Tricare Prime or Tricare Standard?

When your spouse activates for more than 30 days you have a decision to make, you will automatically be enrolled in Tricare Standard but then comes a very personal decision, do you stay with standard or enroll in prime? I have done both and I will outline both to the best of my ability from my experiences. The one thing to keep in mind is that with both of these you don't have t pay for the coverage monthly.

~Tricare Prime~

The main advantage to Tricare Prime is that there is no copays at the doctors/urgent cares/or emergency rooms and most medications. This is a HUGE advantage for many.

There is also no deductible!

-For me the drawbacks were if you lived within so many miles of a MTF (military base with medical, I think it stands for military treatment facility) then you will have to get a primary care doctor on base. You used to be able to go to the Tricare office on base and request to use your off base provider for "continuity of care" but I have heard from other spouses it is getting harder to get that.

-You have to have a referral for EVERYTHING. This also meant getting in and getting a referral for every specialist I was already seeing. (Tip-Take your medical records in with you, this makes this a lot easier as well as a word doc with all your docs names, practice names, addresses, phone numbers, fax numbers so you get referred to the right docs and all of them.)

-You also have to have a referral to go to Urgent Care, if you don't get one, Tricare may not pay, and I have heard this is happening a lot more often.

-I personally always found it really hard to get in for an appointment on base. So if you have a cough or cold or I had a severe ear infection, couldn't get in!


~Tricare Standard~

Flexibility! You don't need a referral for anything, and for me that is huge! I know a lot of women that choose standard when they are pregnant because they didn't want to be seen at a MTF and/or deliver there.

You also see all off base doctors. You don't need to rerefer for any doctor you are already seeing.

You can fill your prescriptions on base still if it is formulary and not pay the copay. I don't live that close to base but if I have several prescriptions I will detour near there and fill them.

Drawbacks of Standard-
There is no monthly fee, but you do have a cost share and a deductible. There is $50/$150 deductible depending on rank, per person in your family...up to $100/$300 per family.

You also have a cost share which means you pay a percentage of what Tricares payment would be. So if the doctor were to bill 1k, and Tricare pays $100, you pay a percentage of that $100. Its 15% I think. Always double check your Explanation of Benefits to make sure your ONLY being charged your portion of what Tricare is paying. I used drastic numbers to illustrate a point they aren't generally that drastic, but I have had doctors try to bill me the wrong amount before. When in doubt call tricare they are VERY helpful.

When talking about the amounts you pay it is important to weigh that you only pay at most $1,000 out of pocket for the family. After that everything is covered 100%, you may have to remind doctors or more often pharmacies that you have met your out of pocket therefore you owe nothing and they should call and check benefits again.

The fiscal year roll over in October, so that is when you deductibles and out of pockets restart every year.

The biggest thing with Standard, is if you go this route, make sure you know your benefits, stand up for yourself, and watch that out of pocket number!



Ultimately, Prime or Standard is a personal decision. My first deployment we went Prime, my second deployment I was seeing multiple specialists, so we went Standard, this time around we are on Standard now, but in October I am not sure what we will do. I prefer Standard but we are on a money saving kick, so I don't know if I want to spend the $1,000 because I do always get there and usually pretty fast.