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Do You Understand Tricare’s Upcoming Changes?

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Did you know that Tricare is changing? Just when you thought you had a grasp on how Tricare works, it’s going to change.

Here are the things you need to know about the changes that are coming, when they will begin, how they will impact your military family and what actions you need to take.

Do You Understand Tricare's Upcoming Changes?

If you are currently enrolled in Tricare, you don’t need to do anything if you want to stay in the same plan.

Upcoming Changes Are Coming to Tricare

Region Consolidation

Regions stateside will be consolidated from the current North, South and West to simply Tricare East and Tricare West as North and South merge. There are 2 contractors that will cover Tricare East, Humana Military and Health Net Federal Services.

Tricare Select

While Tricare Prime will not change, Tricare Standard and Tricare Extra will combine into one program, Tricare Select. This will happen on Jan. 1, 2018.

Tricare Select will be a self-managed program with a preferred provider network option available. You will not need to have a primary care manager (PCM). This will allow beneficiaries to go to any Tricare provider without a referral.

While change is usually unsettling, some things will improve. Access for beneficiaries to network providers under Tricare Select will be expanded to include more non-cost preventive services from network providers. The treatment for obesity, high-value care and telehealth will be expanded under Tricare Select.

Enrollment Deaadlines

Automatic enrollment for current Tricare beneficiaries will take place on Jan. 1, 2018. This means Tricare Standard and Tricare Extra beneficiaries will switch to Tricare Select instantly.

Throughout 2018, beneficiaries will be able to enroll in or change plans. In the fall however, Tricare will begin an annual open enrollment time.

At this point, beneficiaries will have to decide if they want to keep or change their Tricare plan for the next year. The open enrollment time will begin each year from now on the Monday of the second full week in November until the Monday of the second full week in December.

Under the previous Tricare rules, a beneficiary could change from Tricare Prime to Standard and vice versa at any time. Under the new Tricare policy, beneficiaries will not be able to. All changes must occur during open enrollment only.

The rules for qualifying life events (QLE) will also change. When a QLE occurs, the beneficiary has 90 days after the event to change the Tricare program they are enrolled to different one. Any member of that person’s family can also change their coverage during that time.

2018 will be a transition year meaning you can still change your Tricare program anytime however.

Specific Changes

Prime beneficiaries will be able to get appointments quicker by not needing a referral for some things. Going to Urgent Care without a referral by the primary physician will be included in this.

Select beneficiaries will see a change to finances. Currently there is a cost share that requires the beneficiary to pay a percent of the total care. Under the new Tricare program, Tricare Select will pay a fixed dollar amount.

Tricare for Life beneficiaries will see their benefits preserved but the authority is there to restructure and updated them.

How will these Tricare changes impact military families?

As Tricare changes from a fiscal year to a calendar year period, military families might see a shift in money. If catastrophic caps or deductibles have been reached, now that the timeline has shifted, there will be no increase in out-of-pocket expenses during that time.

Tricare beneficiaries will be divided into 2 groups. All sponsors that joined the military prior to Jan. 1, 2018 will be in group A, which will be grandfathered in. Those who join the military on that date or later will be put into group B, known as the non-grandfathered group. There will be distinct enrollment fees as well as out-of-pocket costs associated with each group.

What actions should you take?

Beneficiaries must enroll in one of these programs or coverage will be terminated. If this happens, they will only be able to get care at a military clinic on a space available basis.

If you are currently enrolled in Tricare, you don’t need to do anything if you want to stay in the same plan.

If you want to change plans, you should do so. Before Jan. 1, 2018, dependents should make sure they are registered in DEERS. Updating your information in DEERS is a good idea.

What questions do you have about Tricare’s upcoming changes?

Is Saying ‘Thank You for Your Service’ Enough for Our Veterans?

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It’s become almost a knee-jerk reaction: see a veteran, say “thank you.”

These brave men and women gave years of their lives to protect our nation. Many have suffered catastrophic injuries, both visible and invisible.

Is Saying 'Thank You for Your Service' Enough for Our Veterans?

Thank you doesn’t quite cover everything that our veterans have sacrificed for the greater good of our country.

As a nation, we owe our veterans a debt of gratitude for raising their hands to protect and defend. It’s not an easy job. It requires a willingness to write that proverbial blank check.

