New TRICARE Co-Pays Leave Military Families in Sticker Shock
MJ Boice, Staff Writer
Military families are speaking out against the steep increase in their out-of-pocket health care costs. NMFA has received numerous emails from families experiencing sticker shock after receiving bills for their 2018 provider visits. The only groups not facing these higher copays are families of active duty service members (ADFM) on TRICARE Prime and TRICARE for Life patients over 65.
Many families are blaming TRICARE contractors for the increase, but this time, Humana and HealthNet are not to blame. These copay hikes are coming from our own Defense Health Agency (DHA). It’s just an unfortunate coincidence that the DHA decided to implement these copay increases during TRICARE’s contract transition. The resulting impact has left military families to weather this perfect storm without an umbrella.
There are several reasons NMFA is concerned about these copay increases.
- When it comes to cost sharing for office visits, military families no longer have a health plan that is on par with the high quality commercial plans found in the civilian community. If a military family member requires physical, speech, or occupational therapy on a regular basis, they will now face higher costs than those in a high quality commercial plan.
“I took my daughter for her first occupational therapy visit yesterday and the therapist said TRICARE has not even been paying half (for office visits) and expecting patients to pick up the rest.” – TRICARE Select ADFM
The resulting impact of these costs may end up discouraging military families from seeking medical care they need, simply because they can’t afford it.
- Mental health copays are now $30 per visit for TRICARE Prime Retirees, $31 for TRICARE Select ADFM, and $41 for TRICARE Select Retirees. These amounts are higher than those in high quality commercial plans. After 16+ years of war, we are appalled DHA would create a cost barrier for military families seeking mental health care, especially with such little notice.
“Yes, changes to TRICARE were advertised. However, when copays are more than double, emphasis should have been placed on notifying Prime members that substantial out-of-pocket costs were being made to their insurance.” – TRICARE Prime Retiree beneficiary
- We are alarmed by DHA’s careless approach to setting copay amounts for TRICARE Select; a plan that covers more than two million beneficiaries.
“The 20 percent (it costs) to see a non-network provider is actually cheaper than the $31 copay to see an in-network specialist for several of our doctors.” – TRICARE Select ADFM
TRICARE Select was marketed as an improvement for military families, similar to a Preferred Provider Organization (PPO). But some copays are so high that it’s actually cheaper for families to see a non-network provider. A PPO is designed to steer care to network providers through lower out-of-pocket costs. Why would anyone choose to pay more out-of-pocket just to see an in-network provider? Will these dramatically higher copays impact a patient’s adherence to treatment plans? We don’t know the answer to that, but neither does DHA. They didn’t consider any of this as they were setting the copay amounts.
- Where is all the money going? Savings from copay increases aren’t even staying within the Military Health System (MHS) to improve health care for beneficiaries. The ‘savings’ are being ploughed into military readiness.
We agree that readiness is critical, but military families shouldn’t be the ones to fund readiness or military family support programs through cuts to their own health plan benefits.
Premium free health care is a unique benefit. It’s a large part of the compensation and benefits package designed to recruit and retain service members, despite the extraordinary sacrifices of military service. We appreciate the fact that TRICARE is provided without hefty monthly premiums, but the value of this benefits is now being outweighed by higher out-of-pocket costs for military families.
How do you feel about the increased out of pocket costs? How has your family been impacted? Please share your experiences in the comments below.
My son goes to OT once a week, co pay from $12 to $30 every week is expensive! He needs to go twice a week but who can afford that. I need physical therapy but quite after two appts because it cost $30 per visit. I rather just wait until I can no longer handle the pain.
There needs to be a change, how can we do so?
Does anybody know or have suggestions on how we can get this changed?
Not happy with this change in co-pay…almost double. I will be notifying my congressman as well. If president Trump knew about this, it would change…someone needs to be held responsible here.
Dont waste your breath or time contacting your Congressional Representatives. They do not care. I have been regularly emailing Collins, King and Pingree for years and all I get is form letters. Computer word search form letters.
When the word Military Veteran is flagged you get a form letter stating how proud they are for your Military Service now. They are minutely concerned for our active duty personnel in harm’s way and the medical coverage they will get when they separate or retire. And you will pay when you retire.
Coming in the near future, there will be no retirees getting care in Military Treatment Facilities space available or otherwise.
Whoever is responsible for this atrocity should be fired. Those people fail to understand anything about the impact of catastrophic illness such as cancer, both on income and health. They apparently want us to rely on the VA? Thanks, sure. Cut our quality of care so we die sooner and let them live happily ever after. Before those “”people”” came up with these new rules we had tight but workable finances. Now, the unpaid bills are adding up.
As a retiree AND a Health Care Provider(Physician Assistant),
It just chaffs my hide that many of my patients, on government assistance, have only a $2.00 copay.
Lets see;
Serve and sacrifice (low numbers)- $30.00 copay
Civilian without any service (high numbers)-$2.00 copay
WHAT’S WRONG WITH PICTURE?????
The huge increase in co-pay is unbelievable. I am angry DoD allowed this to happen. I’m a cancer patient and have to see my oncologist and surgeon frequently. My co-pay for office visits has increased from $12/visit to $30/visit – 150% increase! My hospital stay co-pay has increased from $25/admission to $150/admission – 500% increase!! I will be undergoing weekly chemotherapy at the end of the month. I cringe to think of the amount of money I have to spend for each weekly visit. These hikes in co-pay are hitting us hard. Shame on our government!!
