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Thread: Medical Insurance Question

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    #1

    Medical Insurance Question

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    Alright, I'm confused as crap.

    Tricare Standard- any doctor that accepts tricare, on or off base, not needing a referral but but with a copay.

    Tricare Prime- on base or off-base with a referral, no copay unless out of area?

    This is very confusing to me and I'm trying to get it all straight. Would there be a preference if you already have established doctors in the area? Can you get a referral to have those as your doctor if off-base?
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    #2
    With prime, you are assigned a doctor within the military system who is your primary care provider. He or she makes referrals out for specialty care.

    If you have an established dr that you like, I would suggest choosing standard. There is some cost sharing involved but it's not much at all
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    #3
    As far as I know if you have standard you can't use it at a MTF (could be wrong but this is what I thought). You need to use a civilian doctor.
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    I have prime and have a civilian doctor as my PCM(primary care manager). I went to change my PCM online and it had civilians as an option so I picked that. This is the site to change your PCM. https://www.dmdc.osd.mil/appj/bwe/co...bwe%2Fhome.jsp
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    #5
    This is more confusing then anything.
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    #6
    Quote Originally Posted by hockeyprincess13 View Post
    This is more confusing then anything.
    Sorry.
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    #7
    Prime- On base doctor (can get off base doctor if base doesn't have space, this base never refers people off for PCMs even if they have no availability, they suck imo). Need referrals for everything. Free.

    Standard- Can be seen on base space A (varies by base, I know people have here). Can still use ER on base (this was new to me). Pay deductible and co-shares. Max out of pocket while on active duty is $1000/year. Can see any doctor you want. If using Tricare provider it's 15% coshare, 20% if not. Dependent on base can still get prescriptions filled on base. A lot of people up here use Standard because the PCM's are pretty crappy. They get their x-rays, bloodwork and other things done on base when they can to save money.

    I have Standard and just always plan to be seen off base now. I do like it and $1000 max out of pocket isn't bad and I don't have to fight with PCM's for care. It's all preference though of course. Free is appealing to most people.
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    #8
    Quote Originally Posted by armywifey2007 View Post
    Sorry.
    Quote Originally Posted by armywifey2007 View Post
    I have prime and have a civilian doctor as my PCM(primary care manager). I went to change my PCM online and it had civilians as an option so I picked that. This is the site to change your PCM. https://www.dmdc.osd.mil/appj/bwe/co...bwe%2Fhome.jsp
    Thank you so much! This was what I was looking for.


    Quote Originally Posted by Abbynormal View Post
    As far as I know if you have standard you can't use it at a MTF (could be wrong but this is what I thought). You need to use a civilian doctor.
    Quote Originally Posted by Katyp View Post
    With prime, you are assigned a doctor within the military system who is your primary care provider. He or she makes referrals out for specialty care.

    If you have an established dr that you like, I would suggest choosing standard. There is some cost sharing involved but it's not much at all
    Thanks Ladies!
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    #9
    Quote Originally Posted by *Stephanie* View Post
    Prime- On base doctor (can get off base doctor if base doesn't have space, this base never refers people off for PCMs even if they have no availability, they suck imo). Need referrals for everything. Free.

    Standard- Can be seen on base space A (varies by base, I know people have here). Can still use ER on base (this was new to me). Pay deductible and co-shares. Max out of pocket while on active duty is $1000/year. Can see any doctor you want. If using Tricare provider it's 15% coshare, 20% if not. Dependent on base can still get prescriptions filled on base. A lot of people up here use Standard because the PCM's are pretty crappy. They get their x-rays, bloodwork and other things done on base when they can to save money.

    I have Standard and just always plan to be seen off base now. I do like it and $1000 max out of pocket isn't bad and I don't have to fight with PCM's for care. It's all preference though of course. Free is appealing to most people.
    I have no clue if our base will have space, I guess I need to find out. That's the biggest factor to me is using my doctors that I already have.

    I'm really considering just staying with standard. We don't have an ER on base anyway. The woman we spoke to today just kinda herded us through the paperwork/steps with no real explanation of the differences.
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    #10
    Rule of thumb I used at first:
    Prime=HMO
    Standard=PPO
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