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Thread: Tricare Prime or Tricare Standard?

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    #1

    Tricare Prime or Tricare Standard?

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    I've looked around for a thread like this but I couldn't find one, I apologize if I missed it, but...

    I am a new Navy Wife and I was recently put onto Tricare Standard. I understand the difference between Standard and Prime, but I need some personal experiences/advice. I have done my research but I am not sure which would be better. I'm currently up in Washington with my Husband.

    This would be much help, and I would really appreciate it!
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    #2
    I am on standard- I love that I can choose my own doctors , do not need referrals ect. the out of pocket costs have been minimal so far, but I rarely go to the Doctor or need Lab work.

    When I had surgery it was a 14,000 dollar surgery and I paid 265 dollars. I was good with that
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    #3
    It really depends on what you like.

    I've had Prime for this entire time (19+ years) and I love it.
    I don't like to have to find my own doctors, it doesn't cost me anything to be seen (no copays, no prescription costs, etc). I can easily get a referral, which when I see that civilian doctor it doesn't cost me anything.

    Until this base, we had always been seen off base because Air Force doesn't have any hospitals and we were never near a base that had one, so AF contracted out to civilian doctors.
    And even here, almost all the doctors are civilian, I haven't seen a 'military' doctor the entire time we've lived here.

    So, if you don't want to pay anything and you don't want to be bothered with trying to find your own doctors, and have little complications... go prime.

    If you want to find your own doctor and don't mind extra costs, go standard.

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    #4
    When I lived in WA and lived off post, I had Prime. I never had to go on post for medical care. There are tons of great docs in surrounding areas that Prime will cover. I have never used Standard, but I felt that Prime covered all of my needs at minimal cost.
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    #5
    I had Prime for about 3 ish years living in San Diego and I HATED it. We were only given two choices to "pick from" for doctors that would be mine and DD's primary doctors. Then when I was really sick, but not sick enough to need an ER it'd take a week+ to be seen. Which half the time if it was an infection it had just gotten worse... Then getting referrals to anywhere expect to doctors on the stupid base was like pulling teach. I despised going to the "specialists" on base in San Diego, and I always felt like they did a half assed rush job just to get me in and out as fast as humanly possible. (Never had that issue with doctors I've been able to choose if I see or not. Besides once when I went to an ER, but ERs are known for trying to treat you quickly. There job is to make sure you're stable and okay to be home so I don't get as irritated when I go to an ER and feel like they are rushing things.).

    Also, with prime when I would try to get them to give be a different doctor. Especially when it was me trying to tell them I did not like the specialist I had seen, and I wanted to see someone else. It was again like pulling teeth, and when I went in person they'd pretty much make up any excuse to try to talk me out of it. Like "I don't recommend switching. We can try to find you someone else though, but just know it can take another month or more to get you another doctor." That and they'd basically make it sound like I was making their life so much harder. That or when they actually gave me a referral it was only good for a one time use. Like when I finally got a referral to a GYN from my primary I only got to see her once. (One I actually liked too which is rare I normally go through 2-3 GYNS before finding one I really like) That was to do my normally yearly pap, and then when I tried to go back to her a few months later for birth control and issues I was having that related to my girly bits. I was told I'd need ANOTHER referral just to talk to her about birth control, and to talk about the other girly bit issues I knew I had going on.... Which they refuses and they sent me to a on base doctor GYN to talk about birth control. Instead of just sending me back to the doctor they had approved to pay for me seeing before, and they knew damn well I wanted to see again( I told them more than once over the phone and in person I was not okay with going to a new doctor, and I didn't see the big deal in seeing the other doctor again.) I'd of preferred to not go to a new doctor I didn't even know the name of till I got to the base and asked who I was seeing at the check in desk. However, Tri-care wanted to save money by sending me on base over to a civilian doctor..



