Military Significant Others and Spouse Support - MilitarySOS.com
Page 1 of 2 12 LastLast
Results 1 to 10 of 20

Thread: Tri-care Question?

  1. Account Closed
    AMarineLovesMe's Avatar
    AMarineLovesMe is offline
    Account Closed
    Join Date
    Mar 2011
    Location
    Me- Nebraska, Him-Japan
    Posts
    2,044
    #1

    Tri-care Question?

    Advertisements
    Okay so whats the differences between Standard and Prime? Which one is better? Do you pay more for prime? I'm going to be the one doing all the paperwork for DEERS and Tri-care and am not sure which one I need. I'll also be enrolling my son in both. Do they both have Maternity coverage?(we plan on trying to start getting pregnant after he gets stateside).... just really confuse on all of this...
  2. MilitarySOS Jewel
    settles's Avatar
    settles is offline
    MilitarySOS Jewel
    Join Date
    Dec 2007
    Location
    Fort Campbell
    Posts
    14,216
    #2
    You don't pay an upfront cost for either.

    Prime is free but you will be seen at a MTF unless the facility is full or in some other cases. (like there isn't an MTF close by, I believe its 50 miles) You have no copay but must get a referral for everything.

    Standard you pay 15% copays for in network providers and 20% for out of network. Maternity is still covered at 100% just like prime though. You can see any doctors you want and don't need a referral. Once all deductibles have been met and an additional $1,000 have come out of pocket your "catastrophe" cap has been met and you no longer have to pay copays for the rest of that year.

    RX are the same with both plans.

    I always thought it was silly to pay copays when we could have insurance for free. Until I was pregnant and had a child! I'll pay out of pocket to have the best care for maternity and my child and NOT to have to wait on referrals if I think one of us needs to see a specialist.
  3. wishin
    sailornwife's Avatar
    sailornwife is offline
    wishin
    Join Date
    May 2008
    Location
    MD and VA
    Posts
    2,516
    #3
    i have prime! <3 it.. hate standard.. to many loop holes ect.. and you do not have to go to a military doc on prime if you do not want to. you just have to see someone in their group and call tricare to let them know that you will be using them.
    Sometimes the smallest things take up the biggest space in your heart.
  4. MilitarySOS Jewel
    settles's Avatar
    settles is offline
    MilitarySOS Jewel
    Join Date
    Dec 2007
    Location
    Fort Campbell
    Posts
    14,216
    #4
    Quote Originally Posted by sailornwife View Post
    i have prime! <3 it.. hate standard.. to many loop holes ect.. and you do not have to go to a military doc on prime if you do not want to. you just have to see someone in their group and call tricare to let them know that you will be using them.
    What is this information based on? Do you live near a MTF?
  5. Senior Member
    Beach's Avatar
    Beach is offline
    Senior Member
    Join Date
    Dec 2010
    Posts
    6,934
    #5
    We are on Prime, and I hand picked our civilian pediatrician. Almost all specialty appoints are also at civilian doctors. We live less than 15mi from 5 different MTFs.
  6. Account Closed
    AMarineLovesMe's Avatar
    AMarineLovesMe is offline
    Account Closed
    Join Date
    Mar 2011
    Location
    Me- Nebraska, Him-Japan
    Posts
    2,044
    #6
    okay thanks! I dont have a problem seeing a military doctor and doing referrals(kinda used to it actually) my son doesnt live with us right now but im required to have insurance on him.
  7. Senior Member
    *Stephanie*'s Avatar
    *Stephanie* is offline
    Senior Member
    Join Date
    Feb 2008
    Location
    JBER; Anchorage, AK
    Posts
    16,315
    #7
    Quote Originally Posted by settles View Post
    You don't pay an upfront cost for either.

    Prime is free but you will be seen at a MTF unless the facility is full or in some other cases. (like there isn't an MTF close by, I believe its 50 miles) You have no copay but must get a referral for everything.

    Standard you pay 15% copays for in network providers and 20% for out of network. Maternity is still covered at 100% just like prime though. You can see any doctors you want and don't need a referral. Once all deductibles have been met and an additional $1,000 have come out of pocket your "catastrophe" cap has been met and you no longer have to pay copays for the rest of that year.

    RX are the same with both plans.

    I always thought it was silly to pay copays when we could have insurance for free. Until I was pregnant and had a child! I'll pay out of pocket to have the best care for maternity and my child and NOT to have to wait on referrals if I think one of us needs to see a specialist.
    Yep, the deductible goes towards the catastrophic cap. Once you pay the deductible the coshares tend to not be very much. The base we were at wouldn't let me get seen off by a civilian since they had room on base. Even with space on base it took me 2 months to get seen and the I had to wait 2 weeks to have an MRI referral go through that was for something urgent. That's when I switched to Standard. A lot depends on the base you're at. I think maybe if we were somewhere with full medical it would be different, but the MTF near me is pretty much a band aid station.
  8. You are here.
    Frybread's Avatar
    Frybread is offline
    You are here.
    Join Date
    Jul 2008
    Location
    SoCal
    Posts
    23,977
    #8
    Quote Originally Posted by settles View Post
    What is this information based on? Do you live near a MTF?
    yep, I have in Virginia. Military hospital was nearly full to capacity so they said we could choose, we choose civilian family practice and a ped's doctor, and a OBGYN. We lived like three miles away from portsmouth naval hospital, in fact it was their tricare office the choice, and a few others were in there to do the same. I think we did the same with the kids in FL, mayport and NAS Jax was full, so we asked to be sent to a peds and a family PCM in the beaches area and we were good to go. and with that we were definitely within 50 miles of NAS jax and branch medical mayport.
  9. Senior Member
    lacy+chk's Avatar
    lacy+chk is offline
    Senior Member
    Join Date
    Jul 2007
    Location
    Tree Frog: WI/Moo Cow: MCB Quantico
    Posts
    9,749
    #9
    Quote Originally Posted by sailornwife View Post
    i have prime! <3 it.. hate standard.. to many loop holes ect.. and you do not have to go to a military doc on prime if you do not want to. you just have to see someone in their group and call tricare to let them know that you will be using them.
    On Prime, I was initially told I could go either because they were really full on base, but later told I had to be seen on base because they had the space to accommodate me and I lived less than 50 miles from base. I only was regularly followed by my neurologist, who was civi off-base anyways since on base didn't have a neurology dept. I love my neurologist, though...even if she did put me through tests that were just awful

    "The Lord is my light and my salvation; whom shall I fear? The Lord is the strength of my life; of whom shall I be afraid?" ~ Psalm 27:1
    Quote Originally Posted by MamaStrong View Post
    at first I was like , then I was like when I saw how messed up the page it looked so then I was like *click*, *enter*, *click*, *enter*,
  10. You are here.
    Frybread's Avatar
    Frybread is offline
    You are here.
    Join Date
    Jul 2008
    Location
    SoCal
    Posts
    23,977
    #10
    yeah, in fact here, dh is even seen off base by a civilian physician as well.
Page 1 of 2 12 LastLast

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •