some questions... — The Bump
Military Families

some questions...

i just got married in july and i feel like i'll never get the hang of all this military stuff! haha, it can be so overwhelming! 

i was mostly wondering about delivery. when i found out i was pregnant i switched over to tricare standard so that i could have my own doctor. from what i understand i don't have to pay for anything maternity related until the delivery, and then i'll have to pay 20, to 25% of the fees? im ok with paying, but i was just curious as to what the normal cost is. has anyone had any huge fees that i should be prepared for?

and one more thing, hubby and i are thinking about moving onto the air force base, right now we have our own apartment. any of you ladies live on a military base? anything you love or hate about it? advice? 

Baby Birthday Ticker Ticker 1 Corinthians 13:13 Three things will last forever --faith, hope, and love-- but the greatest of these is LOVE.

Re: some questions...

  • I moved home from Guam to have our baby, so I switched from Standard to Prime so I could see a private OB.  I didn't have to pay anything.

     About housing - I see you're in Honolulu, so are you talking about moving onto Hickam?  We spent a lot of time there this past Spring for maintenance on DH's submarine, and we are PCSing to Pearl in January.  Most housing in HI is privatized, so most of the time you don't actually live on base, just in "base housing".  Some of the housing areas there are really nice, and some are God awful looking, and TINY.  We just found out that theres a pretty long wait for officers, so we're probably going to live out in town.  

     We do live on base in Guam, however, and here's what I think about it.  Not having to pay deposits and utility bills is awesome.  All you have to pay for is cable and internet - fantastic.  The other thing I love about living on base in Guam is that it's so convenient.  I have a 3 minute drive to the commissary or Exchange, and even less of a drive to the gym.  I love how safe I feel when DH and I go walking around our neighborhood at night.  Also, since DH deploys a lot, I feel safer living on base.  Anywhere else and I'd have to get a security system.

    Since most housing isn't actually on base in HI, I'm not sure if my reasons would even apply there.  I know some of the neighborhoods are secured, but I don't think all of them are.  Also, in HI (and the rest of the world) you have Walmart and Target, so the convenience of the commissary and Exchange may not matter to you.  

    HTH! 

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  • so you didn't have to pay even for the delivery? hmmmm. maybe i misunderstood what the guy told me then. that'd be great if it was all free! and yes, we're looking to move onto hickam, my DH is in the coast guard and he goes on patrol for 3 months every 3 months lol. i would feel sooooo much safer living on base, especially since we're starting a family!
    Baby Birthday Ticker Ticker 1 Corinthians 13:13 Three things will last forever --faith, hope, and love-- but the greatest of these is LOVE.
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  • I didn't pay for anything, but that may be because there isn't an MTF within 150 miles of us.  It was confusing to me, because I thought that would put us on Tricare Prime Remote, but they denied us Remote and just put us on Prime.  No idea why.. Anyway.

    I really like Hickam a lot.  There is a good bit of housing actually on base there, and it's not bad looking.  I also really like the commissary on Hickam.  It's not nearly as busy as the Navy commissary, though it is quite a bit smaller.  The gym is nice on Hickam, and the little beach is nice if you just want to go hang out without driving far.  I say go for it :)

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  • I was on Standard for my L&D and I haven't paid a cent.  I was told there was a fee for TV/phone that I would have to pay, lie $50, but I haven't gotten a bill yet, so who knows!
  • I have never lived on base so I am no help there but I will tell you if you like your apartment and your rent is under BAH then I personally probably wouldn't move most on base housing takes all of your BAH but not all so I would check to find out.

    I am on standard and the only thing you will pay is a $15 per day charge for you at the hospital that is all. Here ya go (my bill was like 30 bucks) and since I was on standard I had him at a civi hospital.  https://www.hnfs.net/bene/benefits/TRICARE%20Maternity%20Care.htm

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  • Once you disenroll back into Standard, you will have to cover any and all non-maternity costs at the 20%-15% (15% if you use a network provider).  That includes any non-pregnancy related issues DURING your pregnancy. 

