Flyinhigh

A few months ago we were having a discussion on this site about the Tricare Deductible and how it is computed when other health insurance is primary. My wife has FedEx Retiree High Deductible as her primary and Tricare Standard as secondary. For the FY beginning on October 1, 2015, she has had $375.40 in billed pharmacy prescriptions (nothing like living in the South when you have allergies). Anthem Blue Cross paid about $75 and said we were on the hook for the balance of $300. However, since our pharmacy accepts Tricare, we ended up paying only $37.71 out of pocket. Good deal for us!!
Now here is where it gets interesting. Tricare says we have met the $150 individual deductible for this Fiscal Year based on the pharmacy charges for the last month. I am not going to argue with them, but I would sure like to know how they figure we got to the $150 deductible when our other health insurance only paid $75 and we only paid $37.71.
I tried to talk to someone about this just so I could understand it. We used to get a pharmacy summary from Tricare every quarter but back in May they stopped this. The person I talked with didn't really understand how they arrived at my deductible amount either but they did say I could get the summary via email if I requested it. No email so far, but I am sure it will be here any day.

Jughead135

Did your other health insurance (all sources) pay out for other things besides the $75 (other scrips, or doctors visits, etc.)? You're on the right track--the deductible gets met when any money that TRICARE *would have had to pay* (absent the other coverage) gets paid instead.

I think (but you'll have to verify) that that also applies to negotiated rates. Let's say that $75 bucks your other insurance paid on your behalf covered $150 worth of expenses (due to a negotiated rate between the ins co & your pharmacy), but had you used TRICARE you would've been on the hook for the whole $150--that gets treated as if you had paid the $150 ("credit" toward your deductible). Normal disclaimers, I am NOT an expert, that's just my understanding....

Flyinhigh

Your explanation sounds correct. Bottom line, we have met the Tricare deductible for this FY. The FedEx deductible is a lot easier to track. We really are fortunate to have this coverage. Now, if the government will just leave it alone!!

Lurking

We just went to Tricare retired. I have heard we have to pay some kind of fee either annually or quarterly but have not seen any thing on it. does anyone know how this works?

Flyinhigh

I have been retired since 1992 and up until the time I switched to Tricare For Life at age 65 I have never paid any kind of a fee. My wife is still on Tricare Standard and we pay no fee for her coverage. Tricare For Life has a "fee"; it is called Medicare Part B and you do not get TFL unless you enroll in Part B. Medicare Part B is indexed based on your Modified Adjusted Gross Income, so, depending on your retirement income you may pay more for Part B.

Hrkdrivr

Retired Tricare Prime costs you ~$50/month out of your retired pay, Standard has no monthly premium.

Prime has no copays/deductibles but you're tied to network providers.

Standard has copays/deductibles, but you're not tied to a network.

To beat that horse a little more...we've just about had it with Prime...our PCMs are at a MTF. I didn't realize how good I had it with a Flight Doc assigned to my squadron. Getting an appointment is a whole new adventure. Apparently the mysteries of computer scheduling programs are beyond the modern militiary health care system; you can't schedule an appointment for next month until the 15th of this month. If you call after 1000 on the 15th, all of next month's appointments are gone. Not possible to schedule beyond that. Wow.

How you get treated as a retiree is pretty special too.

C17turtle

Hrkdrivr, have you looked into changing your Tricare Prime PCM to a civilian doctor? I have a civilian despite living in close proximity to a military facility, and he is awesome! I can get an appointment whenever I want and he quickly gets me any referral I have asked for...

Sputnik

You are automatically placed on Standard, which as herk stated has no enrollment fees. If you want to be on Prime, you have to enroll. At which point you have to pay for it.

MikeF16

I swapped to standard. Worth every dime to not have to deal with the medical hobby shop.

Lurking

Thanks everyone. The kids and I were already on standard before retirement so that is no issue. I am in SAT so it is either Standard or half day appoints for every kid issue at BAMC (plus when we got here BAMC was under construction and we got assigned out for peds and elected to keep him when the MTF tried to pull us back) I really like standard and the difference when you don't have access to flight med is so worth the 1K/3K I just wondered if there was something on top of that.