So we say thanks.

Thank you for your service, for protecting our collective national values and assisting other nations in need.

Thank you is not enough.

While troops are on active duty, they get many services provided for them. It’s all in the name of readiness. Our troops get medical and dental care provided so that they are ready to deploy at a moment’s notice. They get a housing stipend or are allocated a room in the barracks to make sure there is a place to lay their heads. There are clothing allowances and life insurance policies and retirement savings plans. Service members have the opportunity to live or deploy around the globe.

All of this is great. You might say that these are the benefits of serving your country. Things are often taken care of or subsidized. It’s handled.

This looks almost glamorous from the outside in. It can seem pretty plush: housing, medical, dental and relocation to cool locations. To the civilian community, these are great, especially in an age of uncertain health care and rising housing costs.

It looks great until it isn’t anymore.

The thing that many non-military connected Americans don’t fully understand is what it takes to live that “plush” life. Troops agree to risk life and limb, in a very real sense. It’s a commitment, to say the very least.

Once military life is over, things change fast. There are, of course, stories of beautiful lives post-service. Veterans and their families who go on to successful non-military careers, they take international vacations and remain in good health.

In one way or another, military service marks troops for life. It’s not something you can ever truly walk away from. Troops from Camp Lejeune are feeling the lasting impact of polluted water. Troops who served in Iraq and Afghanistan are now dealing with health issues as a result of the waste burn pits. Vietnam veterans are still suffering from the results of Agent Orange.

In just the current conflicts, there are over 50,000 known/reported wounded service members. Their injuries range from missing limbs and scarred bodies to traumatic brain injuries and post-traumatic stress disorders. I say reported wounded troops because everyone came back a little bit different.

Thank you isn’t enough for those who have sacrificed almost everything.

Many veterans carry the baggage of their service forever, mentally and physically. Thousands of veterans are homeless, accounting for roughly 11% of the total U.S. homeless population. Other vets self-medicate with drugs and alcohol. They are attempting to battle back against their demons, to soothe their wounds, in any way they know how.

Once they leave active duty, veterans are shunted right back into the civilian world. Their VA health care only covers service-related conditions, and getting even those covered can be a fight. Too many veterans have died waiting to see a doctor. There are some safety nets in place to assist a veteran who may be struggling or in need of additional assistance, but again the wait could be long or the services provided are not the right fit.

Is thank you enough for the 19-year-old kid who is now missing his legs? He will carry the scars of his service for the rest of his life. His blank check, his defense of our freedoms, required that he sacrifice his limbs.

What about the veteran who is working through debilitating mental health issues as a result of her service? Is sharing a reflexive “thanks” on Veterans Day enough recognition? She might struggle to maintain mental normalcy for the rest of her life, requiring ongoing therapy or medication.

Thank you doesn’t quite cover everything that our veterans have sacrificed for the greater good of our country.

But it’s a start.

Keep offering your thanks for their service, please. It starts a dialogue about military service and sacrifice.

Saying “thank you” or asking about a veteran’s time in the military can open the door to changing the way the VA is handled. We can all learn more about veteran-specific health care issues or employment concerns.

When we have these discussions, then we can start to work together to support those who have given so much of themselves in defense of our country.

Thank a veteran this month and start that conversation.

Now it’s your turn. What do you think? Is saying “thank you for your service” enough for for veterans?

 

MilitaryShoppers’ Readers Split on Medical Clinic Pilot Program

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Soon you may be able to get walk-in medical care at your commissary! The Navy is planning to test a new model of clinical health care in Jacksonville, Fl., with a walk-in clinic located in the commissary there.

This program is based on similar walk-in clinics available at big box retailers like Walmart and pharmacies like CVS. Details about specific services available are still being worked out by the Navy. However, the plan is to have the pilot clinic and any future clinics staffed by Navy corpsmen.

When we shared the proposal of this plan and ways that we thought it could be best used, MilitaryShoppers’ readers had strong reactions!

Many people had very positive reactions. An almost equal number of commenters had strong negative reactions. A few had neutral views on the issue.

On the positive side, several readers noted the convenience of one-stop shopping and medical care.

“I would definitely go to a clinic at the commissary,” commented Gena O’Neal. “Save me time and get shopping all at one time.”

