Retiree Tricare, Standard vs. Prime
#11
Gets Weekends Off
Joined APC: Apr 2013
Posts: 3,374
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.
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.
#12
Line Holder
Joined APC: Aug 2013
Posts: 70
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.
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.
#13
Gets Weekends Off
Joined APC: Oct 2006
Posts: 945
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.
#14
Gets Weekends Off
Joined APC: Dec 2007
Position: Retired
Posts: 404
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.
#15
Gets Weekends Off
Joined APC: Jun 2006
Position: 737 FO/Capt/FO
Posts: 426
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.
#17
On Reserve
Joined APC: Sep 2009
Posts: 12
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.
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.
#18
Gets Weekends Off
Joined APC: Jan 2011
Position: Wind checker
Posts: 757
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.
#19
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.
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.
#20
Gets Weekends Off
Joined APC: Jul 2007
Position: Permanently scarred
Posts: 1,707
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.
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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01-18-2017 07:53 PM