The little things, part 2: Health insurance. Who knew?

As a uniformed member of the U. S. Armed Forces I have been very fortunate when it comes to health care.  No matter what malady I came down with or injury I suffered medical services were always there, and they were always free.  Everything is covered, from bullet wounds to brain surgery to chipped teeth.  Pretty nice benefit to have, particularly considering the occupational hazards that come with fighting our nation’s wars.

I have never had to really think of healthcare as something outside the purview of my job, but with my transition from active duty to retirement it rose in prominence from “interesting” to “important”.  The need to obtain health coverage was discussed at the various transition briefs, but I didn’t really pay close attention because the actual date of my reintroduction to the civilian world seemed so distant.  Time passed, though, and before I knew it my EAS was just around the corner.  So, after spending some time rooting through the enormous pile of transition related pamphlets, booklets, and notes that I had amassed over the last few months I found what I was looking for: a handout from the TAP/TAMP class that had “TRICARE: Transitioning from Active Duty to Retirement” emblazoned across the top.

Score!

I read the handout, and it had just enough information to point me in the right direction so that I could find a real person to explain it all to me.  In my case, that person is a very nice lady who works on the 6th floor of the Camp Pendleton Naval Hospital, and she took pity on my when I showed up in front of her counter in my quest to ensure that I didn’t enter civilian life unprepared and uninsured.

She also educated me on the ins and outs of health insurance.  It turns out that there are several different insurance products that I could choose, and each had advantages and disadvantages when compared to the others.  Although I am eligible for healthcare through the Veterans Administration, my family isn’t.  Needless to say taking care of myself and not my family is a non-starter, so I had some decisions to make.

The first decision was which level of TRICARE did I want?  There are three basic levels.  As a retiree my family and I are automatically enrolled and covered in two plans:  TRICARE Standard and TRICARE Extra.  These plans don’t have monthly or annual fees, but instead are pay as you go, or “cost for use” plans, so although they are free if you never use them, it can get expensive if you need medical care.  The difference between the two plans is based on providers; for Standard you can be seen my doctors outside the network, but you pay higher cost shares than Extra, in which you select providers within the network and receive a discount.  Here is a link to a TRICARE flyer that gives much more information on the programs: http://www.triwest.com/en/beneficiary/tricare-benefits/handbooks-and-brochures/Standard_Extra_Flyer.pdf

The other available product is TRICARE Prime.  For Prime you have to enroll and pay an annual fee of $520 a year, which seems like a lot when compared to the free healthcare options is incredibly inexpensive when compared to what people in the private sector have to pay for similar coverage.  That said, it is a benefit that military types have earned it the hard way through at least twenty years of service, a lot of which is hard on the body.  As a result, many retirees have conditions (such as combat wounds, partial deafness, and early onset osteoarthritis for example) that could be classified as “pre-existing conditions” and limit accessibility to a new healthcare provider.  So it all works out.  Here is a link to another flyer that has information on all of the available TRICARE options (of which there are a lot more than I cover in this post):  http://www.triwest.com/en/beneficiary/tricare-benefits/handbooks-and-brochures/tricare-choices-at-a-glance/TRICARE_ChoicesatGlance.pdf

I made my decision.  Prime it would be.  As with all things governmental, though, there are a few wickets to hit in order to enroll.  The first and most important is that you must enroll before your last day in the service in order to avoid any gaps in coverage.  If you don’t seek out the TRICARE office, fill out the paperwork, and give them a check before your retirement date your level of coverage defaults to Standard or Prime.  It can be quite a risk because the potential costs associated with care of you and your family can be staggering should something happen when you are not covered by Prime.  If you don’t get around to enrolling, however, don’t despair.  You can still sign up, but you will have to wait until the next month for coverage to start.  TRICARE follows what is known as the “20th of the month” rule, which means that as long as you enroll by the 20th of the current month your coverage will begin on the 1st day of the next month.  Wait until the 21st, however, and your coverage begins on the 1st of the following month.  Needless to say, it behooves you to sign up before you get out.

There are several factors to consider when you sign up for TRICARE Prime.  As a Marine I never had to select a doctor; all I had to do was go to the Aid Station or hospital and I would be taken care of.  As a retiree, however, the option of wandering into a Regimental Aid Station to be seen evaporated.  I needed to determine who my doctor would be.

Noting my puzzled expression, the very nice TRICARE administrator talked me through the process of selecting a provider: first, she checked to see if there was a clinic within 30 minutes of my home.  If there was a clinic, then that is where I would go for care.  It turns out there was a clinic, but she quickly determined that its patient load was full, so I would have to find another provider.  She printed out a list of possibilities (including pediatricians), and after a quick telephone conversation with my spouse we picked providers.  This step is particularly important for retirees who are moving to a new home because they may or may not have access to a clinic or even a TRICARE provider.  For those moving back to the country or out of the country (because TRICARE is administered differently overseas) make sure to surf through the TRICARE website to see what options pertain to your situation:  http://www.tricare.mil/.

So, after about a half hour with the most helpful and cheerful TRICARE administrator I had completed the application process.  She typed my information into her computer and presented me with a filled-in application which I reviewed and signed.  I handed it back along with a check for $130.00 to cover the first quarterly premium.  She gave me some advice, too.  “Call the TRICARE toll free telephone number in about a month,” she said, “to confirm that you are enrolled and that they received your payment.  If you don’t double check and something doesn’t go through you are not covered.  So do yourself a favor and double check!”

Sound advice.  She had obviously been around government agencies for a while.

So off I went, happy as a clam.  And then I remembered that there didn’t seem to be anything about teeth in the flyer.  Hmmm…

Sure enough, another lesson!  Medical care is different than dental care, so if I wanted my family and I to have dental coverage, I would have to apply for that, too.  And pay for it.  Retirement is getting expensive!

__________

Lessons Learned:

1.  Do some research.  There is always a table piled high with flyers and pamphlets at transition courses and seminars, so do yourself a favor and grab one of eveything that is available.  Then, over a cup of coffee or a cocktail, sort it all out and file it away because you never know when one of those bits of paper will prove worth its weight in gold.  For me, it was the TRICARE transition flyer because it was like the Rosetta Stone of post-service healthcare.  It gave me the basic information I needed to find the right people and ensure that my family and I were covered.  The internet is great, having a sheet of paper with all the info you need precludes frantic Google searches.

2.  Don’t let your retirement date pass without enrolling in TRICARE Prime or you are taking a serious risk.  Even if you don’t want Prime, find out where your base TRICARE office is and sit down with one of the helpful administrators – they are pros who will make sure you fully understand what you are entitled to as well as what the various programs offer.

3.  If you are moving then it behooves you to closely examine which option pertains to you.  This is particularly important for those going overseas because it gets complicated very quickly.  So, if you are headed back to the family homestead on the great plains or the mountains of Tibet make sure to get all of your questions answered before you pull chocks and hit the road – TRICARE administrators are difficult to find at the base of Mount Everest.

4.  Talk it over with your family.  They get a vote.  Healthcare is a big deal; indeed a much bigger deal than I had thought.  Make sure you make the best decision for you and your family that you can.

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