    There is also a CAT CAP of no more than $1000 per fiscal year.  So your total amount of coverage no matter what happens to you under Standard is nmt than $1k.

    Below is the chart that discusses the costs.

    TRICARE Standard and Extra Costs

    Type of Service

    Active Duty Family Members

    Retirees and Their Family Members

    Annual Fiscal Year Deductible (applicable to outpatient services)

     

    Note: Applies when you choose to deliver at home or as an outpatient, with the exception of birthing center delivery.

    $50/individual or $100/family for

    E-4 and below. $150/individual or $300/family for

    E-5 and above.

    $150/individual or $300/family.

    Global Maternity Care Fee (if you deliver in hospital as inpatient)?includes prenatal care, inpatient professional services for delivery and postnatal care

    Standard: $01

    Extra: $0

    Standard: 25% 1 of allowable charges.

    Extra: 20% of the fee negotiated by TRICARE contractor.

    Inpatient Professional Services for Newborn Care (not included in global maternity fee, such as pediatric services)

    $0 because newborns are considered a Prime enrollee for up to 60 days for cost-sharing purposes; 100% if newborn?s father is not an active duty or retiree sponsor.

    Standard: If the newborn is not enrolled in Prime after the initial 60 days, 25% 1, 2 of allowable charges apply.

    Extra: 20% of the fee negotiated by TRICARE contractor unless the newborn is enrolled in Prime after the initial 60 days.

     

    100% if newborn?s father is not an active duty or retiree sponsor.

    Hospital Services for Inpatient Delivery

    $14.80 2 per day ($25 minimum charge) for admission.

    Standard: $535 per day or 25% of billed charges, whichever is less.

    Extra: $250 per day or 25% of TRICARE contractor negotiated charges, whichever is less.

    Newborn Cost-Share for Hospital Services

    $0 because newborns are considered a Prime enrollee for up to 60 days for cost-sharing purposes.

     

    100% if newborn?s father is not an active duty or retiree sponsor.  

    Standard:
    Diagnostic Related Groups (DRG) Hospital:

    ?      Same newborn date of birth and date of admission: Unless the newborn is enrolled in Prime after the initial 60 days, the cost share will be the lower of the number of hospital days minus three multiplied by $535/day or 25% of billed charges.

    ?      Different newborn date of birth and date of admission: Unless the newborn is enrolled in Prime after the initial 60 days, the cost share will be the lower of hospital days for the newborn multiplied by $535/day or 25% of billed charges.

    DRG Exempt Hospital:

    ?      25% of allowed charges unless the newborn is considered a Prime enrollee.

    Extra:

    ?      Same newborn date of birth and date of admission: Unless the newborn is enrolled in Prime after the initial 60 days, the cost share will be the lower of the number of hospital days minus 3 multiplied by $250 or 25% of TRICARE contractor negotiated charges.

    ?      Different newborn date of birth and date of admission: Unless the newborn is enrolled in Prime after the initial 60 days, the cost-share will be the lower of hospital days for the newborn multiplied by $250 or 25% of TRICARE contractor negotiated charges.

     

    100% if newborn?s father is not an active duty or retiree sponsor.

    Professional Services Fee (if you choose to deliver at home or as an outpatient)

    Standard:  20%1 of the allowable charge for mother. $0 because newborns are considered a Prime enrollee for up to 60 days for cost sharing purposes.

    Extra:  15% of the fee negotiated by TRICARE contractor for mother. $0 because newborns are considered a Prime enrollee for up to 60 days.

    Standard: 25%1 of the allowable charge for mother.
    Unless the newborn is enrolled in Prime after the initial 60 days, 25% of the allowable charge for the newborn?s provider services, if any.

    Extra: 20% of the TRICARE contractor?s negotiated fee.
    Unless the newborn is enrolled in Prime after the initial 60 days, 20% of the TRICARE contractor?s negotiated fee for services of the newborn?s provider, if any.

