Tricare Prime vs Standard Q's

Junebug060609 · May 2011

XP with PGAL

We're Tricare Prime now and I'm being seen at a military hospital. Long story short, I don't exactly have a lot of faith in their competency there. I'm seriously to the point where I'm nervous about even getting an epidural there, let alone if things go to Hell in a handbasket and there is an emergency with either myself or the baby.

I guess I'm wondering two things:

1) What is the true difference in between Prime and Standard for prenatal/OB care? Is the same amount taken out of my DHs check? Is it just the cost of co-pays? Would having Standard allow for me to go to my civilian OB (also my PCM)?

2) How do I find out the statistics for the military hospital I'm currently supposed to deliver at? I'm wondering things like % of c-sections, complications, etc.

shall923 · May 2011

Maternity is covered 100% by both. With standard you can go to any doctor that takes Tricare. Nothing is taken out of DH's check for medical insurance only dental and that doesn't change if you switch to standard. You don't need referrals (for routine treatment) on standard so you don't have to see a PCM unless you want to see him/her as a general doctor.

I had an emergency c-section with the doctor I picked, at the hospital I wanted and it cost me $63. I think standard is worth it. Also, I am in San Diego. Are you going to Balboa?

Temp76535187505890 · May 2011

A few things to remember when switching to Standard. You cannot switch back to Prime for 12 months. So, after you have the baby and need to be seen by someone other than your OB/GYN you will have to find another doctor that accepts Tricare. And then you will end up paying co-pays to be seen, etc.

With the Global Maternity Care there are sometimes still things you might end up paying a co-pay. Some OBs want certain tests done that are not standard for MTFs (or that Tricare doesn't cover 100%) so you could end up paying a co-pay for those. I think that might be relatively rare though.

When picking your doctors remember that there are in-network providers where the co-pays are 15% and then there are out of network providers who file claims with Tricare but your co-pay for them would be 20%. But there is a catastrophic cap of $1000 per year so you wouldn't pay more than that.

I'm not trying to dissuade you from changing. I, myself, changed so I could choose where I birthed my second child. For me, it was worth the change to get the birth I wanted. But I did consider the costs associated with my care AFTER I was no longer covered by the Global Maternity Care.

TBLilyRose · May 2011

I paid $50 OOP after the birth of DS. Everything else was covered but I know there are some tests/bloodwork not covered unless your doctor codes them medically necessary. Like I know TriCare says they only cover 1 ultrasound at 20 weeks but I had 3 in first tri (one that the doctor doesn't bill to insurance), two Level II u/s, and a bunch of growth scans in 3rd tri.

LemonLover33 · May 2011

ArmyQM:

A few things to remember when switching to Standard. You cannot switch back to Prime for 12 months. So, after you have the baby and need to be seen by someone other than your OB/GYN you will have to find another doctor that accepts Tricare. And then you will end up paying co-pays to be seen, etc.

That lockout starts at a pay grade. E-4 and below can switch back.

https://www.tricare.mil/Factsheets/print.cfm?id=261

Voluntary TRICARE Prime disenrollment may make you ineligible to re-enroll in TRICARE Prime for a 12-month period from the date you disenroll (This rule does not apply to active duty family members with sponsors E-4 and below).

Junebug060609 · May 2011

LemonLover33:
ArmyQM:

A few things to remember when switching to Standard. You cannot switch back to Prime for 12 months. So, after you have the baby and need to be seen by someone other than your OB/GYN you will have to find another doctor that accepts Tricare. And then you will end up paying co-pays to be seen, etc.

That lockout starts at a pay grade. E-4 and below can switch back.

https://www.tricare.mil/Factsheets/print.cfm?id=261

Voluntary TRICARE Prime disenrollment may make you ineligible to re-enroll in TRICARE Prime for a 12-month period from the date you disenroll (This rule does not apply to active duty family members with sponsors E-4 and below).

Thanks for the info. My DH is an E6, so it looks like I'd be locked out.

LemonLover33 · May 2011

Junebug060609:
LemonLover33:
ArmyQM:

A few things to remember when switching to Standard. You cannot switch back to Prime for 12 months. So, after you have the baby and need to be seen by someone other than your OB/GYN you will have to find another doctor that accepts Tricare. And then you will end up paying co-pays to be seen, etc.

That lockout starts at a pay grade. E-4 and below can switch back.

https://www.tricare.mil/Factsheets/print.cfm?id=261

Voluntary TRICARE Prime disenrollment may make you ineligible to re-enroll in TRICARE Prime for a 12-month period from the date you disenroll (This rule does not apply to active duty family members with sponsors E-4 and below).
Thanks for the info. My DH is an E6, so it looks like I'd be locked out.

