This entire article is for Active Duty family members living in the greater metropolitan Washington, DC area. Live somewhere else? Check out this article. For a similar conversation for retirees, see this article.
Move to the greater Washington, D.C. area and one of your first questions will be: Which health care coverage should I choose? Or maybe you’ve lived here for a while, and you’re wondering if the Tricare health plan you’re using is the right one for your situation? This is a common question for military families, regardless of where they live, but the options are greater in areas covered by Uniformed Services Family Health Plans (USFHP.)
While the USFHP is technically part of Tricare Prime, there are enough differences that it is effectively a third choice. (There is one situation where that is important to know – we’ll get to that later!) And the DC area has a huge USFHP, administered by Johns Hopkins. The Johns Hopkins USFHP serves Tricare beneficiaries in Maryland, DC, Delaware, and parts of Virginia, West Virginia and Pennsylvania. It is a popular choice because it eliminates the requirement to travel to Walter Reed for certain specialty care, and because the Military Treatment Facility (MTF) nearest to your home isn’t always accepting new patients.
Tricare Prime, not USFHP
With regular Tricare Prime, active duty family members receive care at a MTF unless they can not accommodate you and send you out into town. It’s possible that your nearest MTF won’t have room for you and that Tricare will expect you to travel to a different MTF before they send you to civilian providers. In most cases, you will be sent to Walter Reed for specialty care.
Prescriptions are filled at any MTF, or you can use civilian pharmacies that accept Tricare (with co-payments) or you can use the Express Scripts mail order pharmacy.
You do not pay for your medical care at MTFs or when referred to a civilian provider. You will pay for a relatively hefty portion of your care if you go to a provider who is not in the network or you don’t have a referral for non-emergency care. (This is called Point of Service and it can add up in specific situations. Also, Tricare Prime Point of Service costs DO NOT apply to your catastrophic cap.)
Tricare Select
With regular Tricare Select, get your care from authorized civilian providers. In theory, you are able to obtain care from MTF on a space available basis, but that’s not the general idea of the program.You do not require referrals for most specialty care, but certain services may require pre-authorization.
Prescriptions are filled at any MTF, or you can use civilian pharmacies that accept Tricare (with co-payments) or you can use the Express Scripts mail order pharmacy.
Each year, you will pay a deductible, and then co-pays for most care and prescriptions, until you reach your catastrophic cap. Once you reach your catastrophic cap, you will only have costs if you go to non-network providers.
Note: If you use Tricare Select, you may be interested in a Tricare Supplement.
Johns Hopkins Uniformed Services Family Health Plan
What Is A USFHP?
A USFHP is a provider of Tricare Prime services. I know it’s a little confusing to think of USFHP as being part of Prime, because there are such visible differences. But at the core of the program, they are very similar: you still have a primary care manager (PCM), and you still require referrals for most care beyond your PCM.
The reason it is important to know that a USFHP is a provider for Tricare Prime is because that means that you can switch from MTF-based Tricare Prime to USFHP Tricare Prime (or the other way) without having to wait for the annual open season. You can switch back and forth at any time during the year without having a qualifying life event, because it’s technically just a PCM change, not a plan change.
Is It Important That It The Johns Hopkins Plan?
From a management standpoint, it’s important to understand that the Johns Hopkins USFHP is one of the six USFHPs in the country. If you do an internet search on USFHP, you may go to a page for another plan. They’re often not very clear. I once spent 45 minutes on the phone with a JHUSFHP rep, trying to understand why they were telling me one thing when the handbook said something different, before I figured out that I was reading the handbook for a different USFHP.
The other important thing to consider is that while it is a large network, the JHUSFHP is still network-based plan. If you want to go see a specialist that is not in the network, you’ll need to get authorization from JHUSFHP and demonstrate why they can’t meet their needs within their network.
How the JHUSFHP Works
If you have selected JHUSFHP as your Tricare Prime PCM, you can not use any MTF for your medical care. You go to civilian doctors, with the same referral requirements as prime.
USFHP members can not use the MTF pharmacies and must fill their prescriptions at the designated civilian pharmacy, or use the JHUSFHP mail order pharmacy.
You do not have copays for your care, but you do have copays for prescriptions.
Why We’ve Picked Tricare Select
Our family has used Tricare Prime, JHUSFHP, and Tricare Select. We just made the switch from JHUSFHP to Select in January. and I’m pretty sure we’re never going back. We have five people using Tricare (not including the active duty one), and that includes one away at college outside the JHUSFHP region, and one special needs kid.
We were paying almost $1,000 per year just in pharmacy co-pays on JHUSFHP, though we could have shaved that amount by using the mail order pharmacy more often.
Plus, the kid at college was on “regular” Prime because her school was outside the JHUSFHP region. Her choices of PCMs was severely limited at her location. Even worse, she had a doctor who was not in-network, so we were paying Point of Service costs for that care. (And those POS costs do not apply to your catastrophic cap when you are on Prime.)
So we were paying almost $1,000 per year for prescriptions, plus the Point of Service deductible plus the 50% of her POS appointments, and we had to use in-network providers, get referrals for everything, and use that one specific pharmacy. Under Select, we pay the deductible and then co-pays, but once we reach our catastrophic cap (which is just $1,000 for active duty families whose sponsor entered the military prior to 1 January 2018), we are done until next January. When we need a specialist (which is all the time here), I just call and make sure that they are an in-network provider.
Obviously, this is a relatively simple overview, but I think I’ve hit most of the big points. I wasn’t unhappy with JHUSFHP – it was a lot easier that Prime, for me – but I love Select and it isn’t costing us any more. $83/month (the $1000 catastrophic cap divided by 12 months) is absolutely worth my time and energy, plus my kids are already getting better care because I have a better selection of providers.
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