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Thread: Tricare Prime vs Standard?

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    #1

    Tricare Prime vs Standard?

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    I am wondering what the difference between Prime and Standard is? I took DS in to the doc a few weeks ago and got a $70 bill in the mail. I thought military insurance was supposed to be good, my old insurance would have covered all of a well baby visit (aside from a $20 copay)

    Is there an extra fee to be on prime? Will it lower the bills I am getting?

    Any info would be appreciated. I will be taking DS into the doc again this week
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    #2
    When your DH is active duty you can enroll in Tricare prime. This provides coverage at 100% with no co-pays or deductibles and there is no cost for it. You do have to see a network provider and coordinate care through your PCM (Primary Care Manager) if you need to see a specialist.

    Tricare Standard is free if you are active duty but it only covers at 80%. The difference is that you don't have to coordinate care or get a referral to see a specialist. You get a discount for seeing a network provider, but a lot more physicians accept Tricare Standard vs. Tricare Prime.

    If you have a new baby, they are automatically enrolled in Tricare Prime for the first 90 days, then they are automatically switched to Tricare Standard. You have to actually enroll them in prime. You can do this online or at a Tricare Service Center.

    Hope this helps.
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    #3
    Quote Originally Posted by CCArmyWife View Post
    I am wondering what the difference between Prime and Standard is? I took DS in to the doc a few weeks ago and got a $70 bill in the mail. I thought military insurance was supposed to be good, my old insurance would have covered all of a well baby visit (aside from a $20 copay)

    Is there an extra fee to be on prime? Will it lower the bills I am getting?

    Any info would be appreciated. I will be taking DS into the doc again this week

    Going on Prime will eliminate ALL those bills!!!!
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    Thank you so much! We are new to the Army (active) so we are still figuring this crap out. I am more than happy to see a specific doc if it means saving money. I will be having DH call tricare tomorrow to get us into Prime!
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    #6
    Quote Originally Posted by CCArmyWife View Post
    Thank you so much! We are new to the Army (active) so we are still figuring this crap out. I am more than happy to see a specific doc if it means saving money. I will be having DH call tricare tomorrow to get us into Prime!
    No prob! I've been on Prime for over years now and haven't had any issues. People do have their own preferences though.
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    #7
    with prime there are no out of pocket costs for office visits and hospital stays, there are small Co-pays for RX's - (3 and 9 dollars each)
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    #8
    Quote Originally Posted by gunsgirl View Post
    with prime there are no out of pocket costs for office visits and hospital stays, there are small Co-pays for RX's - (3 and 9 dollars each)
    only if you dont get them at a military pharm.
    Sometimes the smallest things take up the biggest space in your heart.
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    Prime there are no bills (unless you go to a specialist without a referral). Danica was at a civi NICU and I paid no money towards the 1.5 million in medical bills. Paid absolutely nothing for any of Gabe's cancer treatment and followups as well.
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    #10
    prime really is the best bet...it will cover everything for your son pretty much. of course, there are some procedures that they won't fully cover but they are fairly reasonable in what they pay for the most part.
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