Kelly Montgomery was trying to play the role of both parents to her two boys, ages 12 and 9, while her husband, Greg, was in Iraq fulfilling his National Guard duties.
That would be tough enough in any case, but one day earlier this year, the Montgomery’s oldest son, Brian, suffered an acute case of appendicitis.
What’s more, Greg Montgomery’s employer had removed him from its health insurance plan because his absence from the job lasted more than 30 days.
Kelly Montgomery works a part-time job for which there is no health insurance benefit. When Greg’s health insurance lapsed, the family decided to enroll in TRICARE, the Department of Defense program that administers the health care plan for the Uniformed Services, retirees and their families. TRICARE serves more than 9.2 million beneficiaries worldwide.
Doctors did perform an appendectomy on Brian and he fully recovered after a two-night stay in the hospital.
The majority of costs to the Montgomery family resulting from the operation and a two-night stay in the hospital were picked up by TRICARE. Kelly said TRICARE was a blessing.
“I don’t know what we would have done without TRICARE,” she said. “We would have had to pick up the entire cost and somehow managed. It’s not like we would have had a choice.”
Keeping Coverage While On Deployment
Maintaining health insurance coverage is a top priority for families of the reservists and National Guard. Families need to check with the employer to see whether they can maintain their current health insurance while a spouse is on active duty.
If an assignment lasts for more than 30 days, employers can drop the reservist or National Guard member from their plan — as was the case with Greg Montgomery. If an active duty assignment is for less than 30 days, employers cannot drop members of the Guard and Reserve from coverage.
It is important to talk to the company’s human resource department to get more information on the health plan and to make arrangements to pay your premium while away. If you stay with your current insurance, in most cases you’ll still have to pay the same premium that you’re currently paying or you’ll be dropped from coverage.
That could be a significant amount of money depending on the difference between your civilian and military pay.
If you’ve been called up to active duty for 30 days or more, reservists and their families are eligible for the military’s TRICARE health care and dental program. Guard and Reserve members became eligible for TRICARE benefits in July 2004.
Some members of the National Guard and Reserve who are issued delayed-effective-date active duty orders for more than 30 days in support of a contingency operation are eligible for early TRICARE medical and dental benefits beginning on the later of either the date their orders were issued or 90 days before they report for active duty.
To be eligible for the early TRICARE benefit, reserve members and family members must be registered and TRICARE-eligible in the Defense Enrollment Eligibility Reporting System (DEERS). The member’s service personnel office is responsible for determining the member’s eligibility for the early TRICARE benefit. The services will notify and advise eligible Reserve and Guard members of their TRICARE medical and dental benefits when their delayed-effective-date active duty orders are issued.
If the Reserve member is issued delayed-effective-date active duty orders (for more than 30 days in support of a contingency operation) and the orders are cancelled prior to the member reporting to active duty, TRICARE coverage (eligibility) for the member and eligible family members terminates on the effective date the orders are cancelled.
Uniformed Services Employment Reemployment Rights Act (USERRA) protections for members that ensure an employer-sponsored health plan can be reinstated do not go into effect until the member actually reports for active duty.
Therefore, members and their family are strongly encouraged to consider retaining their employer’s health plan coverage until the Reserve member actually reports for active duty, at which time he/she and family members are fully covered by USERRA protections.
TRICARE has three main coverage choices for health care — TRICARE Prime, where military treatment facilities are the principal source of health care; TRICARE Extra, a preferred provider option that saves money; and TRICARE Standard, a fee-for-service option.
Families can use their TRICARE benefits to receive care at little or no cost at military installation hospitals. They can also visit a TRICARE-network health provider or facility in the civilian community, for little or no cost. Military families also have the option of using any non-network civilian health care provider they choose. But they are responsible for the associated costs pertaining to that care.
Finding the Right Physician
Using TRICARE, families can still see civilian doctors and medical professionals, but they need to check to see if they participate in the TRICARE program. Many physicians do not participate in the TRICARE program, a problem that Kelly Montgomery ran into when her family made the transition.
Her family pediatrician, who had delivered both her sons and had been taking care of them since birth, does not participate in TRICARE. Because the family could not afford to pick up the full cost of even a standard, yearly visit, they were forced to find a new pediatrician.
Aside from the fact that her boys (and herself) had to become acquainted with a new pediatrician, the doctor’s office was about 30 miles from their home in Oklahoma. But Montgomery had little choice because she could not find a pediatrician in her area that accepted TRICARE.
“That is not an ideal thing to do — travel 60 miles (both ways) for a doctor’s visit,” Kelly said. “But you do what you have to do. It’s a little time-consuming but the alternative [no health insurance] was not an option. It may have been an option if it was just me. But with two children, it’s not.”
And when Brian’s appendix burst, the family was forced to travel those 30 miles in an ambulance to get to the hospital.
Jeannie Calabrese, who also lives in Oklahoma with her three children, was in a similar situation. Her husband David is deployed in Iraq fulfilling his National Guard duties.
For Jeannie, the patient was herself. She has been an asthmatic since she was a teen-ager, taking prescription medication for the condition almost continuously since that time.
One night last year, her asthma flared up as it hadn’t for years. Her medication was not working. The only thing left to do was go the hospital. Jeannie lives about 25 miles from a military hospital. But because her family uses TRICARE, that’s where she had to go for treatment.
With her mother driving, and her son and two daughters in the backseat, Jeannie made it to the hospital, was treated and released after spending one night.
Happy to Have Coverage
She said she was grateful for TRICARE (her husband’s employer dropped their family coverage after his deployment passed 30 days) but wishes physicians and hospitals in her area would be more amenable to accepting TRICARE.
“Taking a one-hour drive when you can’t breathe is not the way to spend an evening,” she said. “Fortunately, it all worked out. But it seems to me that if more health care facilities and doctors took TRICARE, I, or anyone else, wouldn’t be put in that situation.”
There is also a long drive for her children’s annual physicals.
All this adds to the stress level for Jeannie as she assumes the role of father, in addition to the numerous responsibilities that come from being a mother, while her husband is serving his country thousands of miles from home.
“We’re trying to make the best of a difficult situation,” she said. “It’s been a strain on all of us without [David]. This adds to the strain, having to travel so far for simple medical treatments.”
Kelly Montgomery also talks about the stress of her daily life as she cares for her two sons as their father does his duty.
“It’s not easy,” she pointed out. “Sometimes my boys have questions that they should really be asking their father. But we make the best of it and hope and pray each day that [Greg] comes home safely.”
She agreed that if local health care providers would accept TRICARE, it would be one less burden off her mind.
“It is something that I think [local hospitals and doctors] should consider, especially when you consider the many National Guard and Reserve troops that have gone [to Iraq],” Kelly said.
Both military mothers/wives agree, however, that the most important issue is that they are eligible for TRICARE.
“It would be financially catastrophic without TRICARE,” Jeannie Calabrese said. “Whenever I get upset because I can’t find a local doctor, I think about that point. That puts the situation in perspective.”
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