For those of you military retirees, under age 62, do you fulltime with Tricare Prime or Tricare Standard?
We are on Prime now and as I understand it if we go ahead and change our address to South Dakota, then we will have to change our provider area. I was just wondering how it all works for those that have Tricare and what happens when you need to be treated or see a Dr outside your covered area?
We are on the road as close to March 17th as we can get going and this seems to be my last hurtle to get through!!
Thanks in advance.
Doris
NorCal Dan said
10:06 PM Jan 5, 2011
We use Tricare Prime. The only issue we have is when not near our doctor. Emergency/Urgent Care is covered. But if you need to see a doctor after the emergency you probably won't be able to get a referral from your home area doctor, I know our doctor won't do it.
We went to the Tricare website and did some research. They have an option called POS where they allow you to use the Standard rules for out of area doctor visits. We just had to use this option ourselves so I don't know how it's going to turn out. I suspect we will have to pay 20% of the covered cost. If I read it correctly, if the doctor charges Tricare $100 and Tricare only authorizes $50, then we will have to pay $10 or 20% of the allowed $50 charge.
The alternative is to switch to Standard and I don't want to do that as you must keep Standard for 1 year before you can switch back. Since this summer we will be back near our doctor we decided to stick with Prime.
There are other places you can go for treatment, I think they are called MTF's, I think that stands for Military Treatment Facilities, where you can get care and don't need a referral from your doctor. VA hospitals and Military Base Hospitals are usually on the list, so if you happen to be near one of them...check the TriCare website as I believe they have a list.
I'm no expert on Tricare and just trying to fumble my way through it. Normally it's not an issue with us, but the DW got run over by the dog and fractured her knee. We don't use it very often so with this current problem we are trying to get smart on the program.
-- Edited by NorCal Dan on Wednesday 5th of January 2011 10:07:46 PM
2fortheroad said
10:29 PM Jan 5, 2011
Our home base is in Idaho. A couple years ago we were in Tucson AZ, we both came down with some sort of bug so we went to a "Doc n the box". We both used our TriCare and also again at the Wal Greens for prescriptions with no problem. As you I do not understand the region thing, maybe a phone call to TriCare would help. If you do happen to get any info please leave a post. We have TC Standard and have no complaints.
-- Edited by 2fortheroad on Wednesday 5th of January 2011 10:35:25 PM
-- Edited by 2fortheroad on Wednesday 5th of January 2011 11:01:56 PM
Delaine and Lindy said
09:14 AM Jan 7, 2011
Dave we have Tri-care Prime, and it works for us. However you can have problems in some areas. Most every Military base will not have any openings. I highly recomend you have at home base a good Primary Care Doctor. We schedule our Phyiscal each year and upgrade out meds. We use Wal Mart for our refills on our Meds. We have traveled thru out the lower 48 and we have had issues in some areas if you perscription expire. But it you have a good Primary Care Doctor, thats just a phone call away. But for emergency's you shouldn't have any issues. In June I will be 65 so things will change???????????????
jimdee said
11:56 PM Jan 8, 2011
We were on Tricare Prime before we went full time, but have since switched to Standard. With Prime you must keep a primary care provider as your "go to" doctor for all care and referrals. With Standard you can see any doctor you want (but you have a lower co-pay if you see a doctor who is in the Tricare network). Overall, the co-pays and deductibles are higher with Standard, but we feel that's out-weighed by the benefit of being able to see any doctor. And you can even see a specialist directly, without needing a referral (which is required by Prime). Another benefit of Standard is, no $460 per year... it's free. We were told by the MacDill AFB Clinic that we weren't eligible for care in a military clinic or hospital; you have to be in Prime for that. I should have questioned him further to find out if he was talking about only the MacDill facility, or any military facility. So not real sure about that.
DorisandDave said
08:52 AM Jan 10, 2011
Thanks everyone for your answers. I have a snow day from work today, so am going to call Triwest and get answers...I'll let you know what I find out.
Doris
Old Snipe said
10:08 AM Jan 10, 2011
Another Tricare question. If you elect Standard and are not eligible to be seen at a military treatment facility, can you still use a military pharmacy to get a perscription filled?
Best Regards!
2fortheroad said
10:59 AM Jan 10, 2011
Old Snipe wrote:
Another Tricare question. If you elect Standard and are not eligible to be seen at a military treatment facility, can you still use a military pharmacy to get a perscription filled?
Best Regards!