    Now? I have Tri-care Reserve Select(It's basically the same as Tri-care standard same rules for doctors, and you pay a little for it.) I LOVE it! I can choose any doctor I want to see, and it's VERY cheap to see even specialists when needed. Like when I hurt my wrist a few months ago I had to go to a specialist, get x-rays, and all that fun stuff. Never paid more than $40 for an appointment, and it only ever got close to that $40 when I got x-rays or some other lab work type stuff done. Then I went to physical therapy for about 4 and a half weeks for the wrist. I didn't pay a thing for the therapy it was 100% covered by Tri-care.

    Most I've paid for a prescription so far is around $20, but it was a medication that without insurance I would of paid a little over $600 for. Most of the time I only pay $5-15 for medications for DD and I when we need them. I've been able to pick and choose when I go to the doctor. Which doctor I see, and I go when it works for ME. I don't feel like I'm on someone else's schedule with a very limited window of options on what day and time I could be seen.(that is exactly how it felt with Prime to me.)


    Oh and I'm going to a OB/GYN I got to choose of my own free will. For this pregnancy for ALL the prenatal care appointments. Which includes a ton of blood work, urine tests, multiple physicals to check on me and baby, and extc. The total for all of that over the next 6 ish months is under $400. The total without insurance would be around $5,000, and I'd be paying 100% out of pocket for any ultrasounds they wanted to do. Right now ultrasounds that are deemed necessary I pay only about $11 for... Oh and when I'm in the hospital with the baby. From what I understand talking to doctors there, and talking to Tri-care I'll at MOST be paying around $150 out of pocket for the hospital costs if things go as planned/hoped for. That would be baby and I staying there for about two days. All the labs and blood work they'd do on the baby, and even my epidural I'm wanting during labor. So that is thousands of dollars worth of tests and other stuff I expect to happen when I have this bay, and yet I'll not have to pay very much at all. While giving birth with a doctor I chose myself, and I will get to go to the hospital *I* want to give birth at...
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    #6
    Quote Originally Posted by LoveMikeyBear View Post
    I had Prime for about 3 ish years living in San Diego and I HATED it. We were only given two choices to "pick from" for doctors that would be mine and DD's primary doctors. Then when I was really sick, but not sick enough to need an ER it'd take a week+ to be seen. Which half the time if it was an infection it had just gotten worse... Then getting referrals to anywhere expect to doctors on the stupid base was like pulling teach. I despised going to the "specialists" on base in San Diego, and I always felt like they did a half assed rush job just to get me in and out as fast as humanly possible. (Never had that issue with doctors I've been able to choose if I see or not. Besides once when I went to an ER, but ERs are known for trying to treat you quickly. There job is to make sure you're stable and okay to be home so I don't get as irritated when I go to an ER and feel like they are rushing things.).

    Also, with prime when I would try to get them to give be a different doctor. Especially when it was me trying to tell them I did not like the specialist I had seen, and I wanted to see someone else. It was again like pulling teeth, and when I went in person they'd pretty much make up any excuse to try to talk me out of it. Like "I don't recommend switching. We can try to find you someone else though, but just know it can take another month or more to get you another doctor." That and they'd basically make it sound like I was making their life so much harder. That or when they actually gave me a referral it was only good for a one time use. Like when I finally got a referral to a GYN from my primary I only got to see her once. (One I actually liked too which is rare I normally go through 2-3 GYNS before finding one I really like) That was to do my normally yearly pap, and then when I tried to go back to her a few months later for birth control and issues I was having that related to my girly bits. I was told I'd need ANOTHER referral just to talk to her about birth control, and to talk about the other girly bit issues I knew I had going on.... Which they refuses and they sent me to a on base doctor GYN to talk about birth control. Instead of just sending me back to the doctor they had approved to pay for me seeing before, and they knew damn well I wanted to see again( I told them more than once over the phone and in person I was not okay with going to a new doctor, and I didn't see the big deal in seeing the other doctor again.) I'd of preferred to not go to a new doctor I didn't even know the name of till I got to the base and asked who I was seeing at the check in desk. However, Tri-care wanted to save money by sending me on base over to a civilian doctor..



