Deciding on healthcare coverage is difficult enough for civilians, who can find advice and resources at every corner. Military health benefits can be more difficult to understand — especially if you’re a new military family. Yet, it’s still extremely important to understand how it all works.
TRICARE is the health plan offered to all active duty service members and veterans of the military along with their dependents. With various kinds of coverage within TRICARE, you’ll have to do a bit of digging to help decide which plan is best for you. Depending on your budget, where you live, and your current health concerns, you’ll need to make important considerations as you go over your options.
Here, we’ll differentiate between TRICARE Prime vs. Standard so you can clearly understand what you need in a healthcare plan.
What is TRICARE Prime?
TRICARE Prime is a managed healthcare option that’s both comprehensive and affordable. You’ll be assigned a healthcare provider that will serve as your primary care manager. This provider will manage your health care, provide routine health services, issue referrals and authorizations, and file your claims.
For the most part, TRICARE Prime will take care of all your healthcare needs and it’s required that active duty service members enroll. There are a few different plans to choose from within TRICARE Prime based on your location:
- TRICARE Prime for those living near the Prime Service Area in the U.S.
- TRICARE Prime Remote if you live outside of the Prime Service Area
- TRICARE Overseas Program Prime or TRICARE Overseas Program Prime Remote for those living overseas
What is TRICARE Standard?
Also known as TRICARE Select, you can think of this plan as a bit of an upgrade. It’s a self-managed, preferred provider option that offers more freedom of choice.
With TRICARE Standard (or TRICARE Select) you’ll pay an annual enrollment fee, an annual deductible, fixed fees for certain outpatient procedures, and part of the total cost of each service you receive. You won’t have to worry about referrals but you’ll sometimes need to make claims yourself.
In other words, if you’re on top of things and want more control over your plan, TRICARE Standard gives you a more hands-on option.
Major Differences to Consider with TRICARE Prime vs. Standard
The biggest differences between TRICARE Prime vs. Standard comes down to two things: freedom of choice and cost. When making your decision, ask yourself these questions.
- Is it important for you to choose your own doctor or specialist?
- Are you on a tight budget?
If it’s important to you that you have the freedom to choose your own doctors and medical specialists, you may want to go for TRICARE Standard (or TRICARE Select). As long as the provider you choose is authorized by TRICARE, you don’t have to stay within the network. The downside is that you may have to pay more out of pocket and make claims on your own. Referrals aren’t required and you’ll get to be picky about your health provider. Plus, if you do happen to stay within TRICARE’s network, you have the opportunity to pay less.
At the same time, if you don’t want to deal with making claims or seeking out a doctor, you may want a more managed plan like the one you’ll get with TRICARE Prime.
The other factor to consider is your budget. Do you have the means to pay out-of-pocket while waiting for a claim to come through? Are you able to pay a higher premium in the first place? If you answered no to these questions, TRICARE Prime is probably your best bet. TRICARE Prime is more affordable upfront which, for many, is ideal even if you’re giving up a bit of control.
Be aware that it’s necessary to enroll in both TRICARE Prime and TRICARE Standard during the enrollment period or after a qualifying life event. Even though you qualify, you’re not automatically covered. Enrolling in the right plan for you is a hefty decision but one that you can easily make with a little more understanding.
For more information and side-by-side plan comparisons, visit the TRICARE website.