Should Tricare start charging co-pay fees for visits?

MAJ Bryan Zeski — Tue, 07 Jan 2014 13:59:20 -0500

As the DoD begins to pare down its expenses and tries to bring costs under control, benefits for Servicemembers and Families are likely to suffer. One of the significant benefits - both in terms of cost to the government AND benefit to the Servicemember and family - is the health care. Tricare is great (barring some exceptions here and there) and works great for 90% of the health care issues encountered by Families.

One of the reasons that Tricare costs the government so much isn't the average Tricare user. The true inflation of Tricare costs to the government come from abuse the abuse of the generosity of the Tricare system by Families who use Tricare facilities at the first sign of a sniffle or the first cough. Personally, I abhore going to the doctor for anything and avoid it whenever possible, but I do know people that take their kids in to the doctor when they get a slight temperature.

I think that the DoD could save a significant amount of money in Tricare expenses by requiring a small co-pay fee for doctors vists - either routine, emergency or other. And by small, I mean around $20. This nominal amount wouldn't bring any significant income to the Tricare system - which it isn't designed to do - but would serve as a "monetary motivator" for people who think that the doctor is the only guy who can fix little Johnny's sniffles. If the over-users had to pay for that privelege, I think we would see a significant decrease in the frivilous use of limited Tricare resources and would help to focus Tricare resources on the actual health issues of the Servicememebers and Families.

I'm just curious as to what others might think about limited co-pays for Tricare use. Thoughts?

Response by SFC James Baber made Jan 7 at 2014 4:51 PM

SFC James Baber — Tue, 07 Jan 2014 16:51:35 -0500

Sir,

The only problem with that is the disproportionate price for all ranks, while an O4 could afford $20 a visit, a PFC with 3 kids could not most likely afford the luxury as it would become of taking each of his children for their shots, physicals for school, minor colds, etc., so many of them would be more susceptible to being sick because they junior enlisted could not afford the $60 per child for 3 visits per of these types of normal everyday occurrences.

One of the benefits of serving is the free medical for families, it wouldn't be beneficial for many to stay if they had to start paying for it in the end. That is one of the reasons why I miss Champus, when that was still in effect, the costs were never an issue like they are with Tricare, you never heard about the budget being eaten up by 50% for medical expenses with Champus, Tricare was another way for someone that was in the back pocket of some politician in the 90s that made a mint on selling the idea to the government and they have become just another money pit of an HMO as any others.

If the recommendation of $20 co-pays or any co-pay for services provided for AD and their dependents takes effect, you will lose a major portion of the force and also not have the strong recruitment again like the late 70s and early 80s were.

Response by MSgt Private RallyPoint Member made Jan 7 at 2014 5:06 PM

MSgt Private RallyPoint Member — Tue, 07 Jan 2014 17:06:13 -0500

I have been on Tricare since 1990, as an AGR I should have been on Tricare Prime Remote - but I stayed with Tricare Standard. The reason was so my family could keep going to our family doctor instead of going to one that was designated as a Tricare doctor. Tricare does not pay what the the hospitals, doctors, dentists, eye doctors, etc. bill - they pay only a vary small portion - if your lucky they write the rest off and you don't get stuck paying what Tricare wouldn't.

So I'm not sure where Tricare is costing so much. I know when it was Champus, they were very disorganized - and Tricare as a whole isn't much better. The time it takes them to pay what little they do pay - a lot of times the places would send me to collections because they didn't want to wait that long for their payment.

If Tricare was using military doctors for overseeing the claims - they would have lower costs - since military doctors are paid way less then corporate types.

Response by CW2 Joseph Evans made Jan 7 at 2014 5:10 PM

CW2 Joseph Evans — Tue, 07 Jan 2014 17:10:12 -0500

Part of the problem was an effort to "civilianize" military hospitals. Used to be recruitment was fairly easy because of what it offered aspiring doctors and nurses. But the number of retirees and straight up civilians that work in most of today's military hospitals, including support roles, nurses, janitors, civilian doctors, receptionists, medical billing, pharmacists, etc.

Military Hospitals have been transformed into little more than HMO with most of the money lining the pockets of the Contractor that got the bid for whatever 5 year stint.

The ACA forces most of that money to go back into the system, so if Tri-care has to put 80% of revenue back into health care or government coffers at the end of the year, prices may start going down, but some politician will end up playing shell games with the governments refund on services.

Response by SFC Stephen P. made Jan 7 at 2014 5:21 PM

SFC Stephen P. — Tue, 07 Jan 2014 17:21:10 -0500

Major, your proposal is reminiscent of the tactic used by insurers to discourage use of name brand drugs. The pharmaceutical companies countered by issuing coupons for the difference. What is to stop a care provider from adopting a similar copay reimbursement strategy?

So long as we employ a 3rd party payer system, costs will increase, or services will decrease. In the case of the service-members themselves, I justify the expense as a matter of readiness. With family members, the readiness advantage is indirect and inconsistent.

Our medical coverage disproportionately benefits members with dependent family with no direct improvement to readiness.

My view is that dependents should be removed from military coverage entirely (although gradually).

My wife's health care is her responsibility and mine, not the military's.

Response by SSG(P) Private RallyPoint Member made Jan 7 at 2014 5:54 PM

SSG(P) Private RallyPoint Member — Tue, 07 Jan 2014 17:54:11 -0500

I think there should be a small copay, even around $5, but if you come in for a persistent issue, then the copay doesn't come into play. That may pursuade some soldiers for using it to get out of PT.

Response by LTJG Private RallyPoint Member made Jan 6 at 2015 1:00 AM

LTJG Private RallyPoint Member — Tue, 06 Jan 2015 01:00:05 -0500

Response by SGM Gregory Miller made Mar 2 at 2021 5:32 PM

SGM Gregory Miller — Tue, 02 Mar 2021 17:32:51 -0500

So now we consider a stated benefit of the military (family health care) a generosity? That’s how we lost the no charge health care for life in the first place. Once it’s not “no cost,” the expense will escalate quickly. Then someone with a bright idea will say “well Sir, we never REALLY said their families were part of our health care system. It’s a slippery slope with our government.

Response by 1LT Private RallyPoint Member made Sep 23 at 2022 2:18 PM

1LT Private RallyPoint Member — Fri, 23 Sep 2022 14:18:43 -0400

Noooo