Tricare prime or standard? — The Bump
Military Families

Tricare prime or standard?

Im currently on prime but Im not really thrilled with the naval hospital so I called another clinic off base to see if I could possibly go there....well the lady told me they put in a request to tricare to see if I get approved on prime but is not likely since we live on base and I have a good healthy pregnancy. She told me I can try to go standard( I still have a chance of getting the approval denied but its way less). Basically Im thinking of changing to standard so I can go to this clinic and then deliver at another hospital..have any of you done that? Standard doesnt seem expensive at all which is a plus.
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Re: Tricare prime or standard?

  • The only thing you should pay for pregnancy and delivery on Standard is the per day rate the hospital imposes (usually around $12-$35 a day). Not expensive at all.

    I'm in the middle of switching to Standard and Tricare is kind of diicking me around so I hope you have better luck than me.

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  • Who did she say was going to deny you if you "try" to switch to Standard?  It's your choice.  You either do it or you don't.  Just like Yoda says. (someone please correct me if I'm wrong!)

    Under the Universal Maternity Coverage there is very little out of pocket expense related to prenatal and delivery.  The possibility of higher out of pocket expenses is after your delivery when/if you need to see a doctor for something else.  Then you would either pay 15% or 20% (in-network vs. out of network) co-pays.  However, there is the catastrophic cap of $1000 per year.  That is the most you would ever pay out of pocket in a years time.  

    Good luck with your decision.  I was comfortable with possibly paying up to $1000 in order to choose my birth experience.  I don't regret it for a minute.  Even after I shelled out around $400 just to get an IUD after my delivery.  To me, it's worth it.  

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  • Tricare Standard is the best kept secret in the military IMO.  You have choices, freedom, can be picky about care, don't waste time at your PCM getting referals for every little thing (and then wait for the "system" to process it, AND it is CHEAP.  Super super cheap for what you are getting.

    I think people get caught up in the "ooh, Prime is FREE!" and forget how many headaches they get and how much time they waste for their "free" care.  My time and sanity are valuable Stick out tongue.

    Married 6/28/03

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    *~*~*~*~*

    No more TTC for us. We are done, and at peace, as a family of 4.

    "Suffering has been stronger than all other teaching, and has taught me to understand what your heart used to be. I have been bent and broken, but – I hope – into a better shape.” — Charles Dickens

     

  • Thanks ladies!! Im like 99.9% sure I will switch to standard UNLESS they approve me for the new DR on prime which I highly doubt..theres no reason for them to refer me anywhere else but I def. do not mind paying out of pocket I want to feel comfortable and confident when Im giving birth!!!! Ive never had a problem on prime but I just dont feel comfortable giving birth in the Naval Hospital so I will probably go back to prime after I give birth. 
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  • image chulita425:
    Thanks ladies!! Im like 99.9% sure I will switch to standard UNLESS they approve me for the new DR on prime which I highly doubt..theres no reason for them to refer me anywhere else but I def. do not mind paying out of pocket I want to feel comfortable and confident when Im giving birth!!!! Ive never had a problem on prime but I just dont feel comfortable giving birth in the Naval Hospital so I will probably go back to prime after I give birth. 
    Which Naval Hospital are you currently being seen?  (just curious)  Also, if your sponsor is E-4 and below there is no wait period to return to Prime but if they are E-5 and above there is a lock-out for 12 months from the date you change. 
  • I switched on June 1.  I was satisfied with the provider I was seeing at a MTF, but I didn't want to deliver at the MTF hospital because it was 30 miles from my home.  I am now seeing a civilian 2.5 miles from my house, with the hospital being 4 miles away.  I am more than happy, and I wish I would have switched years ago.
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  • image sweetpea2003:

    Tricare Standard is the best kept secret in the military IMO.  You have choices, freedom, can be picky about care, don't waste time at your PCM getting referals for every little thing (and then wait for the "system" to process it, AND it is CHEAP.  Super super cheap for what you are getting.

    I think people get caught up in the "ooh, Prime is FREE!" and forget how many headaches they get and how much time they waste for their "free" care.  My time and sanity are valuable Stick out tongue.

    I agree with this 110%. Love Standard!

  • I delivered twins at a civilian hospital (with Standard).  I had a scheduled C-section and I was in the hospital for 4 days.  The only bill I received from my stay was for $65 and it was just the percentage that I had to pay for my son's circumcision because it wasn't a "medically necessary" procedure, so I had to pay a little out of pocket for that.  $65!!!! To go home with two babies, a surgery and a 4 day hospital stay!  I'll take it!!!

    During my entire pregnancy, sometimes I would get a bill in the mail for $3 or $5 here and there for blood tests that my doctor did (honestly, because I believe it wasn't coded properly as an OB thing) so I had to pay a little out of pocket.  Fine by me!  

    I definitely agree with the PP that said Tricare standard is the best kept secret in the military.  I'm SO happy with my choice!

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  • I for one, have loved Prime. I never had any problems with the hospital on base or my PCM. I haven't ever needed a referral for anything so my care has been very simple for the last 2 years.

    Now that i'm pregnant though, I have left every single appointment, in the OB clinic, crying. I have been through hell and back with the BS they have provided for me. I was trying my hardest to just suck it up because if I did switch to standard, i would be locked out of prime for a year. I LOVE my pcm so i didn't want to do that. I figured I would stick it out for a few months to continue to see my normal doc.
    I recently learned my pcm switched to working in urgent care so I would be losing him anyway.
    So here I am switching to standard now =( I am slightly sad but I am SO relieved to have a new OB who I like and wont mess with me.
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  • image chulita425:
    Thanks ladies!! Im like 99.9% sure I will switch to standard UNLESS they approve me for the new DR on prime which I highly doubt..theres no reason for them to refer me anywhere else but I def. do not mind paying out of pocket I want to feel comfortable and confident when Im giving birth!!!! Ive never had a problem on prime but I just dont feel comfortable giving birth in the Naval Hospital so I will probably go back to prime after I give birth. 

     

    Did you try to log online to the Tricare website and switch your PCM to a different one off base...That is how I got who ever I wanted even when I lived close to base in CT now out here in Cali i use a Civilian b/c base is over 30min away. just a thought.  

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