The huge increase in co-pay is unbelievable. I am angry DoD allowed this to happen. I’m a cancer patient and have to see my oncologist and surgeon frequently. My co-pay for office visits has increased from $12/visit to $30/visit – 150% increase! My hospital stay co-pay has increased from $25/admission to $150/admission – 500% increase!! I will be undergoing weekly chemotherapy at the end of the month. I cringe to think of the amount of money I have to spend for each weekly visit. These hikes in co-pay are hitting us hard. Shame on our government!!
As a retired veteran that served over 20 years on active duty serving under five Presidents can only tell what I know to be the truth. While on active duty in the late 70’s and married starting in the late 1980’s with 1 and then 2 children I recall under Tricare Prime that the co-pays were as low as $5.00, which was and can be debated by all on this blog, but it was an option available to us to select for coverage. Upon retiring during the Bush administration, I was PROMISED when recruited i the late 70’s was afforded THE EARNED benefit of choosing Tricare Prime for Retirees upon retirement. At the time of my retirement that coverage was unique and exclusive because it’s NOT available to our veterans that serve less than 20 active duty years or otherwise fall in a few special categories. This coverage was comparable to the level of benefits afforded our elected officials in our three branches of federal or state governments after only serving a fraction of the obligation or sacrifices of military members that become veterans. The problem I have with all of this is that veterans were promised through VERBAL declaration by recruiters representing the military/government and then signed a contract(s) that among other things, we AND our families would receive health benefits on the front and back end as retirees.
To that end, every military member that serves on active, reserve duty, PAYS taxes, and as a retiree continues to pay taxes for our pensions. The only outliers are those veterans that may be disabled from injuries of any rating that may may or may not be so severe that it places them in an exempt status that qualifies them for Tricare Prime for Retirees. I have no problem with that and the government needs to keep their promise because the people that choose to serve moving forward will learn otherwise because WE REMEMBER just like those that served before me even if they don’t understand what that means, because we will inform them.
Active duty members today or yesterday have never been paid or compensated on the level as the private sector for the total benefits and OR compensation that they have been afforded or awarded and to take a meat ax to any of that today, is unjustifiable and unacceptable and those parties responsible need to be held accountable.
I’m a relatively healthy and active person, but recent health issues have caused my having occupational and physical therapy as the first step to avoid surgeries. The facility providing the services were very surprised by the increase in out of pocket for me, and so was I. I might as well just forget the initial least invasive way to try and improve the conditions and simply opt for the more expensive surgery. It would be less out of pocket costs for me. Heaven help those poor folks requiring mental health visits. Who ever developed this new hike in costs certainly didn’t think it through or didn’t care. Now that the former military member is retired, we are on a tight fixed income so these co-payments have come at a really bad time. ‘Thank you’ for screwing over the military members who served and their families!
Retired AF – Again, broken promises. Congress and yes, DoD lies to us after they get what they need from us. Both my sons and son-in-law wear the uniform now. I’ve always said we serve, it how democracy stays strong. But now it becomes increasingly difficult to say defend when the very people that made us promises break them. Question; is our leadership (the politicians and bean counters at the pentagon worth defending any longer?
I live in Alabama and have to go every month to see a pain specialist for a back injury I got in the military. Not only did the co-pays go up but the Hospital and the Doctor’s office charge separate co=pays for the same visit. I get two $20 copays ($40) for each office visit and two $30 ($60) co-pays for the back injections I get every quarter. The co-pay increase is bad enough but now the Hospital is charging us twice for the same visit due to some new rule that allows them to change for the office space separate from the actual reason you go to the doctor for. Unreal how they can get away with this.
We were promised free healthcare and dental when we signed up and severed our country for 20+ years. Benefits gets worse every year. But it’s ok as long as Congress gets their free healthcare for life after serving just a few years.
So…it seems to me that I am in the majority whereas I may not be happy with my annual increase, or my drug cost increase, but I could manage. It is the physical therapy copays which make this medical care unaffordable for many. Personally I am trying to figure out how a copay for PT is equivalent to a copay for a brain surgeon. I fail to understand where and who, defined PT as specialty care for this high of copay. Can anyone show me the DoD definition that puts PT in the specialty care arena for a $30 copy? Please ????
Why wasn’t there a working video on Tricare web site explaining the increase cost and reason.
It is difficult to complain when many of my friends are paying 10x my monthly premiums. That said…those friends have had good incomes for 25 years. What made our deal a good one was the promise of healthcare at a reasonable cost. I too feel a bit let down in that regard….at $30 per visit, my physical therapy would cost $360 per month. Last year…$144. When on Active Duty (last year) I did all that was asked of me, without hesitation. I risked my life…..
Perhaps the financial realities of the country demand this increase ….though I somehow doubt it.
I just saw this article again, I’d commented in March about it. I’d only been to my PCM one time (in February) and the co-pay they charged was $12 — except they were wrong, it should have been $20. So, instead of billing me the $8 difference, they charged my credit card $20.
Apparently Humana never got the word out to it’s adopted network. And certainly TRICARE’s previous contractor didn’t. Nobody told beneficiaries that the co-pays were more than doubling and the prescription costs were going way up too.
