Tricare Standard vs Prime: 8 Benefits Of 80% Coverage

by Heather on November 23, 2014

 tricare standard vs prime

 Tricare Standard vs Prime: 8 Benefits Of 80% Coverage

It’s no secret that I love Tricare Standard vs Prime. I wrote a whole article on it a while ago. But I thought that today I’d just point out the benefits of being Tricare Standard instead of Prime. Prime has benefits too, but I’ll cover those another day.

Here are 8 Benefits of Tricare Standard vs Prime:

1- You can choose your doctor or other health care provider. You don’t have to be “assigned” one. You get to pick! I advise you to pick one that is “in-network” as they cover a higher percentage of the cost. If you choose out of network, Standard may still cover it though. So if you have a doctor you’re desperate to see, go for it. Just know your costs may be slightly higher. From a recent call I made to Tricare, I learned that it’s only about a 5% difference in coverage depending on what type of doctor/need you have. Make sure and call Tricare about your individual situation to find out for sure.

 2- You can choose your clinic location. You can choose a clinic you have heard good things about or that’s near your home. You could also choose a practice that has multiple locations and pick the office that best suits your situation.

 3- Your doctor won’t PCS on you. Yes this happened to me when I was on Prime. He was an OB who was going to help me with fertility issues. Then suddenly he was PCSing to Japan. He gave me a two-month prescription for Chlomid and said “good luck.” Thanks. With Standard, your doctor may leave the practice, retire, or move for some reason, but there is not the constant turnover you’d find in a Navy (or any branch) hospital.

 4- Receive a higher standard of care. Some people may debate this, but due to the horror stories I heard about Naval Hospitals, I was a very happy to be out in town to deliver my baby. I’m sure many navy facilities and individual staff members are quality practitioners, but I had much more peace of mind being outside of a Navy facility.

5- You don’t have to enroll in Standard at new duty station. You automatically end up on Standard if you don’t enroll in Prime. You don’t have to make the trek to the Tricare office on base and spend time doing paperwork. Just call up a new doctor of your choice and schedule an appointment.

6- You don’t need a referral to see a specialist with Tricare Standard vs prime. Fertility specialist? Dermatologist? Physical therapy? Just call and set it up. You don’t have to wait a month to see your primary care physician for the referral, then wait another month for the appointment with a specialist. Standard can save you SO. MUCH. TIME.

7- You can supplement higher costs with MOAA (Military Officer’s Association of America). If your spouse is an officer, you’re eligible for MOAA’s supplemental health insurance. It covers 15% above what Tricare Standard pays. If Tricare covers it, MOAA will kick in. If Tricare refuses coverage for something 100%, that’s the only time MOAA won’t cover it.

On Average, Standard covers at 80%, sometimes 85%. For pregnancy it’s 100%, from what I understand (I had to pay for some fertility procedures). With Tricare Standard, you have a $150 deductable and a $1000 yearly cap on your costs. This can get pricey, but MOAA will cover your charges for the $1000.

8- You have more control over your healthcare. Sometimes control, location, choice, and convenience are worth a little extra. In my opinion, I’m willing to pay a little out of pocket to have the freedom Tricare Standard provides. If you go strictly on money, Prime may be your best option, but prepare for some headaches. It’s all about your priorities and what is feasible for your family. I personally enjoy having more control over my healthcare and enjoying the peace of mind I have from selecting my own care providers.

xoxo,
Heather

Read more at Standard’s Benefits and Why I Left Prime

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{ 6 comments… read them below or add one }

1 Megan Boone November 25, 2014 at 12:52 am

I’ve actually had the pleasure of experiencing both. At our first duty station together, I chose to have my healthcare done on base 30 minutes away. I dealt with the frustrations of having to get referrals and see my doctor just to get a referral and at the time I was too desperate and impatient to get the care I needed for a health issue. So I switched and was able to choose a doctor and place to get my health care in town instead of on base. That was convenient for checkups, it was a small town. BUT, when a serious issue rose I was not taken care of … when we PCS’d to a new duty station (our second together) I decided I wanted all my health care done on base and at the hospital. It’s been GREAT and the BEST decision I ever made. YES I had to deal with my “main” doctor PCSing on me but in all honesty, I never needed to see her and was able to see other doctors. Suffice to say, I’ve been well taken care of on base with the full healthcare plan. Everyone has been nice, genuinely caring, and my issue was addressed. Very different from my first which had some awkward moments. It just depends. Don’t knock it until you try it. 😉

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2 Heather November 25, 2014 at 5:24 pm

Hey Megan! That’s great to hear that you’ve had a good experience both ways and that you’ve found what is working for you. I agree, it definitely depends on where you are and your individual situation. I’ve considered switching P onto Prime if we live closer to base at some point. I was actually on Prime in Rhode Island, Florida, and for almost a year in Whidbey before switching to Standard. I’m planning to do a “benefits of Prime” post in the near future so I can show both sides of the coin 😉 Thanks for your thoughts and I’m so glad you’ve had great care on base at your new duty station! =)

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3 shann January 19, 2015 at 10:45 am

I loved your article…i am retired enlisted and have been putting off switching to standard for fear of cost….i need to look more i to it…. i hate going on base in cliics for issues ….talking to appt line to get in to see a doc.

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4 Heather April 19, 2015 at 4:59 pm

Yes! It’s definitely good to weigh the cost, and then the value of your sanity lol. Hope it all works out for you! Thank you for your service!

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5 Lexie August 25, 2016 at 10:35 am

Thank you so much for your articles on this! I just became a new spouse as of a week ago and wanted to know what the best option for me would be — I’ve heard a ton of horror stories and I’ve always been on the civilian side and had my own health insurance.

This was a huge help!

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6 Heather August 29, 2016 at 9:35 am

Hi Lexie! Glad to help! Thanks for stopping by =)

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