We have gotten prescriptions filled at Mt. Home AFB before. My neighbor is also retired military, we have made a couple day trips to Mt. Home, mainly just for something to do. They have also gone to the AFB to get their Shingles shots, they were free with no co-pay.
MKM said
02:34 PM Jan 10, 2011
I don't post very often on forums, but I wanted to throw in my 2 cents on this particular subject. We just completed our first year of full-timing. We are retired USAF and decided to go with Tricare Standard because of its flexibility. Tricare has an excellent website we consistently use to find a doc in our location. We currently have established ourselves with NC docs, since our dgt lives in NC and that is where we will be when we are no longer able to travel and/or if we have serious medical issues. We have been very pleased with that decision thus far. No referrals are necessary to go anywhere and see whoever. We have used docs in the NC area, as well as docs in AR, where we are originally from. We attempted to get a refill on one of our prescripts at Seymour-Johnson AFB in NC. We were told we would have to "transfer" the prescript from Little Rock AFB but it would take some time to do that. So, we opted to get prescripts at Walgreen's since most states have Walgreen's -- of course, Wal-Mart is another option. You pay $3 for a generic prescript and $9 for the real thing. We asked our NC doc to make the prescript for a 90-day supply, so we get 90 days on each refill, which comes to $9 for a 90-day supply if it's a generic. As far as docs, as long as you select one that is on the Tricare Doctor Preferred list, you pay 20% of the charges. If the doc is not in the Tricare system, your out-of-pocket cost will be 25%. Once you reach $3000 out of the pocket in a year's time, you pay no more. My husband is getting ready to have a prostate biopsy in NC. Since there was only one urologist on the Tricare Standard list in NC, we opted to see someone locally...we will see how much out of the pocket we have to pay for this procedure.
I don't claim to be an expert on Tricare -- can only tell you how it has worked so far for us.
MKM said
02:36 PM Jan 10, 2011
I forgot one thing...we also got flu shots at Walgreen's and Tricare paid for it -- no copay, cost us nothing.
mailman01 said
06:34 PM Jan 10, 2011
Tricare Prime allows one to make appointments at their MTF, usually, next day appointments. One can still be seen at an MTF if using Standard, however, on a space available basis only. Military pharmacies will fill a prescription issued by a local doctor as long as they carry the drug. This all changes when passing the magic age of 65, then it is Medicare and Tricare, seeing the doctor of your choice in the civilian world. I can pretty well guarantee longer waits in the office even with an appointment. Not nearly as prompt on their appointment times as the military, at least that is my experience. But the price is good.
DorisandDave said
08:23 PM Jan 12, 2011
OK, after a couple of hours on the phone ping ponging between Tricare and DEERS, the answer for us is Standard. It works just how JimDee and MKM have described.
We will also use Walgreens just like we do now. We use civilian Dr's now, as our MTF at Fort Riley tends to put retirees last.....very full plate with all the military growth here.
My experiences with waiting times is quite the opposite of Mailman's... always was a long wait at the military hospitals...particularly in peds and the pharmacy. Not once have I waited more than 5 minutes in my civilian dr's office.
And also like MKM, we will keep our primary care provider here for our continuity of care.
The only thing I would add of importance is to make sure that your address at DEERS and your address with Tricare match. According to the claims people at Tricare, if your address with them and the one at DEERS do not match then it sends a red flag up and can delay processing.
Edited to add content.
-- Edited by DorisandDave on Wednesday 12th of January 2011 08:25:30 PM
MKM said
04:31 PM Jan 14, 2011
Doris and Dave, thanks for your post. We do have different addresses for DEERS & Tricare & will now definitely make sure they are the same. We used our dgt's address in NC for Tricare since that's where we are most of the time and where most of our docs are and have not had a problem. HOWEVER, based on your post and the possibility it could delay a claim, we will change our Tricare address.
Thanks again for posting this.
ew9266 said
02:36 PM Jan 25, 2013
We have prime as well and the secret is to have a good PCM. We call when out of the area and she puts in a referral for us for what ever we need and the co-pay has never been an issue. We are on the road a lot and we normally contact our PCM when we are going to be in one place for a extended period so she is aware whats going on. We have been seen at both military and urgent care locations. Watch out for prescriptions and the number of refills, the West coast can't see the East coast computer records at military facilities. Make sure before you leave your home base you have plenty of refills available to you.