I’m going to have to re-evaluate Prime. With the increases, we may be better off going on Standard. I need to do the math.
For the people saying “thanks Obama”, you need to do your research. This isn’t because of Obama, this is because of the Fiscal 2018 National Defense Authorization Act (NDAA) which Trump signed in December of ‘17.
https://www.aarp.org/health/health-insurance/info-2018/tricare-changes-fd
DON’T BLAME TRUMP! These are OBAMA CHANGES In TRICARE HEALTH CARE COST! “”The changes, which went into effect Jan. 1, (2018) alter the way many Tricare recipients pay for and access their health care. The changes were made as a result of the National Defense Authorization Act for Fiscal Year 2017 that was signed by President Obama in December 2016. The changes to Tricare included in the law aim to modernize and streamline the program, and provide beneficiaries with better care. https://www.aarp.org/health/health-insurance/info-2018/tricare-changes-fd
After my husband’s 20+Yr career, we were ready to enjoy or excellent Tricare coverage at low cost. However January 2018 took away the best benefit of his sacrifice. Our copayments went up from $12 to $30 per visit, a 150% increase. Our catastrophic cap went up from $2000 per year to $3000 per year, a 33% increase. The ABA therapy for our 5yo on the spectrum went from $72 per week to $180 per week. All of these increases are funding “military readiness” not improved healthcare. Military families have already sacrificed for their country, why should we continue to sacrifice our children’s financial stability after retirement? Add to this insult, the constant problems created by the reassignment to Humana Military…our coverage has been dropped and reinstated three times since January, causing hours of waiting on hold, dealing with customer reps that don’t know what they’re doing, and having to call doctor after doctor to resubmit claims that got denied because of a “glitch.” Shame on everyone iin our government and military administration involved in this mess for what they are putting retired families through.
I have had the same issues of being dropped, needing to resubmit claims and even them trying to penalize me because they forgot to deduct a mounthly payment.
I also notnplease within ost of care for my Aspergers child or my immune deficient child and physical therapy Afrer my surgery is just not cost efficient either.
Sad that this is what it has become. I have done 19 years so far and wanted to get my retirement for the health benefits but not sure what those are anymore??
I am a 100 % disabled combat veteran. I am also disabled ssd. I suddenly can not afford my health care and prescriptions. How do I tell my wife who has cancer that we can’t afford her doctors visits and prescriptions!? This is terrible. Terrible.
I cannot begin to describe how awful this is…
I feel… betrayed by our Congress and Senate and President. I gave my physical and mental health for our country and now I just don’t know what to do… what are we supposed to do!? OMG
Thanks a lot OBAMA!!!!!!
I cant understand how the co pays have more than doubled. I am a disabled veteran, living on a retired income. These copays has forced me to reevaluate how I take care of my health and pray that my daughter does not injure herself. I am going through physical therapy and can only afford 1 day a weak. When the doctor wants 3. With old rate (12.00) 3 sessions a week for 4 weeks would be $144.00, Now, with a 30.00 co pay for 12 visits $360.00. So much for keeping stress levels down.
I can’t believe all these changes since January 1st 2018 !!!! Promises made … Promises Broken…….Every time I see a doctor the co pays have gone up. I heard about changes to the system but this is ridiculous…this is what we get in return for serving our country !!!!! What do we do about this !!!!
My understanding was this was President Trumps budget cut. I voted for him thinking he would take care of us. I normally see 3 specialists well thats not happening at 30 bucks a visit not including my PCM. And my son also see’s 2 specialist so he comes 1st before me. Almost tripple the normal visit cost.
The decision to increase copays & premiums was passed by Congress & POTUS 44 in summer of 2016. It’s been “said” Congress is attempting to push as many working-age retirees & families in to the civilian employee healthcare plans instead of TRICARE. Too many retirees & dependents driving up the costs. There is projected annual premium for SELECT & cap increases to $3.5K in 2020. I’m using my VA disability healthcare since it’s cheaper, still paying for kids around $1.5K out of pocket nowhere near the $3K cap.
I received a bill for a specialist under the new Tricare Contract and was shocked to find out that Health Care Net Services under Tricare-West paid $14 for my visit. The allowable amount for the specialist was $44, I paid $30. Are you serious! What I would like to know is how we can get a petition going to challenge this change.
My copays for a regular doctor’s visit went from $12 to $28. Not only that, but Tricare will only pay $44.70 of the $110 bill, so I get a bill in the mail for $37.30 (after the $28 copay). So I pay $65.30 of a $110 bill. After serving for 22 years and being disabled as a direct result, I expected better from the government I served.
We have had to cut back our speech therapy sessions in half because copays have more than doubled and our budget is still the same. What this means is that our child is not receiving the therapies she needs because we can not afford the high weekly copays!
Welcome to Trumpcare. Higher co-pays across the board plus higher co-pays on vital medicines from Tricare Pharmacy. Should have known.