    Now? I have Tri-care Reserve Select(It's basically the same as Tri-care standard same rules for doctors, and you pay a little for it.) I LOVE it! I can choose any doctor I want to see, and it's VERY cheap to see even specialists when needed. Like when I hurt my wrist a few months ago I had to go to a specialist, get x-rays, and all that fun stuff. Never paid more than $40 for an appointment, and it only ever got close to that $40 when I got x-rays or some other lab work type stuff done. Then I went to physical therapy for about 4 and a half weeks for the wrist. I didn't pay a thing for the therapy it was 100% covered by Tri-care.

    Most I've paid for a prescription so far is around $20, but it was a medication that without insurance I would of paid a little over $600 for. Most of the time I only pay $5-15 for medications for DD and I when we need them. I've been able to pick and choose when I go to the doctor. Which doctor I see, and I go when it works for ME. I don't feel like I'm on someone else's schedule with a very limited window of options on what day and time I could be seen.(that is exactly how it felt with Prime to me.)


    Oh and I'm going to a OB/GYN I got to choose of my own free will. For this pregnancy for ALL the prenatal care appointments. Which includes a ton of blood work, urine tests, multiple physicals to check on me and baby, and extc. The total for all of that over the next 6 ish months is under $400. The total without insurance would be around $5,000, and I'd be paying 100% out of pocket for any ultrasounds they wanted to do. Right now ultrasounds that are deemed necessary I pay only about $11 for... Oh and when I'm in the hospital with the baby. From what I understand talking to doctors there, and talking to Tri-care I'll at MOST be paying around $150 out of pocket for the hospital costs if things go as planned/hoped for. That would be baby and I staying there for about two days. All the labs and blood work they'd do on the baby, and even my epidural I'm wanting during labor. So that is thousands of dollars worth of tests and other stuff I expect to happen when I have this bay, and yet I'll not have to pay very much at all. While giving birth with a doctor I chose myself, and I will get to go to the hospital *I* want to give birth at...
    This is my thing, I want to be able to choose my own doctor, but I have heard a few of the wives up here tell me the doctors on base here are okay. I dunno. This helped me decide a lot, especially because we are thinking about kids in the near future so, this helped me make my decision. I don't think money is a big issue, (unless I would have to be paying $600+ for an ER visit, or more than $70+ for each doctor visit) or something else even more outrageous.
    I talked to a Tri-Care staff member who told me that getting into a doctor can sometimes have long wait times and with Standard it's even longer (at the naval hospital). Out here with 2 or 3? bases with one hospital is a little crazy, so I could understand why it takes awhile,
    I probably will stick with Standard just because i'd feel more comfortable with it. Especially because I want to see a doctor on my own terms.

  7. Ummmmm...........
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    #7
    I have Standard and always have. I've never had prime and I'm not really interested in it. I love that I can go to any doctor I want. I love that I can just walk into Urgent Care and know I only have to pay 20% of the visit and whatever procedure I may have to have (not sure if this is the same with Prime). Its worked out well for me. It costs me like 12 bucks to go see my regular doctor, depending on what I'm going for. I recently messed up my knee, I had a referral for an MRI THE NEXT DAY. Its just really easy.
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    #8
    I've always had Prime and been very happy. But when I was in San Diego, because the hospital was so overcrowded, I saw civilian docs for everything. So it was like the best of Standard, but without having to pay. Had I been required to see a Navy doctor for every appointment, I might have switched. I can't say for sure. When we are back in the States again, I'll start with Standard and see how I feel about it.
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    #9
    Before I was married, I had BlueCross BlueShield. Then I went onto TRICARE Standard, because I wanted something similar. I wanted to pick my doctors. I have a $150 deductible and a small copay ($9-$30). It's still much cheaper than BCBS. I don't think I could handle Prime, because I don't want some random person in charge of when and where I go to the doctor. Standard will also be important when I get pregnant, because I want ONE OB-GYN for the whole thing, and I want to pick that doctor.
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    #10
    I had both. I preferred Standard over Prime, especially when I was pregnant. I did half of my pregnancy with Prime, and the 2nd half with Standard, and it was 100% better.

    Now that I have Blue Cross Blue Shield, I'd take Prime in a heartbeat


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