Neil and Connie said
12:39 AM Jan 26, 2013
I don't recall all the gory details; but when Connie researched this for our changeover to SD residency we could not stay on Tricare Prime so we shifted over to Standard. Since then we've just used Standard and paid the doctor the deductible once (and twice they didn't want it…so I don't know if they'll bill us later or just write it off, a lot of doctors write off the deductible and just take what Tricare pays them either for patriotic reasons or because it's just cheaper to write it off then try to collect it later.
We'll eventually settle down within the required 50 miles of a MTF and join back up to Prime with a primary care physician but for now Standard is the way to go for us.
CathyJ said
07:28 PM Jul 21, 2014
I have Tricare Standard and it works well for me. I get my scripts through Express Scripts but if we have a paper script we get it filled at any base pharmacy. If you're new to this, just make sure your military ID says "Medical: YES" on it, otherwise you can't get scripts filled at bases. For any of you on facebook, we welcome you to join our military RV group at www.facebook.com/groups/373190462790041/
We are on Prime now and as I understand it if we go ahead and change our address to South Dakota, then we will have to change our provider area. I was just wondering how it all works for those that have Tricare and what happens when you need to be treated or see a Dr outside your covered area?
We are on the road as close to March 17th as we can get going and this seems to be my last hurtle to get through!!
Thanks in advance.
Doris
We went to the Tricare website and did some research. They have an option called POS where they allow you to use the Standard rules for out of area doctor visits. We just had to use this option ourselves so I don't know how it's going to turn out. I suspect we will have to pay 20% of the covered cost. If I read it correctly, if the doctor charges Tricare $100 and Tricare only authorizes $50, then we will have to pay $10 or 20% of the allowed $50 charge.
The alternative is to switch to Standard and I don't want to do that as you must keep Standard for 1 year before you can switch back. Since this summer we will be back near our doctor we decided to stick with Prime.
There are other places you can go for treatment, I think they are called MTF's, I think that stands for Military Treatment Facilities, where you can get care and don't need a referral from your doctor. VA hospitals and Military Base Hospitals are usually on the list, so if you happen to be near one of them...check the TriCare website as I believe they have a list.
I'm no expert on Tricare and just trying to fumble my way through it. Normally it's not an issue with us, but the DW got run over by the dog and fractured her knee. We don't use it very often so with this current problem we are trying to get smart on the program.
-- Edited by NorCal Dan on Wednesday 5th of January 2011 10:07:46 PM
Our home base is in Idaho. A couple years ago we were in Tucson AZ, we both came down with some sort of bug so we went to a "Doc n the box". We both used our TriCare and also again at the Wal Greens for prescriptions with no problem.
As you I do not understand the region thing, maybe a phone call to TriCare would help. If you do happen to get any info please leave a post. We have TC Standard and have no complaints.
-- Edited by 2fortheroad on Wednesday 5th of January 2011 10:35:25 PM
-- Edited by 2fortheroad on Wednesday 5th of January 2011 11:01:56 PM
Doris
We will also use Walgreens just like we do now. We use civilian Dr's now, as our MTF at Fort Riley tends to put retirees last.....very full plate with all the military growth here.
My experiences with waiting times is quite the opposite of Mailman's... always was a long wait at the military hospitals...particularly in peds and the pharmacy. Not once have I waited more than 5 minutes in my civilian dr's office.
And also like MKM, we will keep our primary care provider here for our continuity of care.
The only thing I would add of importance is to make sure that your address at DEERS and your address with Tricare match. According to the claims people at Tricare, if your address with them and the one at DEERS do not match then it sends a red flag up and can delay processing.
Edited to add content.
-- Edited by DorisandDave on Wednesday 12th of January 2011 08:25:30 PM
We have prime as well and the secret is to have a good PCM. We call when out of the area and she puts in a referral for us for what ever we need and the co-pay has never been an issue. We are on the road a lot and we normally contact our PCM when we are going to be in one place for a extended period so she is aware whats going on. We have been seen at both military and urgent care locations. Watch out for prescriptions and the number of refills, the West coast can't see the East coast computer records at military facilities. Make sure before you leave your home base you have plenty of refills available to you.
I don't recall all the gory details; but when Connie researched this for our changeover to SD residency we could not stay on Tricare Prime so we shifted over to Standard. Since then we've just used Standard and paid the doctor the deductible once (and twice they didn't want it…so I don't know if they'll bill us later or just write it off, a lot of doctors write off the deductible and just take what Tricare pays them either for patriotic reasons or because it's just cheaper to write it off then try to collect it later.
We'll eventually settle down within the required 50 miles of a MTF and join back up to Prime with a primary care physician but for now Standard is the way to go for us.