After 24 years of service I thought the military would take care of it’s retirees and veterans who served with a connected problem…unfortunately retiree’s and other members that are in need of specialty care have a copay. This is very contrary to the premise of why some of us joined amongst other benefits and they wonder why recruitment is low…it’s because how you treat your retiree’s, veteran and specialty care individuals, there is no need to join something that is definitely not going to take care of you long term, regardless if it looks good now, the message they’re sending is, IT CAN CHANGE AND YOU WILL FLIP THE BILL. Every month I get badly needed trigger point injections for severe back spasms and selective nerve root blocks every other month for disks that have impinged on nerves on 12 different vertebrae, I pay one cost for the specialty office visit 30.00, one copay for the trigger point injections 30.00 and when I get the nerve root blocks, I get an office fee, 30.00 and an outpatient fee, 60.00. How is the military healthcare system taking care of me? By taking my money from it’s retirees and other people who need specialty care. I wouldn’t be able to get around without these procedures and the military doctors are the ones who sent me to these places in the first place. Unacceptable!
Just contacted my GI Doc yesterday to ask why my bill was so high. First I heard of the increased fees. “Free” lifetime medical was one of the primary benefits that incentivized me to do a 39 year career. Still paying far less than many civilians but way more than promised.
After being wounded in Afghanistan and having a promising career ended early, my family and I now face increased health care and student loan costs because of my medical retirement. This seems to be the exact opposite of how this process should have gone.
Big shock having surgery. Initially had to pay for hospital stay and thats it. But then my surgery happened after the change and got slapped with hospital bill. And forget physical the roof. That cost allmost tripped. Not sure how I will pay for my sons medical treatment. 29 yrs of military and a disbled vet. Thanks President Trump I backed you and you screwed us with your budget cuts. Did the medicaid holders get cuts for doing nothing for this country.
I had shoulder surgery with needed physical therapy sessions post op. Those sessions are 30 dollars each. I can’t afford that and now can’t go to physical therapy to re hab my shoulder. Thanks tricare.
I was diagnosed with breast cancer in December. I had multiple visits to my surgeon along with other diagnostics test and didn’t find our about the deductible hike until the i got a a bill from health first asking for the difference. I understand inflation and co pays have remained for years. I get it. But know I am undergoing chemotherapy where they are billing 3 separate co pays. $30 for the dr $20 for the chemo and $19.96 for the neulasta shot at the end of chemo. Health first tells me they have never billed tricare prime patients for chemo or the neulasta shots yet it’s on my tricare explanation of benefits yet tricare cant tell me if it is correct. they say if it’s at the specialist facility then the specialist copay should cover it so it’s who over is in charge of billing.. say what? who determines the co pays? In the meantime I will be starting 6 weeks of radiation 5 days a week and tricare can’t even tell me if i will have a $30 copay every day i go in on top of the $30 whenever I actually see the radiation oncologist. they don’t seem to have an understanding of their own system. I have noticed that all of the bills submitted tricare only pays half . when I questioned a bill and they saw an incorrect code yet it was approved and paid for they told me i need to go back and tell them to resubmit with the correct code.. first of all that’s not my job and second, you morons have already approved and paid it.
Our providers are charging us prime deductibles when we have standard then not reporting that we have paid $30 at all so that $30 that should go towards our deductible. Second year in a row that I have audited our records to find that is happening. Example–I go in for a routine appt and announce we are standard/PPO and they charge the PRIME deductible although I have told them (all, not just one) that we are NOT Prime…………..then Tricare gets the billing and it reflects that I, as a patient, paid NOTHING. The $30 is not reflected, Tricare pays and then our $30 that should go towards our portion is charged to us via bill. When I call them out they say it is a mistake yet never correct it. Some of the appts are 100% covered (routine mammo, etc) and that $30 should be reimbursed fully to me as Tricare covers it 100% and they keep it. I guess that this is the way providers are figuring out how to make more money in a shrinking Tricare reimbursement world. Meanwhile I am overpaying by $100’s what should go towards our deductible and catastrophic cap that is never being put towards it.
We can no longer afford the mental health care we need. We were so happy to find decent mental health providers close by as we usually have to drive an hour (we live in DFW so that is really absurd to begin with). Now all our good providers want to quit the network bc they are being paid half. They are also just now recieving payment for visits back to Jan 1, which has left us with a balance on every family memeber for the time we apparently owed a $30 copay and paid our normal 12 instead. We have had to quit seeking care until we can catch our balance up. To do this to people with 20 plus yrs of service is totally absurd.
I too have had problems. My provider was the one who had to tell me this month. I had to pay the difference for all my daughter’s weekly appointments going all the way back to Jan.1. She also didn’t get paid at all for her claims for about 2 1/2 months…not to mention her amount being less than she got paid 10 yrs ago. She said one of the other providers went out of business due to non-payment of claims while waiting.
I am running into a huge issue with “”per visit”” not being implemented. If 1 facility has multiple providers (even as far as using the BCBA to supervise the RBT) we are being billed per provider, NOT per visit. They are requiring the facility to file claims as a facility on one form or they will consider it separate visits. I now have a $700 bill (after already paying $500 in copays totally to over $1200 for therapy for only 3 months. 3 month!! $5,000/year for 1 kid and I have 3 that require multiple therapies per week due to disabilities. That does not include all the regular doctor visits we need and pay for and I’ve read that these payments do not count towards out CAP! This is wrong to do to families.
In addition to the higher copay costs we are now being charged 2 copays for 1 single visit to the doctor, one for a facility fee and one for the provider fee. Our contractor is niw Humana, but we had Health Net previously and didnt have this problem. Anyone else getting charged double copays?? If so, who is your contractor?
