Question on the insurance ???

[NicoleH10]

Ok, so my Husband has started his paper work for the finical and going onto enlisting. My question to everyone is how is the Navy insurance, how does it work, can you go anywhere, or will you have trouble finding doctors? We were told since he is married with 2 kids he would receive medical, and BAH right he he starts boot camp, and the only reason I am asking is we just learned we are expecting... :) So any type of comments or help would be appreciated Thanks!! 

[sailorwifenmom]

Hi!  First, congrats on the baby (though  you might want to talk to his recruiter, because having more than 2 kids before he's done with boot camp can cause him to have to get a waiver to enlist if he's not already on Active Duty).

As far as the insurance goes, there are a couple of parts to it.  Dental has recently switched to Met Life.  I haven't had a need to use them since they switched, so I can't speak for how well they work, though I've been told it's very similar to the old company.  You do have to choose to have the dental insurance, and there is a small fee.

For medical insurance, you will be Tricare.  There are a couple of versions of Tricare, and you pick which one you want.  Tricare Prime works like this -- you are either assigned to a Doctor (they call them your PCM, or Primary Care Manager, as far as Tricare goes) on the base where you're stationed, or you opt to go to a civilian PCM.  Sometimes, depending on the availability at the command you're at, you aren't given the choice to go off base, and you have to use the medical facilities on base (they have the full "range" - peds, ob/gyn, etc...).  As long as you are going on base, or to a PCM "in Network" (Tricare will give you a list of Dr's in their network if you're going off base), then you don't pay anything.  You can also fill prescriptions and etc at the base pharmacy for free.  You can request a different PCM if you don't like the one you have and switch to another one in the Network / at the base.  There is no co-pay, you don't have to worry about a catastrophic cap.

If you want more choices over your PCM (say, you have a Dr you really like, but he / she isn't in the network), then you can opt to be Tricare Standard.  Then, you go to the Dr you want, and either you or your Dr's office files the claim with Tricare, then they pay a percentage of the bill (some Dr's will require you to pay up front, then you get reimbursed, others will wait and bill after the claim is filed).  You are then responsible for the remainder of the bill (up to 15% of the bill).  You have a catastrophic cap. 

Finding a Tricare provider isn't that hard, even if you aren't near a base (then you start to get into Tricare Prime Remote and all that, but it works basically the same as regular Tricare Prime).  Our daughter is going to college and isn't near a base, and they gave her a list of Drs she could see.  She's had several visits, including physical therapy, and not had to pay. 

There are pros and cons to both, depending on your family's circumstances.  You can go this site and get a lot more detailed information about each. 

http://www.military.com/benefits/tricare

[NicoleH10]

Oh thank you so much this info is very helpful!! 

One question what do you mean by having more than 2 kids can cause him to get a waiver to enlist if he's not already on active duty... Im sorry Im really new to all this! 

[sailorwifenmom]

While the Navy can't dictate your family size once you are on Active Duty, they do have limitations on family size when you are trying to enlist, for several reasons.  Here's a link that can probably explain it better than I can. 

http://www.navycs.com/blogs/2011/01/07/navy-dependency-waiver

It shows a chart that explains who can enlist without needing a waiver, who would need a waiver, what level each particular waiver has to go to (for example, with your current family size, he has to get a waiver already, but the increase in family size could "bump" you to the next level or waiver requirement), and what you need to do to get the waiver.

The site does a much better job of explaining it.  I would strongly encourage you and your husband to look at it. 

Good luck!!

[meagan5220]

I am on Tricare Standard and I really like it a lot. I am able to pick my own doctors and go where I need to as long as they are in network then I am not paying too much out of pocket. I paid $50 for my doctor visit for a gi doctor bc she wasnt in network. Then I paid another $90 for $7000 worth of tests over the course of about 5 months. So not bad really. Its pretty easy to find doctors that accept tricare but you have to be careful and ask if they are in network too :) Each region has a website and it lists the doctors in the area that are accepting tricare. Then I always google reviews or ask around. I am picky about doctors though. Thats why I refuse to be on Prime. I cant deal with being told I have to go see a doctor and I know where my husband is stationed you go in and see whatever doctor is available. I have had doctors almost kill me in a system like that because they didnt know me and prescribed me meds I am allergic to so now I just stay away from it.

[NicoleH10]

Oh thank you this comment is soo helpful!!! Yes I am very picky on doctors as well, and I don't think I would be able to stand not being able to chose! Do you pay extra for the standard? So theres different levels of this tricare then?

[meagan5220]

You are welcome. Tricare Prime is the one where its free and you get seen on base unless its full or they dont have what you need. You also have to get referals for like everything you have to get done. and they can take forever. Standard you pay your copay, dedcutible and all that jazz. I think the deductible is $100 for a family. and the catastrophic cap is $1000 so even if you have a bad medical year the most you would have to pay is $1000 (thats how it was explained to me.) You dont pay extra every month you just pay your copays and whatnot. Thats why you have to make sure you get an in network providor. They are contracted to only charge tricare a certain amount. If you get an out of network providor they can charge more but Tricare wont pay for it. You have to pay the extra. Dental is through metlife its like $30 a month for families I think. There are pretty much two main types of tricare unless you get stationed in certain areas but that isnt super important right now.