Military Mondays: TRICARE Standard | Anchors Aweigh


Military Mondays: TRICARE Standard

Last week I blogged all about the wonderful world of TRICARE Prime, so today's Military Mondays topic is TRICARE Standard. TRICARE Standard is complicated, and I am the first to admit I don't have all of the answers, but I am going to do my best with the information I do know.

Like last week, I am going to try to stick to the facts and keep my opinions out of it. I was on Prime for 3 years and then switched to Standard when we got pregnant and have been on it ever since. There are pros and cons with both, and you are welcome to email me if you have any questions about my experience with either. :)

Like last Monday, I am going to speak specifically to the active duty spouse side. TRICARE Standard is not available to active duty service members- only their dependents. 

The main difference between TRICARE Prime and TRICARE Standard is cost plus provider. Prime is completely free, while Standard has costs associated with it. Standard also allows you to choose your provider (doctor), while Prime assigns you a provider.

How It Works

You don't have to apply for TRICARE Standard. As long as you are listed in DEERs, you are eligible. Your military ID acts as your insurance card, and you are free to call and schedule an appointment with your provider.

Switching from Prime to Standard

You can easily switch from Prime to Standard by calling the TRICARE offices. Requests to switch are processed immediately and go into effect at midnight of the same day. Once switched, you could be locked out from re-enrolling in Prime for up to a year, so that's something to keep in mind. For instructions on how to switch from Prime to Standard, click here.

How Much Does It Cost?

Oye. This is a hard question to answer. First of all, you must meet an annual deductible before TRICARE will start paying. That deductible is really small compared to most deductibles and is as follows for active duty dependents:

E4 and below: $50 per individual; no more than $100 per family
E5 and above: $150 per individual; no more than $300 per family

Once you meet your deductible, you will pay a percentage or flat copay for certain services. Some services are still completely covered, but others will have copays. To see a complete list of copays and what is covered, click here.

Of note: Even though you are on TRICARE Standard, you can still choose to have prescriptions filled at the base hospital for free if you have a base hospital nearby.

From what I have learned and experienced, TRICARE Standard is all about coding. As long as your doctor codes your procedure/appointment/etc. as "medically necessary", you won't have to pay anything. I'll use my miscarriage as an example. We lost a baby halfway through the pregnancy. My surgery was medically necessary, so it was covered. That was a $10k surgery, and TRICARE paid for it. Before we lost our baby, we had an amniocentesis done to determine her chromosomal abnormality. This was not medically necessary, so I paid $99 out of pocket. As long as what you are doing is deemed "medically necessary" by your doctor, you should be covered.

I hope this has been informative and helpful for some out there! TRICARE Standard is complicated, and I am by no means an expert, but it's a great alternative if Prime isn't for you. If you have any questions on anything I did or didn't cover, feel free to shoot me an email. :)


Jen said...

I've tossed around the idea of switching to Standard but I just can't seem to do it.

Bailey Kay said...

Andy and I keep tossing around the idea of Prime or Standard. I think we're going to stick with Prime until we are ready to have kids and then switch to Standard... unless I have a horrible experience with Prime.

AiringMyLaundry said...

I know lots of my friends have switched to standard for better care.

Stephanie said...

You did a great job explaining these!


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