In addition to the higher copay costs we are now being charged 2 copays for 1 single visit to the doctor, one for a facility fee and one for the provider fee. Our contractor is niw Humana, but we had Health Net previously and didnt have this problem. Anyone else getting charged double copays?? If so, who is your contractor?
I have been a mental health provider for Tricare for almost 30 years. In addition to families’ co-pay increasing, sometimes by double, they have lowered the amount paid to their providers by 30%! When you look at what I as a provider am having to discount and what the families are having to pay in increased co-pays, Tricare is now paying me roughly half of what they did last year.
I have always been so grateful for TriCare and the health benefits provided during and after our family’s 22 years of active duty service. Each of our 4 sons was born in a military hospital. We too have been hit hard by all the new co-pays and coverage changes. Sometimes I really wonder where the decision makers think the money comes from…it feels like they just look at numbers on paper and neglect to consider the millions of impacts each decision they make will have on living breathing families. To C. Joyner who commented on March 12th that only the person wearing the uniform should get the benefits…phooey on you. Our 4 sons and I served this country alongside my husband every day of that 22 years and my husband would be the first one to say so. Where would you suggest we get our coverage? Kind of difficult to set up any kind of serious career when you’re constantly moving or your presence is required at home…because there is no one else there to handle things. These are sacrifices we took on willingly; patriotism, honor, good healthcare and a retirement check are some of the reasons we thought it was a reasonable decision.
My family is under Tri-Care prime retiree and I share the same opinion as many others on the price hikes. I understand that increases were coming to keep with inflation and the challenging times that we live now in 21st century. However, these increases were done incorectly without proper management. It’s hard for many to accept double the price and some cases even more than they can afford. I will really have to pay attention my medical needs. It’s shame this action toward our military community. God Bless to all.
I gave up 30 years of my life so my husband could serve his country..with honor..
Just found out my husband has cancer..more than likely from being around all the fuel and crap from flying and now we have $30 coming out of our pocket for all his apps..like we can afford this crap!!! UGH!! GRRRR!!!
There is absolutely NO we can continue to do business the way we have in the past without some sort of sacrifice, especially for those receiving benefits who did not don a uniform to earn them but rather due to their association with someone who actually did. Rationalize how you will; however, costs associated with providing services for association beneficiaries are almost triple of those who actually earned them. Your anger is misdirected. It’s high time copays increased but the tragedy is it doesn’t include everyone it should. Bottom line up front is if YOU wore the uniform YOU should receive free care. The rest should pay and should have been paying long ago.
I tend to agree with you C. Joyner. I joined the military when I was 17 and was permannetly medically retired after 5 surgeries on my back after 24+ years active duty. The MEB personnel tried to give a 20% VA rating but I pitched a fit and demanded a boatd visit in Texas. I was supposed to be there for 3 days and had to stay 3 weeks after the board could not determine a rating. Mind you the medical board consisted of 3 officers: pilot, civil engineer and a podiatrist yet my condition was vascular and nuerology! I was able to get 80% from VA but was medically retired while still on medical leave and had no idea if I was “fixed”. Well I wasn’t and due to my last surgery I have permanent nerve damage in my arm & hand. I was retired 5 years ago and have been on meds for the last 10 years. I can’t work and I am a single mom. Although I feel for others who need medical for their dependents I should not have to pay more copays because TRICARE has so many subscribers. My children sacrificed a lot due to my career but I was the one who sacrificed my life for 24 years and was injured do to my job. My one one child is now an adult and has her own medical and soon so will the others. However I will always need to see medical specialist and will never work again. I think that the actual retired member should have a different plan than dependents. Similar to the dental plan we had when we were active duty. We had free dental and had to take our dependents off base and pay a copay. I have much respect for military families, including my own, but they were not serving on the front line…I was. I know many will not like my position but your spouse and kids were not working 16 hour days while doing back breaking work like most of us did during our career. I want was promised to me when I signed on the dotted line when I was 17.
My husband is medically retired from a catastrophic injury while deployed to Iraq in 2008. I was shocked at my co-pay for a mental health visit for myself last week. I have been left as his full-time caregiver and I need that space to vent, and get feedback and encouragement. It doesn’t just sadden me, it ticks me off that I was left with this burden and that the DOD/TriCare/Military doesn’t seem to get what it is like to be the caregiver for a young person who will NEVER be the same. My husband died on the battlefield and I was left with a shell of who he used to be. This is insult to injury.
My kids have had to cut their weekly mental health appts in half because of the drastic increase in copays. My husband has TFL secondary to Medicare and they keep denying everything so we have gotten tons of medical bills. He had a life threatening ER visit that they haven’t paid a dime on. It’s not his fault he was medically retired. All these changes are so disappointing and discouraging.
I just found out yesterday at the therapist’s office when they told me the new copay. Evidently, no one knew, and it has been left to the doctor’s office to inform their patients rather than the insurance company. It is shameful. Plus, they told me that they don’t know how much longer they will take TriCare Prime because it cut what they receive by 30% which means that they don’t make anything from seeing these patients. If this doesn’t get fixed soon, I am afraid that we will be searching for a new therapist in a difficult to find field already. People keep pushing single payer health care. They should look to this disaster to see what their future would be like if they got it. Fewer doctors and higher fees, that is what they will get.
