Tricare: Standard vs. Prime

Tricare is the medical insurance given to all dependents of the military. There are two different types (standard and prime) and I always see people asking which is the better of the two. I don’t really think it’s a matter of which is better, but a matter of which best suits your family. So, I’m going to give the ins and outs of both and then explain why I picked the one I did.

Let’s start with prime. After Ken and I got married, we had to go register myself and Kate in DEERS so that we could get his benefits. Once enrolled in DEERS, you are automatically enrolled in prime although they do give you the option to switch, but nobody really actually tells you this. With prime, there are no co-pays and you have to use one of the designated providers. These providers are normally either clinics in the hospital or somewhere scattered around on post. If you have any medical issues, you will need a referral from your PCM to see any other providers. There is a difference between emergent and urgent care. If the issue is life threatening, a trip to the emergency room will only require a post treatment call to your program provider, but if the issue is serious but not life threatening, it requires a call to get a referral to an urgent care facility. You are now allowed two non referral urgent care trips a year. You can however go to the emergency room on post and not have to worry about referrals.

Next is standard. Standard allows you a lot of flexibility as far as choosing your provider, but there are a few out of pocket expenses. There is an annual deductible based on rank ( $50/ person $100/family for E-4 and below and $150/person $300/family for E-5 and above) and a co-pay for certain services. Most preventative services are covered but the co-pay for other services are around 20%.

Originally Kate and I were enrolled in prime for about 2 years. We changed clinics about 3 times because I couldn’t find a provider I was comfortable with. I found that the civilian doctors had a tendency to be nicer than the military doctors, but it was harder to get an appointment with the civilian providers because they were greatly outnumbered. Once I was pregnant, that was the turning point for me and I decided we needed to switch to standard. We were stationed at Fort Campbell, and BACH was not the hospital at which I wanted to have my son. They didn’t even want to schedule my first prenatal appointment until I was at least 12 weeks. This might not have been a big deal to some people, but I had just had a miscarriage so I wanted care a little earlier just to make sure everything was okay. The next thing that bothered me was that they wanted to have group appointments and that I had to see a midwife unless I was deemed high risk. The mother baby suites were also shared. BACH originally told me I had no issues so I was given a midwife. Once I changed to standard, I went to a new OB and had blood work drawn and was told I had a blood disorder that combined with the pregnancy made me slightly high risk. Add that with the fact that I was losing weight due to extreme morning sickness I was seen at least twice a month from the very beginning. Let me back up and add that when I called Tricare to change over to standard, the lady tried to convince me to stay prime and tried to scare me into thinking that I would have all kinds of crazy bills. I decided to change anyway. I had all my prenatal appointments and a monthly hematology appointment. After I had my son, I was slightly nervous about the bills that I was going to receive, but I figured whatever it was the care was worth it. After all of that, I received a hospital bill for $35 for the hospital stay, $7 for a pap, and $42 in lab fees from the hematologist. It was so worth it!!! I haven’t had to pay anything for my kids’ checkups/physicals and the few bills I have gotten for sick visits have all been under $20. We don’t stay on post, so to me the luxury of being able to chose a provider close to home is awesome. I realize that for some people this may not be ideal and that they would much rather have completely free healthcare, but I will remain enrolled in standard as long as we have Tricare.