It certainly could save many service members, veterans and their families from long drives and wait times for simple procedures.

“(H)aving the flu shots at the commissary in the fall could help ensure people would be up-to-date especially if there are short waiting lines,” wrote Willard Bauman. “Many times the lines in the hospital or clinic are long and the kids really can be unruly.”

This program could be used to expedite already common medical issues, like daily sick call.

“This sounds like a good idea,” wrote Edward J. Hermann. “Under certain circumstances I could certainly see using such a facility like a sick call operation.”

Currently, many service members, veterans, retirees and their families are experiencing long wait times to be seen at a military treatment facility. Sometimes they are visiting the local ER for more serious concerns or when they need a same-day diagnosis and treatment plan. This ties up ER personnel.

“It could cut down the use of the ER, especially on weekends, for those runny noses, colds, sinus, aches, etc., that many times plague the waiting rooms,” Bauman further commented. “The ER personnel could concentrate on true emergencies.”

Others commented on the expanded training capabilities and broadening of experiences for medical personnel.

“As a former Army medical member the idea of a clinic in the commissary sounds great,” Joseph Moorhouse wrote. “The medical personal would receive experience in a broad area of patients and an outpatient clinic in the store would be very convenient.”

Readers Question Food Safety

While many on the positive side cited increased convenience and access to timely medical care, others questioned the wisdom of having these clinics where we buy our food.

“Honestly, I don’t think that would be an appropriate place to see sick people. Why in heaven’s name would one allow germs around the foods that we have to eat?” wrote Dee. “I can’t see anything good coming of that idea.”

Many others echoed her thoughts. Some voiced support for the clinics as a place for vaccines.

“As a place to get a shot, I would have no problem with that,” commented Ken Myrick. “I really do not want to have to be around people who have infectious diseases around my food sources.”

Duane Schneider would completely avoid the commissary if walk-in medical care was added there.

“I would not go to the commissary for medical,” he wrote. “In fact, I would quit going to the commissary because it is crowded enough now without the traffic (of) sick people.”

Alternative Suggestions and More Questions

Some readers offered solutions to the concern about food safety. Several readers suggested opening a storefront in the commissary or exchange complex.

“I do think that the exchange venue would be a better alternative,” wrote Janet J. Bamford. “If the idea really ‘took off,’ it would be another step in the right direction. They are found within the military communities, and usually have longer operating hours. Furthermore, it could be an easier program to implement, if you began with a few shoppettes around the country. It’s unlikely that the corpsmen would be deluged with patients, especially if more than one shoppette in the community is staffed.”

Readers also raised concerns about who would be allowed to access these clinics.

“That sounds like a nice idea,” commented Catherine B. “Would they also treat veterans with commissary and exchange privileges?”

This pilot program is still in the planning stages and the Jacksonville, Fl., test clinic has not yet been opened.

It’s not too late to express your opinion on the Navy’s medical clinic pilot program! Share your thoughts in the comment section.

Would You Visit a Medical Clinic at Your Commissary?

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The Navy is in the planning stages of a pilot program that would put corpsmen-led clinics in commissaries around the country.

The 38th surgeon general of the Navy, Vice Adm. C. Forrest Faison III discussed this idea of revamping Navy medicine to mimic walk-in clinics at large retailers at the conference of the Association of Military Surgeons of the United States last month.

“We’re in the early stages of discussing a pilot program that would develop corpsmen-led clinics that might be in our commissaries or in our exchanges, connected by telemedicine to doctors at the hospital,” Faison said in an interview with the San Diego Union-Tribune. “So if you’re a patient, while you’re in the commissary you can get your health-care needs met by a corpsman, and that corpsman is getting the opportunity to keep his skills up.

“More importantly, because he’s the guy there, he’s developing the confidence he’s going to need to save lives on the battlefield — but in a structured way that we’re providing good, safe health care using telemedicine links to experienced physicians in the rear.”

The Navy is planning to have the first medical clinic at a commissary in Jacksonville, Fl. The details of this clinic including if patients would be required to have an appointment haven’t been announced yet. The Navy also hasn’t announced what type of medical care would be offered at this clinic. DeCA hasn’t said if its organization is in support or even interested in this pilot program.