My wife and I have Tricare Prime and our co-payments have increased. To make matters worse my wife is going to have to have surgery and that will cost us $150 per night. Now we find out Express Scripts is going to charge a co-payment, we still don’t know what’s happening there.
Our primary care doctor still isn’t on the list, we’re about to lose all our specialist and if that happens, we have to get all new specialist.
Since our primary doctor hasn’t been accepted yet, we are without a doctor, my wife became very ill and we had no Dr.! This is totally unacceptable.
Forget calling, you can never get someone to answer and when they finally answer they have no answers for your questions.
This is so pathetic.
One of my major complaints is the co-pay for physical therapy and mental health, have almost tripled from $12 to 30. Now that my daughter had knee surgery and my husband is recovering from shoulder surgery both of which need three times a week Physical Therapy. We are paying for six visits weekly. Thats $720 a month for physical therapy for proper, healthy and effective recovery! AND then, there is calling in to get answers to questions of which their websites are NOT functioning the way we were told AND…..being a TRICARE PRIME retired from active duty, being told be a chat person ‘trying to help me’ that my Tricare select does not cover ‘that’! WTF! And to have this other ‘person’ ARGUE with me!? Untrained at itz best! BUT all hope is not lost. This too shall pass and those who are incorrectly teaching/informing others will have there judgement day!
just curious. How much did co-pays for congress healthcare increase? Why do we keep taxing the little guy… higher healthcare cost mean less people will get the care they need because they can’t afford it. This will lead to pre-mature deaths, decreasing the patient population thus saving money because they will have less beneficiaries… it’s win win for the DHA!!!
I have a child with special needs and his appointments have gotten much more expensive. We had to cut some of his planned therapy. I have never had to pay so much for healthcare under Tricare. The worst thing is that if any of us need to see a doctor it has gotten more expensive. It was frustrating since my wife is a diabetic and her medications are not covered 100% anymore. This extra cost for lifesaving medication make us make a decision on food or medication. That is a sad state of affairs for a soldier that has faithfully served his country for years. I don’t see the reason for the change. This is a WTF moment for my family.
I broke my ankle in November and waa paying the normal copay. Once 1 January 2018 came I could only see PT once a week and the Orthopedic every 6 weeks. Since Fort Knox has become a Healt Clinic instead of a hospital it took 2 weeks to see an Orthopedic for my ankle. Now Ft. Knox will stop seeing Retirees within the next year. What the heck am I supposed to do? The VA takes care of my disabled husband, Thank Goodness. Our copays have gone up over 50% and these brave men and women should have free health or very low cost health care and the very best of it.
I am a widow of a retired army service member who had agent orange. I am on Tricare for life at age 71. I think they just want all the older members to die as my co-pays on my prescription drugs has sky rocketed. I have c.o.p.d. am diabetic and now cannot afford all my medications.
A person should have been notified of the change from free to 7 dollars for each generic prescription and higher for brand names. What is next! We should be kept informed of changes.
Thank you for your service. No more free anything.
NOW PAY UP OR ELSE. Thanks republicons.
My husband is retired, 20 years, we have never received free health care. We have always paid our premiums, on time, for tricare prime. This year we were informed that our premiums would increase. That’s it. Third week of January, I’m at an appointment, my co pay more than doubled! I couldn’t believe it. It wasn’t on the website, we werent notified. Needless to say, I left in tears, unable to go to my appointment. I have many health issues, that have required multiple surgeries. I have had over 25 appointments in one month before. Now I have had to cut all my appointments, delaying my treatment and healing. It’s not affordable. There was no gradual increase. No notification to plan for it. God forbid, I get in a situation, or worse, my husband gets in one where he has to to the emergency room. That went from 30.00 to 150.00. This will cause more deaths in my opinion because nobody can afford the treatment they need.
My husband served our country so he has to now pay a substantial amount to be healthy. Shame, shame, shame.
“I will take care of the veterans like you wouldn’t believe.” —- Trump on the campaign trail. Enough said.
Our daughter’s therapy went from 12 dollars a session to now 30! Once a week at two hours at a time it’s like 240 dollars! We can’t do that, it’s outrageous. Now, we have to cut that in half and our daughter won’t get the help she needs. WTF? And don’t forget the much higher costs of urgent care and “”specialty”” appointments that are also 30 dollars. It’s insane! We thought that 20 years in the military, fought in 2 wars would get us at least much discounted healthcare and prescriptions. We DID get that, NOW we are not.
Express scripts copays are up as well. It’s come to a point that you have to decide to take your meds or not. Bralder
The cost of care for someone that give their life for all of us and the families that fellow through the years shouldn’t have to worry about medical. 20 years my husband did and the healthcare is roller coster of payments. When my husband was active with full pay give me the copay but now he makes less then half of that pay, plus we have to pay a yearly fee you charge us like we are rolling in the money. Some can’t afford all of the fees and now care will go down because of it. I paid 60 for a ER visit for my son because he got sick in the middle of the night. Who just has the extra funds, even if you have a saving well that will be spent fast because retires and family has to be seen off post and bam copays. Thanks for my husband and family that did 20 years moving and being without a father at home at times. We shouldn’t be paying those that retire give up to protect us, why can’t we find funds support those that served this country.
