Tricare prime or Standard?

Marinewifey9200 · July 2011

So I have a issue with the Naval Hospital I am hish risk pregnancy cause I have a bicournate uterus and they are taking it very lightly. I cant see a civilian provider cause I am with Tricare prime. I was informed that if I switch to Tricare Standard I can see a civilian provider. Now do any have any expierence with Tricare standard...and is the cost to much? Will I pay out of pocket for anything?

ufsandra85 · July 2011

i had a septum in my uterus and I had no problem seeing an RE for the first stages of my pregnancy and a high risk before i lost my baby. you really need to push that you want to go to an re or high risk doctor because seeing a regular ob with a mullarian anomaly is unacceptable if they arent taking it seriously. Are they even sure it is bicornate? a lot of people get misdiagnosed and really have a septum. did they do an hsg or shg or mri to diagnose you? I got misdiagnosed by the navy hospital and it was terrible. if they dont give you a refferral i would switch in a heartbeat!!

Lissa832 · July 2011

I switched to Standard around 23 weeks, and I have no regrets. The most I've heard anyone pays out of pocket is less than $100, and that is for the delivery.

gunnerwelch · July 2011

I recently became an Army wife and soon to be mom and had the same questions. I was told by other Army wives that I should choose standard as it will allow me to choose the physicians I want, not be a # and stay pay minimal costs. So far - I've been elated with the choices I've had and the low amounts I've had to pay for appointments and medication. Tricare has already reduced my prenatals from $45 a month to $0.66 a month.

Good luck!

Cebs222 · July 2011

We've been trying to decide if we want to switch to Standard as we are planning on moving to a different area before the baby is born in which I don't like any of the mil. hospitals in the area. One of the things stopping us is that you have to pay a premium fee of 100-200 dollars ( i dont know if it varies on rank) and once we switch we have to wait a whole year until we can switch back ( E5 or higher i was told, if your under that bracket then you can change back sooner) and I want prime after the baby is born. I've heard of people having to pay a few hundred dollars for birth and others less than 100 like someone posted. I'd really like a overview paper of it all explained out!

CEHW · July 2011

You can see a civilian if you go to your primary care doctor and ask (beg) them to refer you to a high risk doctor!!!

Anywho... I have standard and we have barely paid for anything! I did have to go in twice for weird pains and we paid $34.50 for some tests, but other than that nothing substantial (nothing has been more than $20, but those tests that weren't under pre-natal care)

With standard, you have to pay for a c-section (if it isn't medically necessary), and if you have a private postpartum room you have to pay the difference, but I heard that it wasn't much! (my hospital only has private, so I guess we will just pay)

With medication if you go on base then it's free, but I went to CVS and it cost $3 for antibiotics.

hmmmm..... that's all I can think of right now!

CEHW · July 2011

Here is the website that goes over the costs!!!

My tricare rep sat down with me and went over everything so I could choose which one I like!

https://www.tricare.mil/mybenefit/home/Medical/Costs?plan=TRICARE+Standard+and+Extra&zipCode=92129&country=United+States&status=Active+Duty+Family+Member

Ilumine · July 2011

Cebs222:
I've heard of people having to pay a few hundred dollars for birth and others less than 100 like someone posted. I'd really like a overview paper of it all explained out!

There USED to be a page on the TRICARE website that listed the Cost Share for TRICARE, but I cannot find it (its gone from my favorites list).

Here is the link to TriWest, one of the Managed Care Support Contractors. https://www.triwest.com/beneficiary/bolt/home.mvc/details/maternity And the Military.Com Breakdown https://www.military.com/benefits/tricare/maternity-care-options-chart

As for the overall out-pocket-costs. There are SOME variables when you use Standard.

YOU MUST REACH YOUR ANNUAL FISCAL YEAR DEDUCTIBLE BEFORE TRICARE KICKS IN ($50/individual or $100/ family for E-4 and below. $150/individual or $300/ family for E-5 and above). You can reach that before you go into the maternity care whenever you pay anything out-of-pocket, like going to Walmart for Rxs.