Yet, despite the lack of specifics, I’m strongly in favor of this pilot program. I hope this concept is implemented at Jacksonville and then replicated at military installations around the country.

Here are 4 situations when I would have jumped at the convenience of a medical clinic at my commissary.

The Overseas Medical Screening Process

I was overjoyed when we found out that the Navy was relocating us to Japan. But before I could get excited about learning the traditions of a tea ceremony, I had to first work my way (and I say work because it felt like a full-time job) through the system of the overseas medical screening process. This process is very detailed and may require multiple trips to your medical clinic.

Imagine if the medical clinic at the commissary had an overseas screening day where you could come in with your medical history and vaccination records and then get your overseas medical screening efficiently completed. Once you’re done with that short appointment, you could stroll into the commissary and pick up some sushi for lunch.

Flu Shots for the Entire Family

Every fall it’s the same thing. Time to make your appointment to get your flu shot at your medical clinic. It would be super convenient have a flu shot walk-in clinic at a medical clinic at the commissary. I could take my children and we could get our flu shots before doing our weekly grocery shopping.

The 0730 Fight for a Parking Space

Finding a parking space at a medical clinic can be…well exhausting. There never seems to be enough parking spaces for the patients on any given day.

The commissary’s parking lot is spacious. Let’s take advantage of that ample parking by moving a clinic to it.

Immediate Medical Care That Doesn’t Involve Broken Bones

As a mom, I know when my child has an ear infection.

I know when she has pink eye.

I know when she has strep throat.

In all of these cases, she needs immediate medical care but our military treatment facility may not have any same-day appointments available so I take her to the emergency room. I would love to see a medical clinic in the commissary that operates as an urgent care clinic.

Right now, we don’t have the details of the Navy’s proposal to put a medical clinic in a commissary. But I think there are a lot of potential benefits. I would use it if it was available to my family. Would you?

What do you think of this proposal to put a medical clinic in a commissary?

Tricare: 2 Urgent Care Visits Without a Referral

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Tricare began an Urgent Care pilot program on May 23, 2016, that extends through May 23, 2019. It allows Tricare Prime, Tricare Prime Remote or Tricare Young Adult-Prime members in the United States to visit Urgent Care facilities twice a year without a referral from a primary care manager (PCM).

Previously, these beneficiaries were required to have a referral from a PCM within 24 hours of going to an Urgent Care facility.

The pilot program allows Tricare beneficiaries to make 2 visits to Urgent Care within each fiscal year, which is October 1 through September 30.

You can now seek help from any Tricare authorized provider. An authorized provider is one that is licensed by a state, accredited by a national organization or meets other standards and is certified to provide benefits under Tricare. These providers are categorized as either network or non-network providers.

If you do receive a referral from your PCM, it does not count against the 2 Urgent Care visits that do not require a referral. If the nurse advice line tells you to go to Urgent Care, it also does not count against your 2 visits per fiscal year.

Tricare Allows 2 Urgent Care Visits Without a Referral

Tricare is trying out a new policy that allows certain Tricare beneficiaries to utilize Urgent Care facilities without a referral from a PCM.

What is Urgent Care?

If you need medical attention within 24 hours and cannot be seen by your PCM in that time, you need Urgent Care. Some examples of why you might need Urgent Care include: treatment for high fevers, sprains such as your wrist, illness that hinders proper breathing (croup), potential concussion from a fall or other urgent matters that do not threaten life, limb or eyesight.

If an injury does threaten life, limb or eyesight, that is considered an emergency. In that case, you would go to an emergency room.

If you are unsure if your illness requires emergency care, urgent care or simply a scheduled appointment with your PCM, you can call the Tricare nurse advice line at 1-800-Tricare. It is available 24 hours a day, 7 days a week.

What type of Urgent Care providers can you see?

You can see both network and non-network Urgent Care providers. Simply make an appointment or walk in to their facility. There are many different types of Urgent Care providers, all of which are approved for you to visit. These include:

  • Family practice
  • Internal medicine
  • General practice
  • Pediatrician
  • Obstetrician/Gynecologist
  • Urgent Care Clinic/Convenient Care Center
  • Physician Assistant
  • Nurse Practitioner
  • Certified Nurse Midwife

While you are authorized to visit these Urgent Care facilities, you may still have to pay network copayments. Visit the Tricare copayments site to determine if this applies to you. Although you do not need a referral to go to these Urgent Care locations, you still need to inform your PCM about the care you received. You may also need to schedule a follow-up appointment.

