I admit it. I'm getting kind of sick of people lavishing praise on Tricare and military health care in general (that includes Jon Stewart and Bill Kristol). My husband is actually in the Navy, full time, and we have Tricare Prime. It is managed by a private health insurer which has the same profit motive and shady claims practices as other private insurers. And over the last ten years, we've had significant problems with Tricare paying claims and even getting access to care.
Years ago, military service members and their families had CHAMPUS or CHAMPVA which was set up like Medicare with copays, deductibles and complete freedom of choice in physicians. Now we have an HMO style plan that can be, no is, extremely restrictive. Those who have access to care at big military bases with hospitals have fewer hassles. Those of us not attached to a big base, as we are, are not so fortunate. We're just like anybody else here. Our health care is stretched to its limits too. People tend to think we're all taken care of and get everything free. But that's just not so.
Healthcare Access Under Tricare
When my husband joined in 1998, we were already married and Tricare was still in it's infancy (it was enacted in 1993). There were twelve regions and six regional contractors and whenever you moved (every three years for us), you had to transfer your enrollment. Now there are fewer regions and contractors, four I think, but you still have to transfer between them and care/billing is not seamless.
Tricare Prime, the only "free" healthcare option, is an HMO plan that requires you to use base medical clinics and hospitals for all routine care and immunizations. Sometimes specialists are available but usually not. In theory this works well, the access standards are great. Bases are centrally located for most personnel and families and medical records are centrally located to ensure continuity of care. In practice, this system has never worked welland with two wars on, things are now much, much worse. We cannot access care...at all. Regular appointments are rarely available and urgent care is even tougher to come by. I’ve been waiting six months to get a check up for myself and still no appointments are available. The only pediatric appointments available were for infants under 24 mos. My daughter is still waiting (again, six months) for an appt for her back to school physical. My husband hasn’t seen a medical professional in almost two years. This is nothing to rave about.
Technically, we have the option to request care off-base when our needs cannot or are not being met on base. In practice though, it’s very difficult to be released to a private physician and few providers accept Tricare Prime beneficiaries for care. You generally have to enroll in the non-"free" plans, Tricare Extra or Tricare Standard, which means paying a deductible and 15%- 20% co-pays for every service you receive. Very few active duty personnel can afford those deductibles and co-pays and that’s certainly not the deal they signed up for. In exchange for lower pay, we’re told to expect first-class, FREE healthcare. That’s not what we receive.
Claims Processes and Denials
Again, because Tricare is managed by private insurers, we have the same problems with claims denialsthat other Americans have. In fact, it’s sometimes worse because our frequent moves make it easy for Tricare contractors to engage in turf wars. My husband and I had a claim go unpaid for two years (resulting in credit dings and a private loan being taken out to pay the bill) because Tricare couldn't decide which contractor should pay when our daughter was born in one region and we lived in another.
Old Retirees Are Not Good Barometers
Many of those most excited about the idea of Tricare have had no contact with the active duty side since Tricare was instituted and/or are only familiar with the retiree plan, Tricare for Life (which essentially grandfathered in retirees and soon-to-be retirees with the CHAMPUS and CHAMPVA benefits they knew and loved) and is designed to work with Medicare. It often results in little/no out of pocket costs and a great deal of patient/physician autonomy. If you pick up any Military Times paper, however, you'll find a regular column devoted to TFL issues so it’s not imperfect. Still, it’s important to note that these folks never used fully-implemented Tricare Prime, Extra or Standard and have no basis on which to judge the health care benefits active duty personnel and their families currently receive.
Now, don't get me wrong, I'm glad to have some kind of insurance, however flawed. But as a military family enrolled in Tricare Prime, it's hard to take folks seriously when they advocate this option for everyone; it barely works for us. Find another example, folks.