Tricare Standard: All costs covered? — The Bump
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Tricare Standard: All costs covered?

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!

Re: Tricare Standard: All costs covered?

  • 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.
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  • 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

    Married 11/27/09 and TTC right away
    Dx: Complete septate uterus with cervical duplication, endometrial polyps, PCOS, endometriosis, hypo thyroid, luteal phase defect
    4 uterus surgeries to correct my complete septum and to remove polyps and 2 years of seeing the RE, medicated cycles and IUIs
    Baby 1 and 2: BFP 3/3/11 with 2 babies EDD 11/1/11, M/C 4/6/11
    Baby #3: 8/11 pregnant EDD 4/27/11 and m/c:(
    Baby #4: 10/12/11 BFP! EDD 6/16/12m/c 10/26/11
    Baby #5: 3/13/12 BFP! EDD 11/25/12 ANOTHER m/c :(

    Baby #6: 2/14/13- BFP! EDD 10/24/13, CP 2/19/13
    Baby #7: 3/15/13- BFP! EDD 11/27/13, another CP
    Baby #8.  BFP 5/19/13 EDD 1/22/14. 8 was not our lucky number

    4th septum resection on 5/31/13.
    Baby #9: 6/29/13 BFP. C section scheduled for March 5th!

    My miracle baby was born March 5 at 9:33am. He was 8 lbs 12.5 oz and 21.25 inches long!

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  • 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.
  • 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.
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  • 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. 

  • Ditto Shall. I'm on Tricare Reserve Select and I haven't paid a dime for this pregnancy yet.
    DC1 (2.5) | DC2 (1) | #3 due 6.1.2012
  • imageshall923:

    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.  

    file:///Users/Ilumine/Desktop/Family%20Portrait%20for%20gift.jpg
  • 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!
  • 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.
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