Military Families
jennipalmer
member
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Prime/standard?
jennipalmer
member
I see some people switching to standard to go to civilian facilites. I am 13 weeks, I see military and civilian doc because they classify me as high risk. I was told I may have to deliver off base depending on how I progress. But I was also told by Tricare I can go to civilian hospital even without being high risk.
I am considering for many reason so I was wondering what you guys have been told. It won't matter much if I am told to deliver off base for being high risk but I don't want to switch and pay 20%. If hubby doesn't make another rank he wont be able to reenlist due to higher tenor so we are trying to save all we can.
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Re: Prime/standard?
Pregnancy is covered 100%. You pay a daily rate for your hospital stay. The baby is covered 100% for the first 60 days. I paid nothing for DD for the first 60 days, and I paid $33 for delivery. I paid nothing for my 6 week check up either.
Your cost share is 15% AFTER meeting your deductible of $150/person and $300/family. It is 15% of what Tricare allows, not what the doctor bills if it is an in network provider. If out of network, your cost share is 20%, and they're allowed to charge you more than Tricare allows.
For me, switching was 100% worth it.
I am currently on Tricare Standard (I work away from the post, so it's easier for me to see civilian Dr's.) After my 1st appointment at 8 weeks, the Dr's office sent me an email with my expected out of pocket "cost". The amount was $221.10. The email also stated the below. I hope this helps!
The charges cover your routine prenatal visits, vaginal delivery, and post partum care. All lab work, ultrasounds, and special testing are not included in this estimate. Those charges are billed to insurance when service is rendered. The special testing only applies if there are complications of pregnancy.
If you are happy/satisfied with your care, and trying to save money, don't switch to Standard. While pregnancy is covered 100%, anything else unrelated to the pregnancy (even during pregnancy) require a cost share.
BTW, if you plan to continue posting, I'd suggest creating a new screen name. Using your name (even if its your maiden name) is unwise. People talk about OPSEC all the time, but PERSEC (personal security is just as important). While in one post you may not reveal many details, if someone were interested, they could piece together various, seemingly random tidbits. No need to make it any easier than it already is for someone to track you down.
I was on Standard for both of my pregnancies and only paid the $16 a day for the hospital stay. Maternity is covered 100% as long as your doctor codes it correctly (meaning everything he/she does is medically necessary).
I will say that I got extremely lucky while I was on Standard and didn't have to go for anything non pregnancy related so I have no clue how the cost shares for that would work.
CJ 05/29/2013
I was told now that I'm on Prime everything is covered 100% when I called Tricare. Is this incorrect?
Edit: I just looked it up and Prime is 100% for medically necessary with in network docs. Phew.
Here's a link to the coverage info for Standard- TRICARE Maternity Care Fact Sheet
I've never had an issue with prime and I've been on Tricare my entire life.
I started out on Standard because I was already established with doctors in our area. I also had supplemental insurance that covered what Standard did not. I got pregnant with high risk twins right before we PCSed. Visits with an MFM, countless NSTs and highres ultrasounds, induction and delivery all took place at a civilian hospital and I didn't pay a dime.
I have now switched to Prime and have had no problems. They do not do OB at our MTF, so if I become pregnant again before we PCS I'll go back to the same hospital.
I made this profile name many many year ago before thought of security when I was pregnant with my 9 year old. I just haven't figure out how to change it. It took me 10 weeks before I figured out adding a ticker which is off by a day but will probably take me 10 weeks to figure out how to change. Hubby is computer guy but wont see him for few more weeks.
Unfortunately, with the way the Nest/Bump works, you can't change your screen name on your account. You need an email account not already linked to the Nest/Bump to create a brand new account with a PERSEC appropriate screen name. You can do it--even if you have to go to Yahoo or Gmail to create an email account.