Tri-Care Prime vs Standard

Several of you have mentioned that Standard works best. Looking at the the comparison charts on the Tri-Care site it seems that standard has the potential of some very high co-pays?

DW is now on Prime (I'm a geezer and on TFL). She has on-going civilian pain management and orthopedic issues.

We are "Frequent Timers"...on the road for less than 6 months (but would like to do more). So far we've had no problems getting her Care Manager at Cherry Point MCAS to refill prescriptions and then we transfer them to CVS if we're on the road. We're home enough to do checkups etc at Cherry Point. Our biggest challenge has been getting class/schedule 2 pain meds.

I'm in the if it ain't broke-don't fix it mode but some of your points make me wonder if I should?

• I think that if we have an emergency, we're ok
  
• if we need to see a Doc can't we get authorization?

;

Thanks in advance...Steve

I don't claim to be a Tricare expert. But, I'll give you my 2 cents.

If you are on Prime you always have the option to go POS (Point of Service). That means you just convert to Standard for that single event. You can see any Tricare authorized provider. However, you become responsible for co-pays and deductibles the same as in Standard. POS does not work for emergency care.

For emergency care you must contact your Prime PCM before getting care. They don't give you much leeway on what's emergency care. Two years ago I was visiting in Wisconsin and got strep. throat. I went to a doc in a box to be seen. I called Tricare prime first and was told it would be covered. It was a weekend and couldn't reach my PCM doctor. However, they only covered it under Standard, not Prime. I ended up with a $200 bill (co-pay+ deductible) for a 5 minute office visit for something I had already diagnosed. But, I couldn't get the antibiotics without the doctor's Rx. It should have been covered under the Urgent Care option, but wasn't for some reason. I just didn't feel like fighting with them at that point in time.

We're planning on going full time in early 2010. I am still on Prime, but thinking I may switch to Standard at that time. Seems like less hassle if I need to be seen anywhere in the US. Maybe someone else can comment too.

I think every situation may be different. Last Jan. while in Key West, Fl. my wife needed care for a cyst on her back. She was on Tricare prime at that time. It was a weekend and we went to the ER at the locat hospital. They had a urgent care clinic attached to it. She was treated and Tricare took care of the entire bill. I called Tricare on Monday and got a authorization #. If emergency care or urgent care is needed on weekends or nights you can go to the care facility and get the care.

While a little dated, this ARTICLE may help you. We found it VERY useful when we started fulltiming and have been on TriCare Standard. We've been healthy and our yearly co-pay and deductible have been less than the yearly fee for Prime. So we've saved money and problems. Even if we did have a serious problem, the catastrophe cap is $3000 (last I knew) per year - the MOST we'd ever have to pay.

But everyone's situation is different. Search these forums - there's other discussions on this same topic.

Interesting points and Larry's article needs study. A quick read says I should switch since the "$ risk" could be higher with Prime and since I'm, on TFL it might make even more sense. Thanks for these points to ponder...more welcome. Steve

We are "often timers" since we still own a stick house here in Oklahoma. We are both on standard but the wife will go to TCL next June. Since we are in relatively good health it has been to our benefit to stay on standard. 1) Our long time doctor was not covered under Prime and we did not want to change. Also, don't like an HMO type coverage. 2) When on the road we want to be able to go anywhere.

Some friends were on Prime when stationed in Colorado. When he retired and moved to Arizona they ran into problems. First time they needed a doctor they were told they had to return to their primary doctor in Colorado. They had to wait until the next sign up period, about six months away, to change from Prime to Standard.

Standard works for us but, again, we are fairly healthy and use it very little.