I have a child with special needs who has multiple therapy appointments a week. I was not aware that there would be a copay increase. My son needs the therapy and I’m trying to figure out how we can do this! I’m afraid we are going to have to cut his therapy!
I’ve had three mental health appointments. With a cost of $30-60 a week I won’t be continuing.
The claim by DHA our co-pays would be going up is completely untrue in our family’s case. We were completely taken off guard. The doctor’s office told me there were already three other people that morning that also had no knowledge. My husband is a disabled vet after 23 years of service and unfortunately I am disabled as well. We have numerous medical appointments. Now, everyone is considered a specialist outside of your primary care doctor. My husband recently had a major surgery and requires Physical Therapy 3 times a week. One of my specialist physicians recommended physical therapy for me as well. I declined it as we would be spending $180 a week just in PT costs. Furthermore, the referral process is a nightmare . In the hospital, you can have many different medical staff seeing you and then find out later they are not in network There is so much waste in military spending which could be eliminated and put toward our care. I am angered they expect those who have served to cover mismanagement. Call your representatives, senators and any other groups , organizations that impact military care! It is tragic that are veterans, and all the families have a fight of another kind after already doing so serving our country.
I have 2 autoimmune diseases. I went for my infusion for one of those diseases, to be told I have to pay $700. My oral medication and inhalers have tripled the cost. We can’t afford this!!!
I work in a small, private, Mental Health Office and I feel your pain. It is horrendous. However, not only have they increased your copays, they have DRASTICALLY cut what they pay the In-network providers. They dropped the allowable charge $37. So, providers have lost $37 per visit, per client. With 70% of our clients being Tricare, it has impacted us hard. I am sorry that they have done this to you, and us. For all you veterans have been through for our safety as American citizens, the sacrifices by you and your families, this really is a slap in the face. This needs to be fought from both sides – Tricare users and physicians!
With the increased copay for retirees $30.00 per visit is quite high. It really discourages beneficiaries to get services or continue to receive services because it’s so costly. I am considering reducing services received on a weekly basis because of the increase. It’s a financial hardship
Thank you Republicans.. During the Obama years. Ted Cruz in the senate, and PAUL Ryan in the house, in there Republican budget one of the ways to pay for huge tax cuts for the ultra rich and huge corporations was To End Military Disability pay and end Military retirement pay until you turn 65 .. Plus tear apart Tricare (stand by this is just the beginning) .. The Justification for this was we are an all volunteer force..
But the senator can retire after 2 terms, with much better benefits . And they only work 120 days a year if that…
It has made a considerable impact on our family. My daughter has several medical issues and the increase of the copays has really hit us hard. She will no longer be able to attend her weekly therapy sessions, we can’t afford them with all of her other appointments. We were promised free health care when we joined the military and now we don’t even get affordable health care. What a great way of thanking us for our service.
As an Air Force retiree, I was appalled after finding out my monthly medical charges had innreased by over thirty dollars. Doesn’t seem like much until you start including the family. We were told that Tricare for Life personnel were excluded – thanks so much for the warning.
I finally received notice in the mail that I will have to start paying copays for my medication. We are tricare prime adfm. This was to start Jan 1 but I only got the notice last week. They pushed us to go on this home mail order program with express scripts for our free prescriptions only to now start charging us. Now I’m fighting over a billing issue I didn’t even know about and I’m going to have to start switching all my meds back to base. Sad.
I was shocked to learn that we have to pay a copay for prescriptions as active duty family members with Tricare Prime Remote. I was even more shocked when the prices went up at the beginning of the year. We have three Class II prescriptions which cannot be ordered from Express Scripts, so we now pay $33/mo for those. Additionally, we are now being charged a copay for Express Scripts, which is another $21 every 3 months.
Families stationed in remote locations should not have to face expenses those near military installations do not.
Not right most retirees went in the service for benefits, one of them being free medical. How can you start charging for it, most can’t afford it.
We retired just as the transition was taking place and they somehow managed to switch us from prime to standard first screw up.. we have a child inn the spectrum who requires Speech and PT…. no matter how many time I have called they still have not paid for all of his therpahy.. leaving us now with a $650. Bill for the ones they didn’t pay and the new $30 copays.. 28 yrs of service and this is how the screw over the retirees family.. we are about to drop therapies cause it’s becoming to much..
I was shocked when I went to my mental health appointment and found it the co-pay went from $12 to $30 without any notice. I called TRI care to check if this was indeed correct. The person told the reason for the increase they had not been one in years.. I think it awful when people cannot afford get counseling due to the increase.
Ginny. I’m so sorry for your loss. I cannot imagine your pain. I pray there can be positive resolution so that we can all have affordable access to desperately needed services. The entire situation is apalling and shocking that such little light has been shined on the subject. I have been writing for almost 2 months to newstations, newspapers, NC representatives and calling every single US Senate Committee on Armed Services….. to no avail. Thank you NMFA for this article!!! Ginny, I know this may sound strange, but I have found great comfort, coping strategies and peace by following Trent Selton on Youtube. I lost my Momma 5 years ago and I miss her more everyday! This video and countless others have taught and comforted me so very much. I pray they will help you too until you are able to resume your counseling as well!
Physical therapy jumped up to $30 copay which usually requires multiple visits a week for multiple weeks. That comes out to $240 out of pocket for one month assuming you only need 2 days a week. Again, discouraging people to get proper care which could lead to surgery or other severe treatments which would cost tricare more….doesn’t add up.
