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How does Medical Insurance work?
Okay, since I am married to a Reservist and my son is a Reservist, I have no clue as to how to use medical insurance/TRICARE.
So, I was wondering if some of you wonderful active/retired Navy personnel or anyone who knows can please walk me through it...you know "Tricare for Dummies". The dummy being me!
That way I can help out some who have come to me for advice. As right now all I can do is this 
.
I CAN provide the link for TRICARE's homepage :-)
Thank you in advance!
FTLW
Views: 217
Replies to This Discussion
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Permalink Reply by Angie on
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FTLW:
For the active duty people, they are automatically enrolled in Tricare Prime (they can not change to Tricare Standard) and their spouse and children are automatically enrolled in Tricare Standard. If they want to have their family as Prime, they need to go and change it to Prime. It doesn't cost the military member any thing for the family to be on Prime or Standard, it is just a choice of which ever they want to use.
With Tricare Prime, they have a PCM (normally on a military base) which they go see that doctor for everything and if they need to see a specialized doctor, their PCM puts in a referral for the other doctor. It is like an HMO
With Tricare Standard, they can see a doctor out in town and they pay a co-pay and sometimes they even have to pay up front and than file a claim themselves. If they try to get seen on base by a military doctor, they are put on a waiting list, and lots of times doesn't get seen by the military doctor. It is like a PPO.
Does that help?
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Permalink Reply by FireTeamLeaderWife aka FTLW on
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Yes! Thank you!
Now, for the questions (LOL)
PCM?
If there is not a PCM (I am guessing here that it means something like PCP...Primary Care Physician) on base...or medical facility...who or what does the servicemember got to/do in that situation?
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oh..sorry PCM is Primary Care Manager guess it would be the same thing as PCP (Primary Care Physician).
If they are stationed away from a base (as all military bases have some type of medical facility on them), they (The Sailor) would be Tricare Prime Remote, they would either be assigned a civilian doctor that takes Tricare or they would contact Tricare to tell them who their doctor is (after the Sailor finds one who takes Tricare insurance)
If it is the spouse, and they are not near a base...it is up to the Sailor if the spouse goes Tricare Prime Remote or Tricare Standard. If Prime remote, same as above that I said for the Sailor. If they are Standard, they can go see what ever doctor they want (mind you for spouse or children only, not for the military member) they either end up paying for all of it and file a claim (themselves) or some doctors will file the claim for them and they just pay a portion depends on the doctors.
Does that answer your question
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Yes, thank you very much!
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Even if you don't live near a base, if you call Tricare, oftentimes they will still have Doctors "in their network" in your area and it's very easy to do the claims. Our daughter is going to college and her school is too far from a base (about 90 minutes or so, if I remember correctly) for her to be seen there. They gave her a list of Drs, she picked one, and hasn't had to fill out any claims stuff. And that's even with her back being messed up and getting a referral for physical therapy. Her physical therapist is also in her network and submits all the paperwork, and her treatment has been covered.
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It really isn't bad (usually - out of the ordinary stuff can be a pain lol) overall :-)
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Permalink Reply by kazzam(SHIP 13 DIV 313) on
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Thank you so much and yes this does help. I will pass this on to my Sailor as he leaves in a week for Japan. Sounds like he will need to get established with a PCM on base in Japan. We were going to visit Lukes Air Force Base here in Phx, but decided to just wait. Thanks again and have a great day~
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