Who is eligible for this pilot program?

All active duty service members in Tricare Prime Remote, activated Guard/Reserve members in Prime Remote and all other beneficiaries enrolled in Tricare Prime, Tricare Prime Remote or Tricare Young Adult Prime can take advantage of this pilot program.

If however, the active duty service member, Guard or Reserve member is enrolled in Tricare Prime, they are not eligible. All beneficiaries enrolled in the U.S. Family Health Plan as well as those families enrolled overseas are not eligible. Those traveling in the United States who are enrolled overseas still do not need a referral from their PCM, they simply are not limited to 2 visits to an Urgent Care facility. Any care received overseas does not count as well.

If eligible beneficiaries exceed more than 2 Urgent Care visits within a fiscal year, they will be required to get a referral from their PCM or will be charged a point-of-service fee. You can avoid this fee by calling the nurse line before going to an Urgent Care facility.

What do you think about Tricare changing this policy for Prime beneficiaries? When have you used Urgent Care?

How to File an Appeal or Grievance with Tricare

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There are options for your family to reach out to Tricare if you have any issues with medical care received or are hit with an unexpected bill.

How to File an Appeal or Grievance with Tricare

Tricare has 4 types of appeals.

Health emergencies can happen at any moment. Typically, things go way too fast for our thought process and there isn’t the luxury to think things through like, “wait, will this decision eventually bite me back with a huge medical bill?” We go to the doctor without question, so ourselves or our loved ones can get treated.

What do we do when that happens?

Your family can file an appeal with Tricare.

How to file an appeal

In Tricare’s words, an appeal is “the action you take if you don’t agree with a decision made about your benefit.” Because it’s particular to decisions, there are separate appeals you can file. Tricare offers 4 different types of appeals: factual, medical necessity, pharmacy and Medicare-Tricare.

Factual appeal: when payment gets denied or stopped for services or supplies that have either been received or authorized already.

Medical necessity appeal: when Tricare denies previous authorization because they assessed that it isn’t medically necessary anymore. The website outlines:

to be medically necessary means it is appropriate, reasonable, and adequate for your condition.

Pharmacy appeal: when your pharmacy prescriptions gets denied when you deem it necessary

Medicare-Tricare appeal: when you qualify for both, you may need to file with Medicare separately with their terms.

With the exception of the Medicare-Tricare appeal, the others require a written letter within 90 days of the decision. Along with that letter, add all your supporting documents that you have and the decision letter itself. For a pharmacy claim, you need to be specific on why you disagree.

The letter needs to be mailed to your contractor’s address (depending on where you are located). Tricare outlines the addresses in this link. You can also take your case a step further by requesting a formal review, reconsideration of decision or an independent hearing, depending on your type of appeal. That’s why I also encourage you to read more about each separate claim on Tricare’s website. That way you can assess your situation better: factual, medical necessity, pharmacy, and Medicare-TRICARE.

There are ways to continue the process when a decision doesn’t come back in your favor.

How to file a grievance

Also, we expect our medical practitioners to be diligent and appropriate when they work. When you are disappointed with your care, there are steps you can take to file a grievance with Tricare, so that your voice is heard.

Similarly to filing an appeal, you must write down your complaint and send it to your Tricare contractor’s address. The letter should outline the description of the event in question (date, time, name of practitioner, location, etc.). I suggest you be as detailed as possible and don’t forget to include any supporting documents.

Also, if you have any issues with dental care with your Tricare Dental plan, that is included too. It’s not limited to situations within medical care facilities.

In addition to your letter, share your sponsor’s Social Security number and all your information as well (name, address, phone number, date of birth, and sign it!). Tricare has a special website for grievances and I urge you to read it here.

If you’re filing an appeal or grievance for a dependent, include all the dependent’s information including your own. It’s good to share more during an appeal or grievance process that way they have the most comprehensive information. The whole family is covered, whether it’s the service member sponsor, spouse and children.

Have you filed an appeal or grievance with Tricare? What was your experience with the process?

