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Tri-Care Standard ?

RunningMom08RunningMom08
in Military Families
Hey Ladies! DS has been seeing the pediatrician he saw int he hospital. We petitioned to have Prime allow us to continue seeing him. (He had a high grade fever when he was born, and the peds who took care of him know his history, so we wanted to have continuity of care.) Well Tri-Care denied our request. We just went in for our 2 month appt today, and I decided that I really want to continue to see this Dr. THis means we would have to switch to Standard. How much are the co-pays? Are there any other out of pocket expenses that I should know about? I will be talking with DH about it tonight, but was hoping to have some numbers to run by him first. Thanks for any advice/info you may have!
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Re: Tri-Care Standard ?

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    BeckyTheEngineerBeckyTheEngineer

    I'm eligible for both Prime and Standard.  I always use prime (because it's free and I get the same services), but sometimes offices mistakenly run me under standard.  I'll get bills in the mail that are pretty low, like a $10 co-pay to see a ob specialist.  I'm not sure what it would be for a pediatrician. 

    One thing to keep in mind, pediatrician appointments are very frequent.  Between routine check-ups, weight checks, stopping in for a flu shot, occassional illness/injury and new-mom overreacting, I'd estimate going to the pediatrician about 10 times in the first year.  Plus, I'm not sure if they would pass on more of the cost of vaccines or any procedures.  So be aware that it could start to add up.  If you do go with standard, ask about the process to switch back ahead of time just in case you want to go with prime again.

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    IlumineIlumine member

    TRICARE STANDARD does not have co-pays, ie 10$ per visit, etc.  It is a Point of Service program, you will have a COST SHARE, which is 15% if you go to a networked provider and 20% if you go to a non-networked, but Tricare accepting provider.  

    https://www.tricare.mil/tricarecost.cfm

    For Active Duty Family Members:

    When you go Standard, you will have an annual (fiscal year) deductible to reach first, $300 for E5 and above. 

    Then you will pay your Cost Share of the visit. 

    When you, as a family, reach a Catastrophic Cap (again fiscal year) of $1000, TRICARE will cover the rest of your out-of-pocket costs till the next October. 

    So the overall out-of-pocket costs depend on the regional costs of Pedis and how often you are going ot have to bring your child to the doctor. 

    ALSO, you are only allowed ONE disenrollment per fiscal year.  If you do it twice, you are locked out for a 12 month period unless your DH is E1-E4.  

    For the PP, it doesnt sound like you are being billed as Standard, but that DEERS thinks you are a Retiree.

    file:///Users/Ilumine/Desktop/Family%20Portrait%20for%20gift.jpg
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    RunningMom08RunningMom08
    imageIlumine:

    TRICARE STANDARD does not have co-pays, ie 10$ per visit, etc.  It is a Point of Service program, you will have a COST SHARE, which is 15% if you go to a networked provider and 20% if you go to a non-networked, but Tricare accepting provider.  

    https://www.tricare.mil/tricarecost.cfm

    For Active Duty Family Members:

    When you go Standard, you will have an annual (fiscal year) deductible to reach first, $300 for E5 and above. 

    Then you will pay your Cost Share of the visit. 

    When you, as a family, reach a Catastrophic Cap (again fiscal year) of $1000, TRICARE will cover the rest of your out-of-pocket costs till the next October. 

    So the overall out-of-pocket costs depend on the regional costs of Pedis and how often you are going ot have to bring your child to the doctor. 

    ALSO, you are only allowed ONE disenrollment per fiscal year.  If you do it twice, you are locked out for a 12 month period unless your DH is E1-E4.  

    For the PP, it doesnt sound like you are being billed as Standard, but that DEERS thinks you are a Retiree.

     

    Thank you for the info!!

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    shall923shall923 member
    On Standard the normal wellness visits are covered 100%. So all his shots will be covered. I have only had to pay when I took her in for an illness. I have taken her twice and was charged $16 each time. That is all I have paid since she was born.
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    ladybug8510ladybug8510
    In DD's life I've only ever paid $6 and that was for her blood draw at 9 months to check for anemia.  Now granted DD has been healthy so far and we've never had a sick visit ::knocks on wood::  I also had DD while on standard and my whole birth was like $50 for delivery.  I love standard and have been very happy with it.
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    RunningMom08RunningMom08

    imageLadybug8510:
    In DD's life I've only ever paid $6 and that was for her blood draw at 9 months to check for anemia.  Now granted DD has been healthy so far and we've never had a sick visit ::knocks on wood::  I also had DD while on standard and my whole birth was like $50 for delivery.  I love standard and have been very happy with it.

     

    Great news! DS is very healthy (knock on wood) and we just love this Dr. I think we are going to switch to Standard and stick with the same Dr.

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