    Prenatal Care, Outpatient Delivery, and Postnatal Care Provided by TRICARE-Authorized Birthing Center (All Inclusive Rate); or; Maternity Care Ending in Childbirth in Hospital-Based Outpatient Birthing Room

    $25

    Standard: 25% of allowable charges.

    ?      Birthing Center: Lesser of 25% of birthing center rate or 25% of billed charge.

    ?      Hospital-Based Outpatient Birthing Room: 25% of billed charges.


    Extra: 20% of the fee negotiated by TRICARE contractor.

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  • I had DS on standard and after my deductible I paid $130?  That included a failed induction in which I was in the hospital for 57 hours.  Then 25 hours of labor, emergency C section and all the drugs and 4 days in the hospital.

    Oh, that also included my 6 week PP checkup.

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  • Im curious to know all about the pregnancy stuff as well. With our first, we were not married yet so i used different insurance.

    As for base housing... there are pros and cons. We live off base and we love it! We love owning our own house and being able to do whatever we want. The biggest con is that living on base eats up your entire BAH.
  • I am pretty sure your 6 weeks checkup is covered under maternity at least mine was. Also I got a sinus infection while pregnant and went to see my OB and was never charged for that either.

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  • thank you so much everyone!!!! my mind is so much more at ease now, i was worried that there was going to be some crazy fees but it sounds pretty bearable! and i'm pretty sure we're going to end up living on Hickam, i do know that they take away your BAH, but we live in hawaii and everything is sooooo expensive anyway that it pretty much equals out either way. thanks again for everyone's input. and especially for the chart, that helped a lot!
    Baby Birthday Ticker Ticker 1 Corinthians 13:13 Three things will last forever --faith, hope, and love-- but the greatest of these is LOVE.
  • Pregnancy and L&D related OB/GYN care is covered 100% under Tricare Standard.  In the fine print I think you might have to pay $15.50 (that is what rings a bell) per night when you are recovering from L&D.

    And even if you did have to pay a percentage of costs, the out of pocket cieling for Tricare Standard is LOW.  The catastrophic cap is $1000 per year.  So even if you are in the hospital for months and your bill is $100,000 you cna only be responsible for $1000.

    In my opinion Tricare Standard is THE BEST KEPT SECRET in the military.  If you talk to Tricare reps they will try and scare you with the cost-sharing and percentages and blah blah blah.  But if you read it yourself you realize that it is simply a $150 deductable and then a 20% cost share until you reach your cap of $1000.  Then it is free. 

    I will likely never go back to Prime. 

  • imagesweetheart18:

    Pregnancy and L&D related OB/GYN care is covered 100% under Tricare Standard.  In the fine print I think you might have to pay $15.50 (that is what rings a bell) per night when you are recovering from L&D.

    And even if you did have to pay a percentage of costs, the out of pocket cieling for Tricare Standard is LOW.  The catastrophic cap is $1000 per year.  So even if you are in the hospital for months and your bill is $100,000 you cna only be responsible for $1000.

    In my opinion Tricare Standard is THE BEST KEPT SECRET in the military.  If you talk to Tricare reps they will try and scare you with the cost-sharing and percentages and blah blah blah.  But if you read it yourself you realize that it is simply a $150 deductable and then a 20% cost share until you reach your cap of $1000.  Then it is free. 

    I will likely never go back to Prime. 

    Agreed. 

    Lilypie Second Birthday tickers
  • imagemegnbrandon:
    thank you so much everyone!!!! my mind is so much more at ease now, i was worried that there was going to be some crazy fees but it sounds pretty bearable! and i'm pretty sure we're going to end up living on Hickam, i do know that they take away your BAH, but we live in hawaii and everything is sooooo expensive anyway that it pretty much equals out either way. thanks again for everyone's input. and especially for the chart, that helped a lot!

    I dont know what you would consider expensive b/c I was totally prepare for my bill. On tricare standard the bill we got was $2,223.

    It was well worth the bill b/c I LOVED my doctor!!

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