If you’re a pregnant military spouse who is considering switching from Tricare Prime to Standard, you’re not alone.
Google the words “pregnant and Tricare” and you’ll find numerous community posts similar to this question:
I’m 17 weeks pregnant with Tricare Prime and currently being seen at a Naval Hospital. I haven’t had any appointments since 11 weeks where there did an ultrasound and pap. I don’t have another doctor’s appointment until 22 weeks. I’m worried and feel like I’m not getting the care I need or deserve at the Naval Hospital. I was thinking of switching to Tricare Standard but don’t know how long that process takes if it would even be worth it.
The responses range from “Yes, you should definitely switch. I switched to Standard and I’m so much happier” to “You need to call your PCM and make another appointment. They’ll get you in if you explain your situation.”
I’ve given birth twice using my Tricare Prime health insurance as a military dependent. The first time I received my prenatal care from a PCM (prime care manager) and delivered at an overseas military hospital as a Tricare Prime Overseas patient.
The second time, I received a referral to an obstetrician and delivered in a civilian hospital because we were stationed more than 50 miles (actually it was 52.1) from a military treatment facility. In my case, I was pleased with the medical care in both situations.
Was my prenatal care prefect? Hardly. Was I upset about some medical decisions that were influenced by Tricare coverage policies? Of course.
Insurance isn’t perfect. But it helps pay for your medical care. And having a baby isn’t cheap. In fact, the average American delivery costs $8,000 and considering I paid nothing to have 2 healthy children, in the end, I’m pleased with Tricare.
What about you? Are you a pregnant military spouse with Tricare Prime insurance? Are you frustrated or pleased with your prenatal care? Are you thinking about switching from Tricare Prime to Standard? Are your military spouse friends recommending that you switch to Standard?
Here are 5 things to consider if you’re thinking about switching from Tricare Prime to Standard during your pregnancy.
Picking Your Doctor Provides Peace of Mind for Many
With Tricare Standard you get to pick your doctor instead of being assigned one. When I was at a military medical treatment facility, it seemed like my doctor was PCSing every 2 months and a new one was assigned to me. For consistency, it would be nice to see the same doctor for your entire pregnancy. With Tricare Standard you don’t need a referral to see a specialist, so you can see an obstetrician during your prenatal care without waiting for referral through Tricare Prime.
Tricare Standard May Mean More Regular Appointments
Many military medical facilities are crowded and busy. There are lots of military spouses and active duty service members having babies which means that the scheduling can get pretty tight. Many people prefer seeing an off-base doctor through Tricare Standard so that they know they will see their doctor every month. At many military medical facilities, pregnant (who aren’t having complications or considered high-risk) military spouses are seeing their doctors every 6 weeks instead of 4 weeks.
Tricare Standard May Lead to Medical Bills
With Tricare Standard, you will have an annual deductible for outpatient services and cost-shares for most services. In general Tricare Standard covers 80 percent of medical costs (you pay the remaining 20 percent) and in many cases, it’s 100 percent if you use an in-network doctor. Review this cost shares chart for more information.
If you have health insurance through your employer, you can use that insurance and Tricare can be your secondary insurance.
If you don’t have a second insurance plan, you may want to purchase one. You can purchase a Tricare Standard supplement insurance through MOAA (Military Officer’s Association of America), Air Force Association, Uniformed Services Benefits Association or Association of the U.S. Army. Before purchasing a policy, Tricare recommends that you consider several aspects of the available coverage. You can compare Tricare supplement companies with this chart.
Tricare Doesn’t Cover Routine Ultrasounds (Standard or Prime)
I noticed many small differences between Tricare prenatal care coverage and other health insurance companies. One of these differences deals with ultrasounds. When I was seeing my Tricare Prime-approved obstetrician, he complained to me at EVERY appointment about Tricare’s ultrasound policy. He wanted to do a 20-week ultrasound because “it’s routine” in his opinion.
Here’s what Tricare’s maternity care fact sheet says:
Some providers offer their patients routine ultrasound screening as part of the scope of care after 16–20 weeks of pregnancy. Tricare does not cover routine ultrasound screening. Only medically necessary maternity ultrasounds are covered by Tricare.
Because I wasn’t a high-risk pregnancy I didn’t get a 20-week ultrasound. Later I was measuring small and then it was medically necessary to have an ultrasound, so I did. I think it was around 30 weeks and it confirmed that my baby was small, but still growing at a healthy rate.
Choose What’s Best for You and Your Baby
You can switch to Tricare Standard at any time. Here is a link with by step-by-step instructions for how to leave Prime and enroll in Standard. You can start using Tricare Standard on the day after your Tricare Prime coverage ends.
But let’s say you want to go back to Tricare Prime? You may not be able to re-enroll in Tricare Prime for up to one year after you disenroll. So consider your options carefully before making the switch.
Every baby is a unique individual and every pregnancy is a unique experience. No two pregnancies are created equal. You may have a smooth sailing 9 months followed by a difficult delivery. Your sister may be the opposite. That’s why in every pregnancy you need to be your own advocate and listen to your body.
Before switching to Tricare Standard take time to research your options so you fully understand your decision and the outcome of your decision.