Quote:
Originally Posted by 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.
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