The Do’s and Don’ts of the Tricare Nurse Advice Line

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We should always take our health seriously, but sometimes we’re on the fence about what to do. For example, what if it’s been a week and you can’t beat that terrible cough. Do you need to go to the doctor?

When and How to Use the Tricare Nurse Advice Line

Is this fever too high? Should I take her to the doctor?

For those that need more guidance, Tricare beneficiaries have the opportunity to reach out to a health care professional no matter what time of day on any day of the week with the Tricare Nurse Advice Line. To reach the Nurse Advice Line, call 1-800-TRICARE (874-2273) and press option 1.

The team of registered nurses at the other end of the line are ready to help families with whatever health concerns you have and can lead you in the right direction for self-care or assist you in scheduling an appointment at the correct medical facility.

The Tricare Nurse Advice Line supports a majority of Tricare beneficiaries, including Alaska and Hawaii. Eligible Tricare beneficiaries include:

  • Tricare Prime
  • Tricare Prime Remote (TPR)
  • Tricare Prime Remote for Active Duty Family Members (TPRADFM)
  • Tricare Standard
  • Tricare Extra
  • Tricare Reserve Select (TRS)
  • Tricare Retired Reserve (TRR)
  • Tricare Young Adult (TYA)
  • Tricare For Life (TFL)

Please keep in mind that those enrolled in the US Family Health Plan can’t utilize the Nurse Advice Line. Also, if you’re on Tricare Overseas Program (TOP) traveling to the United States, you can call the Nurse Advice Line for medical advice, but if in-person care is recommended, you need to call your TOP Regional Call Center first.

I can’t stress enough how important it is for you to keep your information updated in DEERS. That will help the staff of the Nurse Advice Line to either, make sure you qualify, give you sound medical advice and to direct you to the proper care at your current location.

My suggestion above is a great example on how the Tricare Nurse Advice Line can help guide you to care for yourself appropriately. I don’t know what it is, but I routinely acquire a cough at the change of seasons. Typically, it goes away after a handful of days, but every once in a while it evolves to a sinus infection. Before making the effort to schedule an appointment with my PCM, I can call the Advice Line to discuss my symptoms with a nurse.

How else can the Tricare Nurse Advice Line help you?

The Tricare Nurse Advice Line is not only wonderful for you to get the guidance for any ailments that come your way, you can call it to discuss any questions regarding your children’s health too. Children seem to come up with all kinds of different issues that parents may not know how to handle, especially if it’s never came up before.

For example, your toddler has lice and you have no idea what to do. The Nurse Advice Line can pass along the tools needed to combat this new and acute annoyance. If there is anything else bugging your little ones, the Nurse Advice Line can assist you.

It’s requested that your child be present at the time of the call. That will allow the nurse to get the most accurate information. Also, you can request the nurse to check in on your child to make sure things are progressing positively.

When shouldn’t you use the Tricare Nurse Advice Line?

If it’s really something that needs immediate attention, call 911 or get yourself or your family member to the emergency room at your nearest medical facility. Most of the time, those situations can be gauged at the moment.

For example, you believe your child broke a bone. Don’t pick up the phone, take them to the ER as soon as possible. Since the Nurse Advice Line is 24/7, they could also encourage you to head to the emergency room ASAP, but don’t hesitate.

Have you used the Tricare Nurse Line in the past? What was your experience with it?

More and More Military Children Are Missing Their Vaccinations

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We all want to keep our children healthy and on track with immunizations, but it can be tricky when you constantly move. Switching doctors multiple times becomes frustrating when you have to repeatedly ask for your medical records to be sent to your new provider. You come to trust and rely on one doctor and then before you know it, it’s time to move again. Transitioning to a new health care provider can be stressful on both parents and military children.

Navigating the military health care system can be quite frustrating and keeping your military children on target for immunizations becomes difficult.

How can you as a parent of military children ensure they get the proper treatment on time?

According to a study published by the American Academy of Pediatrics this year, 28% of military children between the ages of 19 and 35 months are not up to date on their immunizations compared with 21.1% of all other insured or uninsured U.S. children.

The conclusion of the study was that the most likely reason for this is that military children move so often.

Two other reasons for this include the lack of a universal military children immunization registry to collect and store all the records of immunizations as well as incomplete documentation of vaccinations.

