While TRICARE provides essential healthcare coverage for military members, retirees, and their families, specific plans within the program can have certain drawbacks. TRICARE Standard, for instance, presents several notable disadvantages for its beneficiaries.
Disadvantages of TRICARE Standard
Beneficiaries enrolled in TRICARE Standard, a fee-for-service option, may encounter the following limitations and costs:
| Disadvantage | Explanation |
|---|---|
| Higher Out-of-Pocket Costs | TRICARE Standard is often regarded as the most expensive TRICARE option among its plans. Beneficiaries typically face higher out-of-pocket expenses compared to managed care options like TRICARE Prime, particularly for routine medical care. |
| Deductibles and Cost Shares Apply | Beneficiaries are required to pay a deductible before TRICARE begins to cover their medical expenses. After meeting the deductible, a cost share (a percentage of the allowed charge for covered services) is also required for each visit or service, increasing the financial responsibility. |
| Absence of a Primary Care Manager | Unlike TRICARE Prime, TRICARE Standard does not assign a Primary Care Manager (PCM) to guide and coordinate a patient's care. This means beneficiaries are responsible for managing their own healthcare journey, including finding specialists and obtaining referrals if needed, which can be less convenient. |
These factors can lead to increased financial responsibility and a more hands-on approach to managing healthcare for those enrolled in TRICARE Standard.
