Tricare Standard: All costs covered?

bootsandheels · November 2011

My quest to switch over to Tricare Standard continues and up until now, thought all prenatal care was covered under Tricare Standard. Now I've been told that may not be the case, yet folks have told me that they never encountered costs. Does anyone know anything about this? The Tricare Offices have been all but helpful so any firsthand advice would be welcomed!

Gismo123 · November 2011

I think it depends on weather you pick a provider on the list or not. Also you still have to pay a co pay so it's not 100% covered either way. You're paying for the convenience of picking your own doctor.

ufsandra85 · November 2011

i have been told many times that there are no copays when you are pregnant and that everything is covered under global maternity coverage. meaning no matter if you have standard or prime all you pay is the 16 dollar or see daily fee at the hospital for your stay

JENandJEH · November 2011

Once you receive a pregnancy diagnosis, everything maternity related should be covered under global maternity on Standard except for the hospital stay. For me, my initial appointment was the only thing I was billed for because my doctor had to diagnose me as pregnant. You shouldn't pay a copay once diagnosed unless you are seen for something non-pregnancy related (i.e. sinus infection, respiratory infection, etc). This is all my understanding and could be totally wrong - Tricare is a complicated system.

Emilia0101 · November 2011

Pregnancy related cost covered after deductible. Non pregnancy related subject to copay, % out of pocket. So if you fall and break your leg you have to pay your portion of the copay/charges. You go to the dr for your pregnancy covered.

shall923 · November 2011

Normal pregnancy related cost are covered 100% no deductible, no co-pays. This is under the global maternity as pp said. If you have extra stuff done you will have to pay 15% of the tricare negotiated rate (20% if you see an out-of-network doc). I had thyroid issues and had to have extra blood work. It cost me maybe $50 for the whole pregnancy. I had an emergency c/s and it cost me $63. Well worth it IMO.

Good luck.

marielovestimothy03 · November 2011

Ditto Shall. I'm on Tricare Reserve Select and I haven't paid a dime for this pregnancy yet.

Ilumine · November 2011

shall923:
Normal pregnancy related cost are covered 100% no deductible, no co-pays. This is under the global maternity as pp said. If you have extra stuff done you will have to pay 15% of the tricare negotiated rate (20% if you see an out-of-network doc). I had thyroid issues and had to have extra blood work. It cost me maybe $50 for the whole pregnancy. I had an emergency c/s and it cost me $63. Well worth it IMO.
Good luck.

The problems arrive when you have to see your provider for ANYTHING NOT PREGNANCY RELATED. Once your pregnant, you will only be seen by an OB, since what happens to you affects the fetus. But if, say you get pregnarelated used GERD, and your OB prescribes meds, he/she will code that visit, even partially, as no pregnancy related and you will get charged for it.

This is why you (the general you) need to really review your finances and timing before you switch to Standard. While there is a CAT CAP, be sure you can cover $1,000 at a pop or $2,000 if you switch at the end of the fiscal year.

bootsandheels · November 2011

Thanks everyone. Tricare definitely isn't easy to understand. I talked to a few more ladies and they backed up pretty much all the responses here, all standard maternity care is covered (with no copay) with the exception of non-pregnancy related visits/procedures and any optional U/S. I've never expected health care to be completely free anyway so I'm more than prepared for a few bills here and there but it's just nice to know what to expect. Thanks!

bridget1543 · December 2011

If you want to become a part of Tricare Standard you first have to disenroll from Prime. All the costs are not covered, your spouses rank will determine your deductible as well as if they are active duty. reserve, etc. and then you pay 15% for tricare providers and 20% for non-network providers. I refuse to been seen by the docs at the military installation where i live so my husband and i decided to get on standard (/extra). Going through the process of switching now.

Tricare Standard: All costs covered?

Re: Tricare Standard: All costs covered?

Choose Another Board

Search Boards