Some parents of military children are diligent about keeping track of their kids’ vaccination schedules and continue to make appointments on time no matter where they are stationed. There are an array of circumstances that could prevent military children from receiving regular medical care however that is beyond the parents’ control. There was an Hib (haemophilus influenza type b) shortage between 2007–2009, which prevented many military children from receiving this shot, for example.

Not all doctors recommend the same shots, nor do they all follow the same timeline for when each vaccination should take place. The American Academy of Pediatrics does provide a recommended schedule of vaccinations that is meant to introduce immunizations at a particular period in a child’s development, but it isn’t always followed. Some parents fear the potential risks that may be involved with different shots or getting multiple shots in one visit.

This can lead to some vaccinations being delayed or missed all together for military children.

Finding a new medical provider and getting an appointment each time the military sends a family and their military children to a new military installation can be difficult.

In small hospitals, such as the one on NSF Dahlgren which only has 2 doctors, it can be difficult to get an appointment. It can be just as hard to get an appointment at military treatment facilities on large military installations where there are many doctors because there are so many military children and other dependents trying to make appointments.

How can you as a parent of military children ensure they get the proper treatment on time?

Most importantly, you should keep track of their medical records and not rely on a hospital to do it for you. Ask for a copy of the documentation of each vaccine they receive at the time of that appointment. You can get an immunization tracker card from your health care provider. You will need a copy of your child’s immunizations for child care, school enrollment, camps and international travel and it is much easier to have this on hand than to wait for your clinic to provide one.

Take the time to become knowledgeable about vaccines. If a previous physician has recommended an immunization and your new one does not, or vise versa, you need to know why and be able to make an informed decision as to whose recommendation you want to follow. Some doctors suggest spreading out vaccines while others lump multiple shots into one office visit. You need to understand why and speak up if you want to separate them.

If you are able to, while you are at the doctor’s office, make the next appointment for your military children to have their next well visit. This will ensure that you keep them on time for getting the next round of vaccinations.

If the office does not make appointments that far in advance then put a reminder on your calendar to call closer to the date needed. It’s easy to tell yourself you’ll remember to do so, but life gets in the way and especially when the military sends you and your military children to a new location.

What has been your child’s experience with the military’s health care system? Are they getting their vaccinations on time?

Tricare’s Long-Term Prescription Policy Changes

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It seems as if every time you turn around there’s talk of Tricare changes. It isn’t just talk any more. As of October 1, 2015, there is a big policy change by the Defense Department. It issued a major change to how beneficiaries receive long-term medication that is brand name.

Tricare will no longer allow these maintenance medications to be filled at retail pharmacies.

All reoccurring medications must now be either ordered through the Tricare mail order pharmacy system, Express Scripts, or picked up at a military treatment facility (MTF).

Why is Tricare changing their policy on maintenance medication refills at retail pharmacies?

The reason why is abundantly clear, to save money. The government is always looking for ways to save money and this is yet another avenue they are choosing to go down. 61 million prescriptions, last year alone, were filled at retail pharmacies using Tricare. That cost the government $5.1 billion.

Using military treatment facilities or Express Scripts will save the government 32% on brand-name maintenance medications over retail store purchases. Government officials estimate moving to this new policy will save $88 million annually.

It isn’t just the Department of Defense that will save money. Beneficiaries are forecasted to save around $176 per prescription over the course of a year by no longer paying co-pays at retail pharmacies and instead having them filled at an MTF or through Express Scripts.

How Tricare's Long-Term Prescription Policy Changes Affect Military Families

What will happen if you don’t switch to Tricare mail order pharmacy and instead try to fill your brand name drug at a retail pharmacy? You will pay 100% of the cost.

For immediate needs, new prescriptions for brand-name long-term care medications can be filled at retail pharmacies, but only for a 30-day supply or less. If more than 30 days is needed, the beneficiary is required to get further medication from a MTF or through the Tricare mail order pharmacy.

What happens if you run out or there is an emergency and you can’t get to a military treatment facility?

Tricare will continue to grant case-by-case exceptions for beneficiaries to include personal hardships, emergency and other circumstances. Those requests will need to be made through Express Scripts.

What will happen if you don’t switch to Tricare mail order pharmacy and instead try to fill your brand name drug at a retail pharmacy? You will pay 100% of the cost.

