I just heard a report on talk radio that the government wants to get rid of Tricare Prime. My husband has Tricare Prime. I've written about this before. Our co-pay for meds just went up 60% for generic and 75% for non-generic. Plus, all of our doctors are now charging between $12-25 just to write a prescription (if we don't have an office visit).
So I decided to do a side by side comparison of Standard and Prime. When my husband was getting ready to retire from the military, 11 years ago after serving 20 years, we compared the two programs and decided Prime was best for us. At the time, there was a yearly fee for Prime, and then you paid a co-pay for each visit. Standard didn't have the yearly, and you paid 20% of what Tricare allowed. Providers who agreed to take Tricare insurance, accepted whatever the government allowed and wrote everything else off. We have a special needs son, who possibly would need another heart surgery. Prime was the best choice for us, even under those conditions.
Those conditions have now changed. With Standard, you not only pay the 20% (25% if you're retired) of what is billed, but you have to pay whatever wasn't "allowed." In other words, if the doctor bills you $200 for an office visit, but the government only allows $100, you pay $25 (for your 25%) plus $100 that wasn't allowed. With Prime, it doesn't matter what the doctor bills, you pay $12 for an office visit. With Standard, there is no yearly fee, but you don't have a primary care physician. You can go to anyone on the "list." With Prime, everything (including referals) have to go through your primary care physian. So, in order to see a specialist, you have to first go to your primary and get permission. With Prime, you pay a yearly fee. I came in (and for the past 11 years have paid) $460 a year. I don't mind that going up a bit. Nothing else costs the same as 11 years ago. It just went up 13% to $520. I put away each paycheck spread out over a year so that I can pay that when it comes up every June. I JUST found out it was going up. My premium is due in 4 months and I have to make up that extra money.
Also, with Prime, I only pay $25 for out-patient surgery and $30 for emergency room treatment. With Standard, I would pay 25% of what is billed for the ER plus 25% of any doctor's bills. Have you ever been to the ER? You see a doctor, a technician, if you get x-rays, you have an x-ray tech. I'd wager to say you see at least 4 people. So I'd pay 25% of 4 different doctors/technicians, plus 25% of the actual er bill. NOW, I will also pay what is above what they "allow." I've seen what the government reimburses at. They pay 12% of what is billed for an MRI. Let's use $100 so it's easier to figure out. So, the ER will charge me $100 for an MRI. The government will pay them $12. I pay $3, so they actually only pay $9. That leaves $88 that I'm responsible for. Plus the copay of $3 that I already paid, I'm now paying $$91 for that MRI while the government paid $9. This is worse even than Medicaid. At least with Medicaid the hospital has to accept whatever the government pays.
I have stage 4 Breast Cancer. I can't even wrap my mind around how much I would be forced to pay if I had to switch to Tricare Standard. I might as well just die. But I suppose that's what they want in the first place. If you're healthy, it won't cost you anything. And if you're not healthy, the government has no use for you.
