Prime vs Standard — The Bump
Military Families

Prime vs Standard

I currently have tricare prime but I'm debating whether to switch to standard while hubby is away retraining and I move back home in January. I'm just wondering what you guys have and what works best for you? 
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Re: Prime vs Standard

  • I have Standard.

    It is still very cheap, but I need the flexibility and time saving that comes with Standard.  As a busy mom (who works a little bit), I dont have the time to make an appt. with my PCM, wait for that appt, etc. all with the desire to get a referral to the specialist I need (eg: a scary mole that needs to be seen by the dermatologist - I want to just make an appointment with the dermatologist). I just simply don't have time for all of that.

    So I pay a little bit extra to be able to choose my doctors, not need referrals, etc.  The cat cap is $1000 (and that is a FAMILY cap - not an individual cap).  Yes, that is a decent chunk of change, but in the health insurance world it is NOTHING.  And the deductibles are low. 

    I personally really don't have anything against military medicine.  I was on Tricare Prime for awhile and, for the most part, was happy.  I still advocated for myself and made sure I was getting good care.  I really went to Standard when I needed more choices and was working a lot and couldn't take time off to have two doctors appointments for every specialist ailment.

    My advice is to do your research on Tricare's website.  Honestly, Tricare really pushes Prime.  If you go to a patient rep they tend to be like, "eeeeeek, it is pricey to switch! and you can't switch back for a loooooong time" kind of thing.  In reality, it is up to you to decide whether you can afford it and care about the benefits.

    Married 6/28/03

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  • Personally, I think it has to do with the care available at your current location. Where we are currently the military system is flat out overwhelmed. So much so that often the standards of care just can't be met in regards to offering appointments within acceptable timeframes, etc.  

    At our last duty station I was on Prime and perfectly happy with it but when we moved I chose to switch to Standard in order to birth where I chose. I've remained on Standard because it is next to impossible to get an appointment within a reasonable amount of time and, like the pp said, my time is limited so I can't exactly be at the mercy of whatever the clinic or hospital has available. I'm willing to pay out of pocket for a bit more flexibility.

     However, when we move soon I will probably re-enroll into Prime and make my assessment of the situation then.  

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  • I have standard. I am happy I have standard because where I live, if you have prime, you HAVE to go to a military medical facility and been seen by a military doctor AND deliver your baby at the military hospital. There isn't a choice because we live so close to 2 military hospitals. 

    I personally don't like being told what doctor I can see or which hospital to deliver at. I also don't like having to make 2 appointments every time you need to see a specialist about something. I think its redundant and stupid.

    As for the costs...its super cheap to be on standard. I use to have Blue Cross and the copays were ridiculously high and far more expensive than what we are paying now. I would definitely do your research and discuss it with your spouse. Once you drop Prime, you have to wait until open enrollment to join again.  

  • imagesaywhut82:
    Once you drop Prime, you have to wait until open enrollment to join again.  
    Unless it's changed recently, dependents of E-4 and below can change back immediately while those E-5 & above must wait a year. 
  • I had Prime for the first 7 years of my marriage, and I switched to Standard halfway through my last pregnancy. My only regret is that I didn't do it years ago. No more referrals. No more military doctors. The flexibility of being able to go anywhere I please is the biggest advantage, IMO. I suffered through years of incompetent healthcare because I was fearful of the additional costs. I educated myself, and the costs are so low, it has not been a burden as I thought it would be. Now if I am unhappy in my care, I go someplace else. 
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  • imageArmyQM:
    Once you drop Prime, you have to wait until open enrollment to join again.  
    Unless it's changed recently, dependents of E-4 and below can change back immediately while those E-5 & above must wait a year. hubby is that's what I was told. Didn't know it was different for E-4 and below so thanks for the info. :D 

  • I was on Standard or a long time and loved it.  I was actually able to get a supplemental insurance that covered most of the costs, which was great.  I particularly appreciated standard during my twin pregnancy, as I was able to pick a high-risk OB to handle my care.  After the twins were born I switched to Prime, since we had just moved and I didn't want to bother finding doctors etc.  I've been happy at this duty station, but would go back to Standard in a heartbeat if I were not happy.
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  • I called TriCare after I knew I was pregnant to ask about what my maternity coverage would be.  I ended up switching from Prime to Standard. I heard nothing but negative things about the way Madigan Hospital (Ft. Lewis, WA) handled their prenatal patients, and I knew I did not want to birth there.  According to the Standard maternal care benefits, all appointments, lab work, and sonos are fully covered.  I will end up getting a hospital bill for around $14.05 for each day I am admitted for labor, and that's really it.  My doctor's office said most insurance's don't offer much towards a prenatal vitamin perscription, so I've just been buying them over the counter.  I didn't actually have them call in a script to see how much it would have been out of pocket.  But paying for vitamins, and a single hospital bill for less than $30 seems more than worth it, in order to pick my doctor, appointment times, etc.  I should have switched to Standard a long time ago!  Prime gave me nothing but headaches.
    BFP #1 07/05/09 EDD 03/12/10 DS Born on 03/15/10 BFP #2 10/11/12 EDD 06/22/13 M/C discovered on 12/7/12 (measured 8w 3d) D&C on 12/10/12
  • I'm very happy with Standard. They tried to make me go to NH and leave my regular OB/GYN behind and that was a little out of my comfort level, in addition to how far the NH is from my home and how fast my last little one came. We decided Standard was the best option for us, I paid a $150 cost share for my maternity care (some people pay less while others pay nothing but that's my personal experience) and I haven't paid a single cent more for anything else, including an extra in depth ultrasound I needed to look at baby's heart. I will probably switch back into Prime after baby is born though, as long as they don't try to make me use a PCM at the NH :)
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