TRICARE Standard: Is it right for you?

flag-stethoscopeAs a new spouse, or even a seasoned spouse, the difference between TRICARE Standard and TRICARE Prime can be somewhat confusing. I remember how overwhelming it felt when I was faced with the decision on whether I wanted “Prime” or “Standard”. After reading through the literature available, as well as on TRICARE’s website, I decided TRICARE Standard was the best for me. If you are considering TRICARE Standard for your family, here are some points to consider:

TRICARE Standard is an option which allows you to choose your own doctor. You are able to see any type of doctor, from a specialist to a primary care physician. To search for the type of doctor you need, go to TRICARE’s “Find a Doctor” feature. If you choose a network provider, you end up paying less of a cost share . The cost share depends on what care you get at that particular appointment, whether or not you use a network or non-network doctor, or whether you are an active duty family member, retiree, or retiree family member.

The “in network” doctors file the TRICARE claims for you so you do not have to deal with the paperwork of filing the claim yourself. Using a network doctor is called TRICARE Extra . Also, there is no pre-authorization required when you need lab work or testing done. Each fiscal year you have an annual deductible to meet, which varies based on your service member’s status. As an active duty spouse, I pay only 20% of any allowable charges after I have paid my deductible for the year. There is also a $1000 “catastrophic cap” for active duty families. This means your out of pocket expense will not exceed that cap.

TRICARE patients have the option to choose which pharmacy they would like to use. Using TRICARE retail pharmacies are especially convenient for patients using TRICARE Standard, but are the most expensive option. Major drug store chains such as RiteAid, CVS, Target, and Walmart are in-network pharmacies. By using an in-network pharmacy, you are responsible for a $5.00 copay for generic medications and a $17.00 copay for brand name medications. You can save money if you use the TRICARE Pharmacy Home Delivery to have your prescriptions mailed right to your home.

A common misconception of TRICARE Standard is the idea that patients are not able to use the military pharmacy because they are not seeing a doctor at a Military Treatment Facility (MTF). As a TRICARE Standard user, you have the option to use the MTF pharmacies, which may be the best value if the MTF stock your drugs. Personally, I have never used a MTF Pharmacy because they were not as convenient for me because I did not live on the Army Post. However, if you want to save money, using the MTF pharmacy is a great option because both generic and formulary drugs have no copay!

TRICARE Standard has been the best choice for me because I enjoy choosing my provider instead of being assigned one. I also enjoy the flexibility of changing providers if I am not happy with my current doctor. Unlike TRICARE Prime, TRICARE Standard does not require a referral to see a specialist. Because of these choices, I don’t mind paying to see a doctor when I am ill and can’t survive another day without an appointment! I feel I am in control of my healthcare experience with TRICARE Standard. I encourage you to read about the other differences between Prime and Standard in order to make the best decision for your family. I hope that by shedding some light on the sometimes confusing and often-misunderstood TRICARE Standard, your decision may come a little easier.

Stephanie-OSullivanBy Stephanie O’Sullivan, National Military Family Association Volunteer, Fort Bragg, NC


Add yours
  1. 1
    Angie Sillonis

    Military family members who live in one of six areas of the United States where US Family Health Plan is available have a third option for their TRICARE. USFHP is a TRICARE Prime option which uses an all-civilian network of doctors. The costs and covered benefits are the same as with TRICARE Prime, but the different US Family Health Plan contractors offer additional benefits, such as chiropractic care, hearing aid and eyewear discounts. If you live in the northeastern United States, parts of Texas, or the Seattle area, US Family Health Plan might be an option for you. Check the national website at to see if you live in a USFHP coverage area.

  2. 3
    ken k

    ya’ll very much i was so confused you really shed some light on the whole subject pick a or b etc and still confused again thanks retired wowoCW3 Army God Bless U/and America\\\\\

  3. 4

    This is a great read and has really been a great help; my cousin has transferred from the British Army over to the US and he’s a smart kid but got really flustered with choosing a tricare plan.


  4. 5
    Nancy Krail

    Thank you so much Stephanie. This is good to know as many Prime subscribers are having to make some tough choices. The Tricare military treatment facility catchment area has changed from 40 miles to 100 miles. This means for us who retired 40 to 100 miles from a MTF we are now being forced to use those facilities. And, for those who retired in Central Texas, we’re being pulled back to Ft, Hood as they have a big, new hospital that needs to stay busy. I always wondered why they were building that hospital as a whole division (4ID) was leaving post??? I have no problem with military medical service providers. I DO have a problem driving 52 miles for medical care. Working for employers who don’t offer half vacation days, that means I have to take a full vacation day for a medical appt. Who wants to use their vacation days for medical visits? What goes around comes around. The changes in coverage change the conversation we have with our kids approaching adulthood about the benefits of serving in the military.

  5. 6

    Forgive me, but i still require clarification. I am retired Army

    So for tricare standard

    I pay 300.00 for family annually
    My cap is 3000.00 annually in visits/care – meaning that once i reached this 3000.00 in visits/ care… i no longer pay out of pocket expensives to see pcm’s/ care?

    So as a new standard recipient, all i pay upfront is 300.00 for my family & then the rest is pay as i go until or if that 3000.00 cap is reached?

    Can anyone post an example about what 20% actually looks like for a routine child visit at a pediactric or fam clinic for lets say….immunizations or sports physical?

    Thanks so much

  6. 8

    EMAIL: bobbycole15@hotmail>com

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