The Pros and Cons

The Pros and Cons

The Pros and Cons

You might want to consider both sides of the picture before you ultimately sign up. This page highlights both the advantages (such as subsidized costs) and the disadvantages (such as limitations on the health care providers you can see).

TRICARE is a military initiative, comprising the health care program for over 9.5 million beneficiaries worldwide. Part of the United States Department of Military Health System, TRICARE covers uniformed service men including active duty, guard / reserve, retired and their family members. As is the case with any type of health care program, TRICARE has certain advantages as well as disadvantages.

TRICARE is essentially medical insurance for the United States military personnel (army, navy, air force) and their families (spouses and children). It means that it will cover all costs related to any kind of medical procedure, emergency or routine checkup. Since healthcare can be quite expensive when you have to pay out of your own pocket, TRICARE is an advantageous service available, which aims to support the military medically. In addition to benefiting from military medical service, TRICARE also enables beneficiaries to take advantage of getting civilian medical services as well. Normally, TRICARE benefits will depend upon and vary according to the type of plan that is in intended usage. TRICARE covers hospitalization and outpatient visits as well as procedures involved in preventive care and maternity care. Immunizations as well as mental / behavioral health care are also included under the coverage program.

Moreover, special programs are available for dependents who require specific circumstantial care, which includes chiropractic care and cancer treatments. Beneficiaries with disabilities may also qualify for TRICARE assistance through an electronic accommodation program. Active duty members along with their families who qualify for any of the four type of TRICARE programs available do not have to pay any additional fees or premiums. The terms of the four available TRICARE programs are also very flexible.

TRICARE Extra is very similar to traditional health care insurance plans. You do not have to enroll before hand and it allows you to visit any available and listed TRICARE Network Provider (TNP). The only item of authorization needed is your authentically issued military or dependent’s identification card and you get to benefit from prompt and reliable medical care. TRICARE Prime, on the other hand enables you to get treatment from the Military Treatment facilities (MTFs). Active duty members and their families do not have to pay any enrollment fees, annual deductibles or charges altogether. Under the TRICARE Standard health plan, you can visit and consult with almost any medical provider, be it civilian or military. Under TRICARE for Life, a retiree and his/her family is also eligible for coverage. This however is possible in simultaneous Medicare insurance, in which case TRICARE becomes secondary insurance.

Furthermore, TRICARE covers most inpatient and outpatient care, which is medically necessary and proven. TRICARE benefits are incredibly easy to access when talking about enrollment and eligibility. The process is simple and easy to procure without the hassle that is synonymous with regular insurance policies. Active duty personnel are automatically eligible for and can access TRICARE instantly. They in turn act as sponsors for their families and get them registered into the Defense Enrollment Eligibility Reporting System (DEERS), and upon the issuance of a family member military ID card, TRICARE is available for usage. It is a comprehensive and accommodating health care plan. The four types of plans offered have unique benefits and aim to cater to every kind of person in need.

Moreover, TRICARE is a vast and complex health care system, which other than covering active, reserve and retired personnel residing in the United States, also covers military personnel and their dependents who are stationed and in service overseas. TRICARE will cover 100% costs for any type of medical attention for the soldiers and their families. It also includes a yearly physical exam, any kind of surgery, be it robotically assisted, preexisting conditions, pharmaceutical prescriptions and other types of medical emergencies, including but not limited to cosmetic surgery as a result of disfigurement due to burns and so on.

Like most healthcare plans, TRICARE too has its drawbacks, which need to be highlighted. Despite covering all medical procedures that are proven and deemed necessary, there are special rules or limits on certain types of care, while other types are not covered at all. Some services or treatments require prior authorization. TRICARE does not cover certain services. For example, TRICARE coverage does not pay for chiropractic services. This type of coverage only applies to treatments that can be administered in a hospital or doctor’s office.

Other instances of medical procedures and treatments that aren’t covered at all include: abortions (unless the mother’s life is at risk), emergency contraceptives, including condoms (however other birth control pills that require a prescription are covered), cosmetic surgery or drugs used for cosmetic purposes such as botox, non-surgical treatments for weight loss or obesity, Alcohol, smoke and drugs cessation products and treatments. Further, TRICARE also does not provide coverage for most dental work. The military has an entirely different and separate insurance program for dental work.

Despite the apparent cost free nature of TRICARE, there are certain charges that have to be borne, which come in the form of premiums, additional charges and annual deductibles. As is the case with benefits, the disadvantages of TRICARE also vary according to the type of plan that is underuse. TRICARE Prime is the most cost effective plan, but it is only so if you live near or on a military base and are able to access the Military Treatment Facilities. If you are a retiree on TRICARE Prime, you have to a $460 enrollment fee. TRICARE Extra will cost you annual deductibles, $150 as an individual and $300 per family member for the year. In addition, for a civilian outpatient visit you will have to bear 15% of the standard negotiated service fees. With TRICARE Standard, you will have to pay a certain charge for every kind of service procured and in case of civilian outpatient visits, 20% will be charged of the negotiated service fees.

Furthermore, TRICARE Standard disadvantages include beneficiaries to prepare and file their own claims, an absence of a primary care manager, and more paperwork that is required for civilian outpatient visits. In addition, TRICARE patients are required to make a co-payment, which is deductible and in which they would have to pay the remaining balance if the bill exceeds the amount, which is allowed and if the care provider is not part of the program. Despite its comprehensive and well-aimed intentions, people covered under TRICARE are often faced with difficulties, especially in civilian hospitals.

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