a spouse you have to navigate what is best for you and your family
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