TriCare Insurance Coverage

[Mary, Proud Mom of Nick]

Hi ladies ---

It's been a long time since I was on Tri-Care insurance but our daughter and her beau are talking about doing a "paper" wedding so they can get a jump on the housing list and some other benefits that are offered to married soldiers vs. single ones.

 

Can you tell us what the difference is between Tricare Standard and TriCare Prime?

 

She will graduate from college in December and there are no military bases in her immediate area for health care and her beau is currently deployed in Iraq when he returns he is stationed in upstate New York.

 

Appreciate anything you can share.

 

Thanks!

Mary

[Miranda (Ryan's wife - FC)]

Tricare Standard will allow them to see civilian healthcare professionals within the network without getting a prior authorization. There are some copays and premiums. You also are not first priority with military installations on standard - if they can get you in they will but prime comes first. With Tricare prime you are limited to military healthcare options unless they are unavailable or prove unsatisfactory at which point you can appeal for a prior authorization to be seen by a civilian which takes a little more red tape. I think alot of your choice depends on where you're stationed and the quality of care given at that particular installation. I know some base hospitals/clinics are overpopulated with patients so it may take a while to be seen as a prime member even so it may be in your best benefit to go with standard as I understand it.

Luckily in GL it's not exactly a family oriented installation so our appointments have been given to us in a very timely manner but apparently that may not be true at our next base so we will give it a shot and if it doesn't work for us we'll switch the Standard.

In a nutshell - Prime = no out of pocket costs (except for dental which is a whole nother monster) and Standard = slight out of pocket cost for more freedom of choice in care.

[Mary, Proud Mom of Nick]

Thanks for the good break down, it gives them something to start thinking about.

[Anti M]

We're retirees on Prime and live near an AF base. We can get into the clinic same day almost always. Getting referrals hasn't been difficult as the base clinic is rather small and the doctors are willing to send us to specialists. There are co-pays off base, but they are very low. I get my prescriptions on base for free, although some I have to fill off base and they're dirt cheap. I can call in after hours and go to the civilian Urgent Care clinic easily if I get sick in the evening or weekend. Any ER visit (if it is a true emergency) needs no referral and is totally covered.

One year I had TWO kinds of cancer, four surgeries, and all the appointments and treatments which went with it all. On Prime, our co-pays for the year added up to under $500!!! I rarely had trouble with referrals unless the doc's office messed up the paperwork. Happened once and a follow-up office visit cost $115 instead of $12. I always made sure my referrals were right after that!

Standard is more flexible, which may appeal to busy parents who work.

[cricket926]

We decided to stay on standard. For me, it's honestly worth the extra co-pays to have freedom of choice. I have 2 kids, and having a pediatrician that's on the same page as me is very important. We do have military friends in Charleston, and from what I've heard, the clinic there is horrible when it comes to the pediatricians. It's nearly impossible to get a sick child visit the same day you call, and the pediatricians are very much by the book, anti-breastfeeding and natural parenting. I'm worried we'll run into the same problems on different bases.