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Retiree Tricare, Standard vs. Prime

Old 07-19-2014, 10:07 AM
  #11  
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I was told at TAP that as a retiree, you have the option of using the clinic with no copays, but that it is not mandatory for any MTF and it is actually discouraged because the length of time that it generally takes to get an appt. If you are Retiree Prime, you should be able to just choose your PCM online like others did above and be good to go. No need to get authorization to go off base. The only stipulation is that you have to live a certain distance from a MTF, but I am not really sure why that is in this day and age of no in-person service centers.

I plan on using prime for health and declining dental. My company has a much better dental plan and it is a boatload less money.
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Old 07-19-2014, 10:09 AM
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I don't know... I have had Tricare Standard since I got out and it has been wonderful. Out of pocket costs for visits and my three kids being born has been very low. Most visits haven't cost me a dime.

I remember a few years back calling to figure out the difference and got a bit confused but, understood that I had a little more freedom with the standard. So I went that route and all has been great.
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Old 07-20-2014, 06:51 AM
  #13  
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Originally Posted by Mink View Post
I have TriCare Standard and am very happy with it. Have not stepped foot on a base (other than to see an airshow) since I retired in 2008. Between my company's coverage (primary) and TriCare (secondary) the out-of-pocket is minimal.
Edit: Sorry, I have Standard...that's what I meant to say. Agree with Orangemx, more freedom of choice, and it's worked well so far.
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Old 07-20-2014, 01:10 PM
  #14  
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The first thing you want to find out is if your doctor accepts Tricare. If they do not accept it you will have to file the paperwork yourself and will only be reimbursed the Tricare allowed amount minus your cost share. For example, if an office visit is billed at $160, the Tricare allowed amount may only be $100. You would have to pay the doctor the $160 and then file Tricare to get reimbursed $100. If they accept Tricare, then the office visit will only be billed to Tricare for $100.
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Old 07-20-2014, 04:38 PM
  #15  
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Originally Posted by Flyinhigh View Post
The first thing you want to find out is if your doctor accepts Tricare. If they do not accept it you will have to file the paperwork yourself and will only be reimbursed the Tricare allowed amount minus your cost share. For example, if an office visit is billed at $160, the Tricare allowed amount may only be $100. You would have to pay the doctor the $160 and then file Tricare to get reimbursed $100. If they accept Tricare, then the office visit will only be billed to Tricare for $100.
I was told by tricare west last week to ask not only does the doctor participate in tricare but if he participates tricare standard. Apparently some will accept only tricare prime and others participate in both. Tri west rep told me there had been some expensive surprises for some...
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Old 07-20-2014, 05:20 PM
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What about Tricare for reserve retirees? Is there anything available between age 44-60?
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Old 07-21-2014, 05:19 PM
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Default Retiree Tricare, Standard vs. Prime

We had Tricare prime when I retired last year, but were cut out of it with the reduced coverage areas. Best thing that ever happened to us. Tricare standards freedom makes it worthwhile. I got a supplement from AMRA this year that covers the fees Tricare doesn't pay after a deductible, but I don't think I'll do it again next year. The 20% fees have been manageable since you really only pay 20% of the Tricare negotiated fee.
My opinion, try standard for a year and see if the costs are manageable. Oh, btw it's nice that I don't have to pay the few hundred dollars to Tricare for the standard fee.
When we need to see a dr, we call and see if they take Tricare, then go see them. No referrals, no heartache.
We don't live anywhere near a military facility.
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Old 07-21-2014, 10:46 PM
  #18  
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Standard here. Wife was frustrated with the referral process with three kids. As long as the provider is in network, we pretty much have discretion. I believe the $3000 catastrophic cap is the same as for Prime. Happy wife...happy life. YMMV.
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Old 07-22-2014, 07:57 AM
  #19  
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I just checked with Tricare. At at my location, Prime is the local military hospital, but due to overcrowding, I have the option to go off-base. I was surprised i could find out about the availability prior to actually enrolling.

From my analysis, it's about a wash on cost, depending on how many times a year you see the doctor....unless you need surgery. Then standard starts to get pricey, and you could hit your catastrophic cap for the year. Going to a civil provider (your local doc) is almost always easier than the mil doc.

I've got one in my family that needs minor (but expensive) surgery. Prime will be the way to go for me; the local doc makes the convenience the same as Standard.
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Old 07-22-2014, 08:26 PM
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Originally Posted by Mulligan View Post
We had Tricare prime when I retired last year, but were cut out of it with the reduced coverage areas. Best thing that ever happened to us. Tricare standards freedom makes it worthwhile. I got a supplement from AMRA this year that covers the fees Tricare doesn't pay after a deductible, but I don't think I'll do it again next year. The 20% fees have been manageable since you really only pay 20% of the Tricare negotiated fee.
My opinion, try standard for a year and see if the costs are manageable. Oh, btw it's nice that I don't have to pay the few hundred dollars to Tricare for the standard fee.
When we need to see a dr, we call and see if they take Tricare, then go see them. No referrals, no heartache.
We don't live anywhere near a military facility.
Same here. Started out with Tricare Prime, but when it looked like I was going to need shoulder surgery and I was being told to go see the AF docs (for eventual surgery at Eglin) I opted for Standard. I ended up not needing the shoulder surgery, but had I gotten it a doc from the Andrews Institute down the road in Gulf Breeze would have been doing the cutting. Andrews as in the docs who do a lot of work on guys like Favre and RG3. I did get surgery on my arm and wrist and while I don't recall the total costs it wasn't so much to stand out for me to remember. Love the freedom of standard. No supplements, but maybe that's something I should look into. Any other recommendations from those with standard who use a supplement?
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