Flyinhigh

I need some advice from some of you who may have gone the High Deductible/Tricare Standard route for your health coverage. My wife is under 65 and is currently enrolled in the Buy Up Plan. We are very satisfied with the plan but the cost went to $507 per month this year and will probably go higher next year. The High Deductible is $133 per month. I tried to talk to the folks at Tricare but it was like talking with someone in the Third World (probably was.)
Here are my questions:
What will Tricare pay when you use it as a supplement? For example; she has an office visit that costs $200 and Blue Cross allows $200. Lets say we have already met our $500 deductible so we owe the copay under the High Deductible plan which is $70. If Tricare only allows $100 for an office visit will they pick up the $70 copay or do they consider the $130 that Blue Cross paid as full coverage for the Tricare allowed amount?
Same question for Pharmacy. What will Tricare pay if the Blue Cross alowed amount is more than the Tricare allowed?
I know that Tricare has a $3000 maximum out of pocket. Does this include copays? The $3000 individual maximum out of pocket under Blue Cross High Deductible does not include copayments.
I know some of you guys have gone this route. I just wondered how it has worked and if you are satisfied. Of course, changes to Tricare could make all of this N/A!!
Thanks for any help.

moondoggie11

The FedEx ALPA Retirement folks may be able to answer your questions or refer you to someone at Tricare who can 'splain it a little better.

BTW, Retirement Briefs coming up on 5/14 and 5/21...must register in advance.

olly

I can't provide any factual answers on Tricare as a supplement to blue cross. However I have been using Tricare standard for over 13 years as primary. Monthly premiums zero (you earned them the hard way), enrollment fee zero. deductible $150 per person, $300 family (i.e. you had $300, wife had zero - you just met family deductible).

In network co-pay 20%, out of network 25%. See whatever doc you like, but consider the in/out of network, and if they accept Tricare.
Home

Family catastrophic out of pocket $3000.

I live in an military concentration area, and almost all the docs accept Tricare except a few OB/GYN partnerships for new patients.(caution the reimbursement rates are tied to medicare rates). If you don't live near/around a military area, your experience may be different. Call your current docs, and ask if they accept Tricare standard. If they don't accept the Tricare rates, your co-pay may be a little more, but is limited to a certain cap- they can't charge more than X% above the reimbursement rate. Rare- but something to ask.

Tricare monthly cost zero~ downside risk is your max out of pocket is $3k/year. (all your co-pays count toward this cap).

At $133/month your annual cost- before co-pay & deductible is $1596.

For me it was a no-brainer- I've gone with Tricare standard as my primary insurance. No monthly payments, and unless one my fam has had significant hospitalization (happened a few years), 11 of 13 years never met my catastrophic cap. (so my total health care outlay is just the co-pay & deductible)

Pharmacy- Prescription Costs
free at mil hospital/clinic. Home delivery- generic free, brand $13, nonformulary $43. Network pharmacy, $5/$17/$44.

I have been Very satisfied with my single payer health care provider, and personally recommend it.

The customer service reps for the North region have always been helpful. The gov contracts out the service for different geographic regions, so maybe you got a bad rep, or your region is not as customer oriented as the contractor for the North region.
Health Net
(1-877-874-2273)
www.hnfs.com

Flyinhigh

Thanks for the information. I am already retired (left 18 months ago) and over 65 so I am on Medicare/Tricare For Life. My wife is 61 so she has a ways to go yet before Medicare kicks in. My concern with going Tricare only is,as a retiree, once you leave the FedEx system you can't go back. So, if Tricare makes any drastic changes I am stuck. Good to know about the Tricare copays counting towards the cap. Sounds like in the worst case I could be on the hook for 3 grand as long as the facility/doctor accept Tricare.

olly

Right - worst case your out $3k for the year. There are forthcoming changes to Tricare pharmacy benefits. The retail pharmacy co-pays may go up some after your first 30 day prescription, but the mail order pharmacy refill option is going down in price, and no changes from mil facility. They're trying to save $ by attempting to curtail the middle man (retail pharmacy network). Pro's & con's to this, but it will save them quite a bit. So far most are happy getting their refills in the mail. However, some drugs are temperature sensitive, and some folks want the face to face with the pharmacist. They is waiver criterion for retail pharmaceuticals.

That is the only proposed change that has been enacted into policy. DoD wants more cuts, as they have to pay active & retiree health care out of the defense budget, but the house & the senate have a pretty good history of pushing back on those proposals over the past 10 years.

Flyinhigh

Again, thanks for the information. I will try again with the Tricare folks on Monday to see if I can get an answer about what happens when the Tricare allowable is less than the Blue Cross allowable. That could be significant because the Tricare allowable is usually less than Blue Cross and two of her doctors do not accept Tricare. I guess I will be filing that paperwork and waiting to get reimbursed from Tricare.