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Tricare Prime vs. Standard

At this point I am 95% certain that I am going to switch to Standard after my laparoscopy surgery later this month.

For those of you who have Standard, what do you love about it and what do you hate? Have you ever had issues with Tricare not paying for things? Are ER visits covered? My catostrophic cap is 1,000. After I reach that does that mean I won't have to pay anything else for that year? Thank you for any input you can offer! :)

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Re: Tricare Prime vs. Standard

  • Here this website will help

    http://www.humana-military.com/south/bene/tools-resources/handbooks/cost-summary/std-and-extra-costs.asp

    I will be changing to standard very soon. But I do know that unless pregnancy related that E.R. vists are copays at 20% after you pay your dect.

  • I changed mid pregnancy, so I've had a little experience with both.

    Prime- Biggest plus was that everything was covered.  There was no wondering if a bill would come in the mail and no worries about co-pays.  Biggest minus is that you are at the mercy of Tricare regarding where you go for service.  Example: As soon as I popped the pregnancy test with my PCM (also an OB), Tricare made me go to the military clinics rather than my civilian provider saying they had room to take me (they didn't, but that's another post).  You also have to get referrals to see someone outside of your PCM, including my PCM having to do a referral to herself for my pregnancy care.

    Standard- Biggest plus so far is that I can go where I want as long as they take Tricare.  I switched back to my civilian PCM for maternity care, for example.  So far the biggest minus is the co-pays.  Compared to previous health insurance I've had the caps we have are awesome, but its still unexpected bills to come up with money for.  My caps per fiscal year (DH is an E6, I'm pretty sure lower ranks pay less) are $150 for me, $300 family and $1000 catastrophic.  Lucky me with my EDD falling just after the fiscal year starts anew (FY starts Oct 1), I get to pay the personal cap twice in one pregnancyConfused

    I'm not sure if ER visits are covered with Standard.  I think so, at least to some degree (ie to the point of the caps).  With Prime they are, but I had to go to the military hospital for my ER visit (we're pretty close to a major military medical center). I'd imagine if one was on Prime I could go elsewhere, but it would be more of a headache.

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  • imageJunebug060609:

    I changed mid pregnancy, so I've had a little experience with both.

    Prime- Biggest plus was that everything was covered.  There was no wondering if a bill would come in the mail and no worries about co-pays.  Biggest minus is that you are at the mercy of Tricare regarding where you go for service.  Example: As soon as I popped the pregnancy test with my PCM (also an OB), Tricare made me go to the military clinics rather than my civilian provider saying they had room to take me (they didn't, but that's another post).  You also have to get referrals to see someone outside of your PCM, including my PCM having to do a referral to herself for my pregnancy care.

    Standard- Biggest plus so far is that I can go where I want as long as they take Tricare.  I switched back to my civilian PCM for maternity care, for example.  So far the biggest minus is the co-pays.  Compared to previous health insurance I've had the caps we have are awesome, but its still unexpected bills to come up with money for.  My caps per fiscal year (DH is an E6, I'm pretty sure lower ranks pay less) are $150 for me, $300 family and $1000 catastrophic.  Lucky me with my EDD falling just after the fiscal year starts anew (FY starts Oct 1), I get to pay the personal cap twice in one pregnancyConfused

    I'm not sure if ER visits are covered with Standard.  I think so, at least to some degree (ie to the point of the caps).  With Prime they are, but I had to go to the military hospital for my ER visit (we're pretty close to a major military medical center). I'd imagine if one was on Prime I could go elsewhere, but it would be more of a headache.

    I think you have some terms mixed up.   You are saying caps were you should be saying deductable.  The deductables are as you stated $150 for single depandent, $300 for family.  This means before your co pays start you must meet your deductable. Meaning you pay full cost up till to the cost of your deductable. (which does not take to long to do)  Your Cast. Cap is $1000. This means once you pay $1000 out of pocket for the Fiscal year then your co pays end till the begining of the next fiscal year.

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