3 Things to Know: New Tricare Kid Coverage


Tricare recently announced that they are expanding well-child check-ups coverage in all Tricare coverage plans to all kids over age six.

If you have children over age six, you may be sitting there thinking "hold the phone -- we've always received well-child check-ups for our kids. Every single year. No matter their age. No question. No charges. So ... Huh?"

I'm with you: huh? I thought I already had that covered. So what gives?

3 things to know about Tricare well child check coverage

1. You weren't really getting well-child checks before. ... Sort of.  Maybe. From what I've been able to dig out, some of this change is really a coding and payment issue.

While you may have been taking your kid for a well-child check all along, it may not have lived up to certain preventative visit standards promoted by the American Academy of Pediatrics (AAP) in a policy known as "Bright Futures." Or, if it did live up to those standards, your office may not have been charging Tricare for it completely, and instead just providing it essentially for free. Some people also were being rejected for those checks completely, Tricare officials said, because their policy specifically said well-child checks were only for kids six and under.

2. The changes mean you'll now get a well-child check-up that meets certain standards. The new Tricare policy allows you to, for sure, get an annual well-kid check-up, and it requires that the check-up meets the Bright Future guidelines.

For many people, an AAP policy expert and doctor who regularly treats military kids told me, this could mean that parents will notice additional mental health screenings during the annual appointments, for example. And, better yet for the healthcare community, the doctors will now be able to be fully paid for the services they provide.

3. There's still work to do. File this one under "fun facts about Tricare insurance," the whole system is exempt from the rules passed as part of the Affordable Care Act, also known as Obamacare (although it is considered "minimal essential coverage").

That law ushered in certain treatment standards, which meant that no matter what, kids would receive specific screenings and prevention help. The well-child check expansion brings Tricare coverage closer in line with those standards, but there is still coverage missing, AAP experts told me. Among them? Fluoride.

This may come as a surprise (it did to me, as someone who has only ever had kids seen through the Tricare system), but at well-child checks for little kids (think under age four) many doctors paint fluoride on kids' teeth. Tricare? Doesn't cover it. The AAP doctors I spoke with said to really meet care benchmarks, Tricare needs to cover even more, such as fluoride.

One more fun fact: Tricare doesn't like it when you call the system "insurance." They prefer to be known as a "healthcare" plan.

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