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Thread: Another Tri-care question :)

  1. I'm holding you closer than most because you are my heaven.
    KW080410's Avatar
    KW080410 is offline
    I'm holding you closer than most because you are my heaven.
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    #1

    Confused Another Tri-care question :)

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    This is probably a silly question, but I'm new to this. So please bare with me

    I'm currently enrolled in Tri-Care standard, do I have to have anything when I pick/go to a dr?? Anything like a proof of insurance or anything? Aside from my Mil ID?

    Also, how do I figure out the co pay?? All of the charts on the Tri-Care site say its a percentage, but how can I figure it out? Or would I just be better off asking someone?

    DH and I sent in my paperwork to get put onto Prime, but it hasn't gone through yet. Any information would be a HUGE help!! this is all just so frustrating.. it makes me want to .

  2. Feelin' fly like a Cheesestick
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    #2
    Your Prime enrollment will most likely be effective Jan. 1. They will probably send you some information before the end of this month to let you know who your PCM is going to be, etc. etc.

    As for Standard, your military ID is your proof of insurance. Some doctors will expect your copayment up front and will tell you exactly how much it is. Some will just bill you for it. I can tell you this--my doctor (who is a Tricare network provider) charges, say, $100, but the amount they have agreed to accept from Tricare is $60. My share of that is 15%, which is $9. I'm sure specialists are more, but I would imagine for most routine appointments your copay won't be too much.

    HOWEVER--you DO have a $150 deductible (can't remember if this is less for E-4 and below??) and you have to pay that before Tricare starts any cost-sharing. That means that if you go to the doctor and the contracted amount is $60--you will actually pay that $60. You will pay 100% until you've paid $150, and then Tricare starts cost-sharing.
    Beth, Mama to Emmalee (12), Evan (9), and Ella (4 on May 7) (I really REALLY need to update my picture!)
  3. I'm so much cooler online
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    Justangelyn is offline
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    #3
    If I remember right, when I had Standard all I need was my Military ID for Proof of Insurance. And I could go to any doctor that took Tricare. If you look up on their website they'll have a list of doctors who take Tricare. And I never paid a Co-Pay up front. They billed me later. But thats how it worked when I went. Every doctor is different.

    Feel free to PM if you have any more questions
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    #4
    They should have told him when it would be effective when he filled out the paperwork. If I was in the process of switching to Prime I probably wouldn't bother trying to see a civilian doctor on standard unless it was an emergency.

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