HOWEVER, for ANY medical care NOT directly related to the pregnancy will be charged following the normal TRICARE STANDARD Formula (15% if you go to a network provider and 20% if you use a provider who just accepts TRICARE).

I had GERD due to my pregnancy, but it was not actually pregnany related, so every provider visit that dealt with my GERD, I had to pay for.

BUT, TRICARE has a CATASTROPHIC CAP of $1000 per fiscal year as well. So you will never pay more than $1000 per family while your DH is AD.

chulita425 · July 2011

I switched to Standard at the beginning of the month. I just didnt feel comfortable at the Naval Hospital. When I switched I was told I will have to pay a copay of $50-150 at my first appt with the new doctor and then after that all I have to pay is $16 a day for my hospital stay! Its cheap !

SapphireKat18 · July 2011

Tricare Standard covered everything but $50 of my maternity care and that was delivery cost. I had 3 ultrasounds in first tri, 2 level II u/s and 1 or 2 regular u/s in 2nd tri, and then growth scans and NSTs the last 6 weeks or so. As long as your doc codes them as medically necessary, they should cover them.

We also wanted Standard so we could take DS to a pediatrician off base. I wanted to be able to get him in the same day I called, not wait until the next available appointment 4 days later like tends to happen on base here (my friend would purposely wait until after hours so she could take her kids to the ER instead of having to go on base until she switched to Standard). His well baby visits are covered but it doesn't take long to hit his $150 deductible (I think it was 2 sick visits at about $75 each that did it for us. Plus, we just LOVE his Pedi (and so does he - he gives her big smiles every time he sees her, but never smiles for the male docs in the practice, lol).

Well worth it, imo.

Junebug060609 · July 2011

I was in the exact same situation you are.

Husband is stationed in San Diego. I have a bicornate ute (heart shaped in my case). When I tested positive for the pregnancy Tricare Prime booted me from my civilian OB to Balboa (assuming that is where you are going, they said my ute was something the midwives weren't allowed to deal with). In my case it was my docs seeming lack of knowledge about common tests for older moms (I'm 34) that made me feel Balboa perhaps wasn't the best choice for me. I switched to Standard and back to my civilian OB at around 18 weeks.

So far we've gotten a single bill ($29 for a UTI test that Tricare was billed $300+ for). I'm pretty sure I only got a bill for that bc it wasn't specifically pregnancy related. That $29 counts towards my $1000 annual cap. My understanding with the Standard coverage for pregnancy is that most things are covered under the 'global' umbrella. I was told we'd get one bill come delivery time, and it was a totally reasonable amount assuming we have a normal delivery (<$100).

FWIW, my civilian provider is taking my heart shaped ute pretty lightly as well. Basically I've been told that the most common issues with my type of anatomy come near conception (implanting in a bad spot, etc) and that if I've gotten this far there is unlikely to be an issue. I know from reading up on bircornate utes though that if yours is two separate horns there can be more issues (premature birth due to running out of roome & c/s due to breech presentation bc of no room for baby to flip being the two most common Dr Google could find).

marinewife709 · August 2011

I too choose not to have my baby at balboa and am on standard i see a civilain doctor and she is great. I have had several friends give birth on standard and the most i have heard of the paying was less than 100 dollars. the most i have payed my doctor so far is 37 dollars. good luck hope this helps!

allyall10 · September 2011

I was in this position when I got pregnant. I was prime and went to the base to be made to feel like they couldn't help me. I promptly switched to standard. Here is Florida, the only thing you may possibly have to pay is $250 for your fist initial visit with the OB and then $17.00 (or something like that) a day while you are in the hospital. EVERYTHING else is covered at 100%.

For all other medical treatments NOT associated with your pregnancy, you will have a copay and then have to pay 15% of all medical bills incurred up to $1000 maximum per year.

This is actually a HUGE bit better than most private insurances, and it will give you the peace of mind of picking your own physician.

Good Luck! After doing this, I have NEVER been happier! The base scared the crap out of me!

Megan Stahl · September 2011

In the AF if you go standard they still pay for everything related to the baby. You just have to have all your appointments and u/s and anything else approved by your PCM if on prime. I am on Prime and I go to a civilian OB cuz of high risk as well and havent had any issues.

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