I thought your H had been in for a while. I just wanted to clarify was PP said. My SIL fought for a referral off base because she felt uncomfortable with her ob/gyn on. She was still on prime. But, it took talking to a paitent advocate and some leg work. But, she got the med-free birth at a birthing center that she always wanted.

Temp76535187505890 · May 2011

LemonLover33:
ArmyQM:

A few things to remember when switching to Standard. You cannot switch back to Prime for 12 months. So, after you have the baby and need to be seen by someone other than your OB/GYN you will have to find another doctor that accepts Tricare. And then you will end up paying co-pays to be seen, etc.

That lockout starts at a pay grade. E-4 and below can switch back.

https://www.tricare.mil/Factsheets/print.cfm?id=261

Voluntary TRICARE Prime disenrollment may make you ineligible to re-enroll in TRICARE Prime for a 12-month period from the date you disenroll (This rule does not apply to active duty family members with sponsors E-4 and below).

Huh, interesting. Guess I didn't know that since we're well beyond that. Thanks for enlightening me!!

MostFruitfulBethie · May 2011

Both my husband and I are in the Army. My husband is Active Duty, and I'm a Reservist.

I was able to stay on Tricare Prime, and still going to deliver with the doctor I wanted. (Let's just say, don't go to Darnall !!!!)

In order for me to do that, I had to change my address through tricare to my mother's address. My mom happens to live only an hour away from my husband and I, and she is a nurse at the local hospital there, which is waaaay better than Darnall. That hospital takes Tricare Prime, and so I lucked out big time.

Anyway, as far as Tricare is concerned, I live with my mom...at least until the baby's born. Then all I would have to do is switch my address back. Or not? I think I like going to a non-military doc! It's only an hour away anyway.

shall923 · May 2011

MostFruitfulBethie:
Both my husband and I are in the Army. My husband is Active Duty, and I'm a Reservist.

I was able to stay on Tricare Prime, and still going to deliver with the doctor I wanted. (Let's just say, don't go to Darnall !!!!)
In order for me to do that, I had to change my address through tricare to my mother's address. My mom happens to live only an hour away from my husband and I, and she is a nurse at the local hospital there, which is waaaay better than Darnall. That hospital takes Tricare Prime, and so I lucked out big time.

Anyway, as far as Tricare is concerned, I live with my mom...at least until the baby's born. Then all I would have to do is switch my address back. Or not? I think I like going to a non-military doc! It's only an hour away anyway.

This could be seen as insurance fraud. I don't think you should advertise this.

Junebug060609 · May 2011

shall923:
MostFruitfulBethie:

Both my husband and I are in the Army. My husband is Active Duty, and I'm a Reservist.

I was able to stay on Tricare Prime, and still going to deliver with the doctor I wanted. (Let's just say, don't go to Darnall !!!!)

In order for me to do that, I had to change my address through tricare to my mother's address. My mom happens to live only an hour away from my husband and I, and she is a nurse at the local hospital there, which is waaaay better than Darnall. That hospital takes Tricare Prime, and so I lucked out big time.

Anyway, as far as Tricare is concerned, I live with my mom...at least until the baby's born. Then all I would have to do is switch my address back. Or not? I think I like going to a non-military doc! It's only an hour away anyway.

This could be seen as insurance fraud. I don't think you should advertise this.

Agreed.

SteelerFan-Thanks for the heads up. With subsequent pregnancies while we're still living here I'll likely have genetic counseling (AMA), so I should ask that question before I switch.

GreenFlamingo7 · May 2011

MostFruitfulBethie:

I was able to stay on Tricare Prime, and still going to deliver with the doctor I wanted. (Let's just say, don't go to Darnall !!!!)

I had an excellent experience throughout my entire pregnancy and delivery at Darnall. Sorry you are buying into the rumor mill.

Emilia0101 · May 2011

I switched to Standard for my pregnancy and it was the best thing I ever did. My OB expenses were all covered but a 150.00 deductible. I was off of prime for 12 months then went back. It was the best thing I did

NavFCywife89 · May 2011

I just did this, I switched to Standard(we are Navy and in San Diego, they had me doing prenatal at NTC) I will have to pay 33 dollars for my hospital stay. And nothing for any of my appointments. Also, I got a letter in the mail from Tricare saying that if the Sponsor is E4 or less you can switch back to Prime whenever you want, no wait period. So now I'm back on Prime. Switching for my pregnancy was the best thing I did. I LOVED my hospital and doctor.

Want a personalized experience?

Tricare Prime vs Standard Q's

Re: Tricare Prime vs Standard Q's

Choose Another Board

Search Boards