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Thread: PRIME OR STANDARD - Pls advise

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    #1

    PRIME OR STANDARD - Pls advise

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    I'm not sure if I should take TRICARE: PRIME OR STANDARD. I called tri west for info and they were very vague and had the "it's up to you" attitude

    I'm very new to this as I have moved from Canada so our healthcare systems are diff too! Here is my situation and hopefully you guys can direct me to what would be easier and cheaper for us!!!

    I am diabetic with oral medication and insulin
    we are trying to have a second child
    I also need Physical therapy/laser therapy for my carpal tunnel syndrome on my wrists.

    I also have a 21 month old daughter so I just need her regular check ups etc..
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    #2
    I juuust became a mil-wife, so honestly, I dont know that much about it, but MF wanted me on the better one so he signed me up for Prime if thats any indication.
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    #3
    the easy answer is: if you're near a base and you visit with them & like the service/facility, then i would advise getting prime. if you prefer to choose your own doctor or are not near a base, then go with standard. with standard, you will pay a percentage up to your yearly cap. prime is free.

    it might be a little more complicated with your conditions if you need any kind of specialist. i don't know much about that.
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    #4
    Quote Originally Posted by scentce View Post
    I'm not sure if I should take TRICARE: PRIME OR STANDARD. I called tri west for info and they were very vague and had the "it's up to you" attitude

    I'm very new to this as I have moved from Canada so our healthcare systems are diff too! Here is my situation and hopefully you guys can direct me to what would be easier and cheaper for us!!!

    I am diabetic with oral medication and insulin
    we are trying to have a second child
    I also need Physical therapy/laser therapy for my carpal tunnel syndrome on my wrists.

    I also have a 21 month old daughter so I just need her regular check ups etc..

    I believe Canada has a similar health care system as Australia. I see Tricare Prime as Public system and Standard at Private.SIMILAR not totally the same. Even though pregnancy is 100% covered under Standard, with your othe medical issues, I think you will be better off on Prime.


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    #5
    I have tri care standard and I absolutely love it. I would never set foot in a military healthcare facility, but that's just me!

    I see my normal doctors and have no co pay. It's great!
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    #6
    Quote Originally Posted by LES210 View Post
    I have tri care standard and I absolutely love it. I would never set foot in a military healthcare facility, but that's just me!

    I see my normal doctors and have no co pay. It's great!
    LOL. I have Prime and wouldn't ever go to standard. I prefer military facility versus trying to find my own doctor.


    OP, you are going to get varying opinions.. those who prefer Prime and those who prefer Standard. It really is up to what you want.

    If you want to find your own doctor, pay a co-pay, a monthly fee for standard, then go for it. If you prefer to have everything free, and also the ability to go off base for care (if the bases nearby don't have it) then go with prime. Prime to me is just easier, but that's just me.

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    #7
    Quote Originally Posted by scentce View Post
    I'm not sure if I should take TRICARE: PRIME OR STANDARD. I called tri west for info and they were very vague and had the "it's up to you" attitude

    I'm very new to this as I have moved from Canada so our healthcare systems are diff too! Here is my situation and hopefully you guys can direct me to what would be easier and cheaper for us!!!

    I am diabetic with oral medication and insulin
    we are trying to have a second child
    I also need Physical therapy/laser therapy for my carpal tunnel syndrome on my wrists.

    I also have a 21 month old daughter so I just need her regular check ups etc..
    Basically the only difference is with Prime you have to go to a military facility or an approved civilian treatment facility and everything covered with standard you have to pay premiums I'm not sure what providers are covered but I know if you pick standard you have to keep standard for at least a year.

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    #8
    Quote Originally Posted by LES210 View Post
    I have tri care standard and I absolutely love it. I would never set foot in a military healthcare facility, but that's just me!

    I see my normal doctors and have no co pay. It's great!
    Really? How did you manage that? I have a $50 copay with standard.
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    #9
    I see that you're in San Diego. You'll likely be able to choose a civilian provider for your PCM (Primary Care Manager) if you're on Prime, because the clinic at the MTF is typically full. I'm on Prime and have a civilian provider.

    On Prime, I don't pay any copays and there is no deductible (even with the civilian provider).

    On Standard, I would pay a $150 deductible (I believe it's only $50/year for E-4 and below) before Tricare would start paying any of the claim (maternity care is the exception--you don't have to pay copays or deductible for maternity care), and then I would pay a copay for every appointment. I want to say there is a $1000 out of pocket limit, but still, who wants to pay $1000 a year for their medical care if they can get comparable care for free, right?

    Since it sounds like you may see a doctor regularly, I would recommend sticking with Prime so that your copays don't add up. You can always switch to Standard if you feel like you need more options.

    I have always been on Tricare Prime and have been very happy with it. I DID switch to Standard when I was pregnant with my third because I wasn't having good luck with the OB clinic(s) at Balboa, but I know others who haven't had a problem. After I had my daughter, I switched back to Prime.
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    #10
    Quote Originally Posted by missinghim View Post
    Really? How did you manage that? I have a $50 copay with standard.
    Hmm... We don't pay co-pays on standard either. Just a $50 deductible and 15-20% co-insurance depending on whether our provider is in or out-of-network.
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