Because it doesn’t cost the government nearly as much, beneficiaries can still fill generic drugs using Tricare at retail pharmacies. Medications that treat acute illnesses and prescriptions that are covered by other insurance can also continue to be filled at retail pharmacies.

What are maintenance drugs?

Maintenance drugs are medications taken on a regular basis for chronic, long-term conditions. These include drugs that control blood pressure, antidepressant medications and painkillers, for example.

Related: Military Families May Need to Pay for ER Visits in the Future

They do not include short-term prescriptions such as drugs prescribed for short term uses, such as antibiotics.

How can you be sure if you need to fill your prescription through Express Scripts?

The Defense Health Agency has a list of drugs it categorizes as maintenance medications. This list will be available to beneficiaries on the Tricare Pharmacy Program website and will be available through Tricare Pharmacy Program Service Center phone system. You can also review the list of brand name maintenance drugs here.

If you are unsure if your prescription should be switched over to Tricare mail order pharmacy system, call Express Scripts at 1-877-882-3335.

What questions do you have about Tricare’s change to long-term prescriptions?

The Ideal Surrogate, the Military Wife

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The Ideal Surrogate, the Military Wife

Did you know that officially, Tricare does not cover surrogacy?

Twenty percent of the 1,000 babies born each year via surrogate in America are carried by military wives, or some say. There is no official data, though you’ll see this number over and over again in so many sources, as surrogacy is highly unregulated. In fact, there is no federal law governing it.

State laws vary on surrogacy and in New York for example, it is illegal and any parties to a surrogacy arrangement can be fined up to $10,000. For a lawyer or agency, if they are caught a second time it is a felony. Other states, such as New Mexico don’t have a law at all. Tennessee, on the other hand, has a statute that expressly authorizes the surrogate birth process.

This makes surrogacy a bit complicated for some hopeful would-be parents. Finding the ideal surrogate in the right location can be a challenge. This is where military spouses come in. For some, they are seen as the ideal candidate. According to multiple agencies, military spouses make up 15 to 20 percent of their surrogates.

Military spouses are considered the ideal surrogates for many reasons.

Doctor examining a pregnant woman

What’s your opinion on military wives being surrogates?

Military spouses are generally independent and self-sufficient from years of being part of the military lifestyle. Their spouses are away a lot and so they must learn to overcome and do things on their own. They are mentally able to handle situations in a strong responsible way. Giving up a baby you’ve carried for 40 weeks is hugely emotional and some feel that military wives are more emotionally equipped.

The Ideal Surrogate, the Military Wife

How do you feel about military wives being surrogates?

Having a sense of duty and a desire to help is something strongly felt within the military community. Many surrogates state that their desire to help another couple have a family is their driving factor. Many people have the assumption that women become surrogates for the money, but looking at surveys and community boards, it is clear that most of them say the No. 1 reason they choose to do this is because they truly want to help another family.

The money however is also a driving factor. Service members do not, in general, make a lot of money. Surrogates are compensated between $25,000 and $50,000, with an average closer to $35,000. This is a substantial amount of money, especially for lower ranked enlisted who don’t earn much.

Health insurance, Tricare, is one reason agencies particularly like military spouses. Tricare pays for all of the doctor appointments, pre-natal care and deliveries. That is a huge savings for potential parents, as purchasing health insurance for the surrogate could cost them up to an additional $25,000 on top of the average $100,000 cost of having a baby though a surrogate via an agency. There is huge controversy in using Tricare however.

Officially, Tricare does not cover surrogacy. Doctors aren’t likely to specifically ask if you are having the baby for yourself. If Tricare becomes aware of this however, they have the right to recoup the cost, which they have done. The Chief of Public Affairs though has said,

We have 9.5 million beneficiaries and our beneficiaries will have roughly 2,100 birthday every week. We have to be focused on making sure everybody gets their care. We can’t be a big police force.

People have very strong opinions of those that take advantage of this loophole. Some don’t see a problem with it at all. Tricare is a benefit they are entitled to as part of a military family. It is their body and their right to do with it as they please.

Others say they are abusing the system. They are using taxpayers’ money to have babies for other people, possibly for would-be parents in other countries. I’m not quite sure how I feel yet even after all this time researching surrogacy in the military.

What’s your opinion on military wives being surrogates?