As 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.