As a medically retired family of 6 on select our costs have gone through the roof, and co-pays were just the start. Our medication costs have tripled overnight, and we have had to choose between food and essential medications like ventolin and inhaled steroid asthma controller, the two medications were $74. In 22 years we have never seen a cost for
Medications like that. Someone needs to stand up for the retirees who live on a limited budget.
I have tricare prime and I also work at a physical therapy office. I can say first hand how disappointed tricare patients are when they are informed of the cost increase. I understand we get by cheaper than commercials plans but an increase from $12 a visit copay up to $30 is a little too steep.
My son has been going to the same office for speech and occupational therapy for almost three years. Up until February, we had only been paying about $15/$24 a week. Now it’s $62 for two 30 minute sessions a WEEK. Tricare isn’t even covering half of his bill now either. Also, the provider was not aware of the change and had us pay on “the deductible” Oct-Dec and is now making us back pay… but is not considering what she charged us Oct-Dec to 2018. Where did that money go? $15 to $62 a week and not even covering half is a huge difference for something my son cannot go without. Dealing with the doctors, referrals, and the entire system on post is ridiculous or we would switch. Extremely disappointed and, sadly, not surprised!
I’m confused. Co-pays, even at $30 or 40, really aren’t that much when compared to the cost of other things. And with Prime you know there aren’t going to be any surprises. You don’t get a bill for anything else when in the network with proper referrals. My network provider copays this year have still been just the $12 or $15 (I don’t remember, except that it hasn’t gone up much in a decade).
I used to pay $12 per visit for our daughters PT/OT/Speech/ABA. She saw the provider twice a week totaling $24 per week and resulting in $1,248 out of pocket per year without the additional visits on days school was closed and summer break which was manageable. On January 1st, TriCare changed the rules and the provider must now charge per service vice per visit so it is now $120 ($30 per service) per visit or $240 per week totaling $12,480 per year. Fortunately we have a $3,000 cap but at this pace, we will hit it by the first week of April. I completely understand increases but this much this quick puts an undue financial burden on families.
I think some research should also be done into what the new contract allows for a Mental Health visit….from what I have seen and heard, that amount dropped by 30-35%. So along with a steep increase in copays….the message is sent and received that our Mental Health doesn’t matter that much….going backwards again…… I have also heard that new Mental Health visits have to be pre authorized ….the Benefit as defined by Tricare is that 8 visits are authorized before authorization needs to be given for more….
Our son is a rare disease kiddo who needs multiple specialties and therapies. We dropped ou patient therapy because no one in our area will even bill Tricare now. We can’t afford the out of pocket costs. So he will suffer. His specialist most are now no longer in network which is okay since the 20% is lower but it would have been nice if they would have explained the higher out of network deductible and that it does not count to the in network deductible (ie it is in addition, you are required to pay both) so now we are getting hit for out of network deductible and in network deductible all at the same time. Tricare has totally screwed over retirees who do not live near a military base. We have zero options. We live in SC and the closest geneticist for our son with a rare disease is in Tennessee.
This is unacceptable!!! I have Tricare prime. I have to go to go see the doctors on base but the quality service is so bad that i have question why i even have it but i also cant afford all the out of pocket expenses. I have to go to patient advocate to get any kind of response regarding my health care. This should not be happening every time i need help. No military family should have to suffer with worrying about health care costs or the quality of health care they receive. The sacrifices the military and their families make for this country are so great, there should not be a price put on that to keep our military and their families taken care of.
Doctor I’ve had for 6 plus years is now all of a sudden out of network and the surgery I have scheduled at hospital is now said to be “”out of network”” so I’m going to be hit with huge chuck of the cost. In addition I had imaging done prior to this and could not understand my bills till now, again “”out of network””.. SO WHAT IS IN NET WORK. NO ONE. I went through the so called list of in net work and it’s a joke. No one that can do surgery and no one Id trust with my care.
We have a special needs child and another child that should go 2x per week for OT and Speech therapy but we’ve had to cut it to 1x per week. Our copay would have been $240 each week just for both children. Oir copay is $120 each week. We struggle and no one has answers. It’s helpless and infuriating.
SAD; why is the cost of military readiness being pushed onto the families and veterans health care? Many including myself are reluctant to go to the Dr. If in need. Even beyond this issue, we are retired, live in a military college town with multiple Drs and facilities but still have to drive 50 to 60 miles to a primary Dr unless we switch to select. This would make our copays and out of pocket to much to seek care unless an emergency and mental health, I thought was suppose to be a priority for these men, women, and their families. The health and welfare of our families should be top priority. Healthy families make for healthy soldiers and productive members when readiness is a need, but we should not pay for that.
As a disabled veteran, I’ve seen my co-pays literally double for 2018. Being on a fixed income, this is terrible! DHA – taking affordable military healthcare and making in unaffordable in one fell swoop. Shame on them!
The hikes seemed to hit mental health care providers unaware as well. We lost my husband from a service connected illness Dec 31st. I have my daughter and myself in counseling. In February we were hit with a major bill for both of our weekly counseling Fees for almost two months of visits. Luckily the office allows payments and were understanding at our surprise in the fee hikes. I cancelled my visits so my daughter can attend weekly.