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Thread: Tricare Questions

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    #1

    Tricare Questions

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    Hello Lovelies!
    My Husband and I got married on Dec 22, 2012 (YAY!) and we've done pretty much everything that a new spouse needs to do. However I have a few questions about Tricare's healthcare plans. I learned that in order to be enrolled in Tricare Prime, (which is apparently what he is on) there is an application that has to be processed. And while that's not a big deal, can anyone explain what the difference between regular the Tricare plan and Tricare Prime?

    Also just want to make sure that it covers all the bases (health, dental, vision, etc...)
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    #2
    One you have to be seen on base, the other you can be seen off. I can't remember which is which Also, dental is separate you have to pay for it. Vision is included in tricare but only covers glasses exam and not the actual glasses, contacts or contact exam.


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    #3
    Tricare Prime, you use the medical facilities on base & you need a referal to use a civilian doctor. If you ever happen to go to the off-base ER, you must call & let them know.

    Tricare Standard, you choose your own civilian doctor & cannot be seen by an on-base doctor. But there usually is co-pay with this option. Not much but because it's standard, it doesn't cover 100% of the costs.

    Dental is not a part of Tricare. It is through Met Life & you have to enroll separately online.
    https://www.metlife.com/

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    #4
    Prime is generally zero out of pocket expense and you are generally seen at a military hospital if space is available and you are close enough. Standard allows you to pick your own provider as long as they accept tricare standard. This is a cost share and I THINK it is 20%. Vision is just for the exam and does not cover glasses, frames, contacts, or the contact exam. Dental is different and I believe it is like 10/month with like a 1200 benefits cap, where met life pays 50% of covered procedures and you pay the other half.


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    #5
    Prime you get seen at an MTF (military treatment facitlity) and doesn't cost you anything, you can be seen off base if space isn't available or you get referred out.

    Standard you have to find your own doctor off base and you will have copays and other costs depending on the procedure, etc. You can only be seen at an MTF if there is space available.

    You are automatically enrolled into Tricare Standard once enrolled in DEERS, if you want to change to prime, contact Tricare. Your husband will always be prime as long as he remains active duty.

    Dental costs per month and its $30 a month (maybe less for just a spouse) and it covers routine cleanings/exams and there are various amounts of out of pocket expenses depending on procedures done.

    Vision covers exams only.

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    #6
    Tricare Prime: you will receive most of your care from your PCM (primary care manager). Your PCM can be either an MTF (military treatment facility) or a civilian TRICARE network provider. Your PCM provides routine health care and coordinates referrals for specialty care that he or she cannot provide. There is no co-pay to visit your PCM, whether it's an MTF or civilian provider, unless you are a retired vet or dependent of a retired vet.

    Just letting you know because I live 30+ miles from the closest military base and MTF, but I have Tricare Prime. I regularly see a civilian doctor.
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    #7
    Quote Originally Posted by Deifick View Post
    Tricare Prime: you will receive most of your care from your PCM (primary care manager). Your PCM can be either an MTF (military treatment facility) or a civilian TRICARE network provider. Your PCM provides routine health care and coordinates referrals for specialty care that he or she cannot provide. There is no co-pay to visit your PCM, whether it's an MTF or civilian provider, unless you are a retired vet or dependent of a retired vet.

    Just letting you know because I live 30+ miles from the closest military base and MTF, but I have Tricare Prime. I regularly see a civilian doctor.
    That is called Prime Remote... if you are more than 30/40 miles from an MTF you are considered Prime Remote... and its any MTF, not necessarily the base of station MTF.

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