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Thread: Which health care?

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    #1

    Which health care?

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    Which healthcare would you suggest that I go with? I know there are different levels, and I know there are perks and disadvantages. I have read online but I am just getting more and more confused. Can someone simplify and give suggestions? My mom is keeping my health insurance through her as a secondary. What about dental? I am also being kept on my mom's as a secondary for dental.
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    #2
    Well there's only Tricare Standard & Tricare Prime.

    Tricare Standard, you cannot be seen on base. You get to choose your own off-base provider, you may have to pay a co-pay for each visit.
    Tricare Prime, you can only be seen by a military provider unless you have a referral for a civilian provider.

    It's really a personal choice. I'm on standard because I prefer to choose my own doctor.

    As for dental, you don't have any choices as far as I know. You have to sign up for it online & there's a small monthly deductible.

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    Wow! You always have such great info. Im glad this was posted
    Quote Originally Posted by Rissa*Rawr View Post
    Well there's only Tricare Standard & Tricare Prime.

    Tricare Standard, you cannot be seen on base. You get to choose your own off-base provider, you may have to pay a co-pay for each visit.
    Tricare Prime, you can only be seen by a military provider unless you have a referral for a civilian provider.

    It's really a personal choice. I'm on standard because I prefer to choose my own doctor.

    As for dental, you don't have any choices as far as I know. You have to sign up for it online & there's a small monthly deductible.

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    #4
    I have standard as of right now. I can go to any doctor in the country (except base medical) whether or not they accept tricare. If the don't accept tricare I am responsible for 20% of the visit. If they accept tricare I pretty much always have a co-pay of $10-20.

    So it's really up to you. Do you want your choice of doctors and have to pay co-pays or do you want no co-pays, wait on referrals to see specialists if base medical doesn't have one, and only be able to see the doctor they tell you to see?
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    Standard sounds more like my cup of tea I am really picky about my doctors, and with my secondary I probably wouldn't have to pay anything. Thank you ladies, so much easier than reading the articles on google.
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    #6
    Quote Originally Posted by lambe91 View Post
    Standard sounds more like my cup of tea I am really picky about my doctors, and with my secondary I probably wouldn't have to pay anything. Thank you ladies, so much easier than reading the articles on google.
    Since you mentioned using your OHI as a secondary just wanted to point this out to you (this is from Tricare):

    "TRICARE is the last payer to all health care benefits
    and insurance plans, except for Medicaid, TRICARE supplements, the Indian Health Service and other programs and plans identified by the TRICARE Management Activity.
    If you have other health insurance (OHI), you should send proof of your OHI to your regional contractor or bring it to a uniformed services identification card-issuing facility. You should follow your OHI’s rules for filing claims and file with the OHI first. If there is a billed amount your OHI does not cover, you may file a claim with TRICARE for reimbursement. It is important to meet your OHI’s requirements. If your OHI denies a claim for not following its rules—such as obtaining care without authorization or using a non-network provider—TRICARE may also deny your claim. However, if you obtain a statement from your OHI showing the amount that the plan would have paid if the claim had met the plan’s requirements, your TRICARE claim can be processed. In these cases, TRICARE will pay its share as if your OHI had paid the amount shown on the statement, as long as the claim also meets TRICARE’s requirements. If you do not submit such a statement, no payment from TRICARE is authorized.
    Keep your regional contractor and health care providers informed about your OHI so they can coordinate your benefits and help ensure that your claims are not delayed or denied.
    TRICARE Network Providers and Non-Network Providers Who Agree to Participate on a Claim
    TRICARE will pay the lesser of:
    • The billed amount minus the OHI payment
    • The amount TRICARE would have paid without OHI
    • Your liability (OHI copayment and/or deductible)
    Non-Network, Nonparticipating Providers
    When receiving care from nonparticipating providers, certain conditions apply. Nonparticipating providers may only bill you up to 115 percent of the TRICARE-allowable charge. If your OHI paid more than 115 percent of the TRICARE-allowable charge, no TRICARE payment is authorized, the charge is considered paid in full, and the provider may not bill you. Otherwise, TRICARE pays the lesser of:
    • 115percentoftheallowedamountminustheOHIpayment • The amount TRICARE would have paid without OHI
    • Your liability (OHI copayment and/or deductible)
    For more information about using your TRICARE benefit when you have OHI, visit www.tricare.mil/ohi."


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    #7
    I know when you have a secondary dental insurance they only cover a certain percentage of what you primary didn't. So if you primary dental only covered %60 of a crown and your secondary covers 40%, the secondary will only pay 40% of the 40% left over. 60 plus 40 doesn't exactly mean your 100% covered, kwim?

    I'm not sure if that's how it works with health insurance but don't be surprised if you still have some co-pays.
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    UGHHH. Fantastic. I don't want the OHI, but my mom is insisting. She thinks DH can't take care of me and that our insurance will be shit. It sounds like it's just going to make EVERYTHING more complicated.
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    #9
    Quote Originally Posted by lambe91 View Post
    UGHHH. Fantastic. I don't want the OHI, but my mom is insisting. She thinks DH can't take care of me and that our insurance will be shit. It sounds like it's just going to make EVERYTHING more complicated.
    I've personally never had an issues with Tricare in general. I've had both Prime and Standard, and I've paid very little, if anything, on both.


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    #10
    Quote Originally Posted by *IGrowPeople* View Post
    I've personally never had an issues with Tricare in general. I've had both Prime and Standard, and I've paid very little, if anything, on both.


    Tricare is the best insurance I have ever had. Everything I have needed, which hasn't been much, has been covered very well. I mean I still have some co-pays but, it's still worth it, IMO.
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