Retiree Tricare, Standard vs. Prime
#21
Just retired. Never even considered Prime... partly because I wasn't going to live near a base, and partly because I didn't want to be tied to the PCM system and have to get referrals. The freedom of choice seems liberating to just pick a doctor and go if I need a specialist (of course, call first and see if they're in the Tricare network).
As UALT38 said, cost may not be a big difference, depending on how much you have to go see a doc. I'm guessing people think Prime is the best because "it pays for everything." But you have an annual premium, and are tied to the PCM for a referral process (which I got very tired of during my last couple years of active duty). Standard has no premiums... the cost involves an annual deductible and 25% copays.
As far as supplements, I've been looking at MOAA to cover the copays and overcharges (some providers can charge up to 15% over the Tricare rates). MOAA has a few different options: just in-patient, or both in/out-patient, and a couple different levels of deductible. I chose the in & out-patient plan, with the $400 deductible (or maybe $800, I don't remember offhand). My plan, to cover me & the wife (ages 47/42, she's a smoker) and two teenage kids, was $67/month or $203 per quarter.
I don't know how MOAA's plan compares to others, I was already a member so I just went with their plan. I'm sure there's other military associations, even USAA, that offer Tricare supplements.
As UALT38 said, cost may not be a big difference, depending on how much you have to go see a doc. I'm guessing people think Prime is the best because "it pays for everything." But you have an annual premium, and are tied to the PCM for a referral process (which I got very tired of during my last couple years of active duty). Standard has no premiums... the cost involves an annual deductible and 25% copays.
As far as supplements, I've been looking at MOAA to cover the copays and overcharges (some providers can charge up to 15% over the Tricare rates). MOAA has a few different options: just in-patient, or both in/out-patient, and a couple different levels of deductible. I chose the in & out-patient plan, with the $400 deductible (or maybe $800, I don't remember offhand). My plan, to cover me & the wife (ages 47/42, she's a smoker) and two teenage kids, was $67/month or $203 per quarter.
I don't know how MOAA's plan compares to others, I was already a member so I just went with their plan. I'm sure there's other military associations, even USAA, that offer Tricare supplements.
#24
Been on Standard for 15 years. The civilian care has been top notch. Out of pocket most years has been less than what Prime payments would have been. One year the wife had 2 major surgeries. One planned...one (the more serious one involving days in the hospital and months of antibiotics and home nurse visits) not planned. That year we hit the catastrophic cap of $3K. Peanuts compared to the hospital bills that rolled in for tens of thousands of dollars that said "you pay 0." I don't use company medical, but I do use company dental.
#26
Gets Weekends Off
Joined APC: Oct 2006
Posts: 650
Been on Standard for 15 years. The civilian care has been top notch. Out of pocket most years has been less than what Prime payments would have been. One year the wife had 2 major surgeries. One planned...one (the more serious one involving days in the hospital and months of antibiotics and home nurse visits) not planned. That year we hit the catastrophic cap of $3K. Peanuts compared to the hospital bills that rolled in for tens of thousands of dollars that said "you pay 0." I don't use company medical, but I do use company dental.
So after you hit the cap there are no more out of pocket expenses? I am currently prime but the wife is sick of fighting to find a DR that takes it as it seems that list is getting shorter daily. That 20% of the negotiated rate is what scares me, especially not knowing what that rate is. We have a baby on the way and I don't want to switch and get stuck with a couple grand in hospital bills when on prime it would be $12 so any insight would be great.
#27
So after you hit the cap there are no more out of pocket expenses? I am currently prime but the wife is sick of fighting to find a DR that takes it as it seems that list is getting shorter daily. That 20% of the negotiated rate is what scares me, especially not knowing what that rate is. We have a baby on the way and I don't want to switch and get stuck with a couple grand in hospital bills when on prime it would be $12 so any insight would be great.
#29
Gets Weekends Off
Thread Starter
Joined APC: Mar 2007
Position: Petting Zoo
Posts: 2,074
So after you hit the cap there are no more out of pocket expenses? I am currently prime but the wife is sick of fighting to find a DR that takes it as it seems that list is getting shorter daily. That 20% of the negotiated rate is what scares me, especially not knowing what that rate is. We have a baby on the way and I don't want to switch and get stuck with a couple grand in hospital bills when on prime it would be $12 so any insight would be great.
Congrats on kid, and reminder that on standard your cost share of hospital bed is ~$800ish a day. So you could hit your annual limit real quick.
#30
Gets Weekends Off
Joined APC: Oct 2006
Position: Ret AD, back to AA
Posts: 115
I do prime but the family is standard
I'm AD AF retired, and do Tricare only, but use a "split" system--I do prime for myself, since it's only about $22 a month, and my civilian PCM sets me up with a few specialists I see regularly each year. Just $12 a visit.
My family, however, has standard. My wife's doctor and kid's pediatric clinic don't accept Tricare Prime, but do accept standard, just at the out of network rate of 75/25, which I can live with. I've been out a year and it has worked well. I have them on a MOAA supplemental plan to protect against the big $3K hit if it came, it's merely a hedge as it kicks in at $400 per individual, or $800 per family.
I'm with AA, and do their dental and vision. A better deal than Tricare in my opinion...
My family, however, has standard. My wife's doctor and kid's pediatric clinic don't accept Tricare Prime, but do accept standard, just at the out of network rate of 75/25, which I can live with. I've been out a year and it has worked well. I have them on a MOAA supplemental plan to protect against the big $3K hit if it came, it's merely a hedge as it kicks in at $400 per individual, or $800 per family.
I'm with AA, and do their dental and vision. A better deal than Tricare in my opinion...
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