Congratulations! You just peed on a stick and that magical second pink line appeared. You’re pregnant! Unfortunately, when you’re a military wife, you know that the 1001 questions that the average woman has when she finds out she is pregnant are tripled when you are entrenched in military life. As military wives, we have to think about things that others don’t, like: Will the father be deployed before the birth? Will I have help when the baby comes with my family living on the other side of the country? How do I see a doctor and what kind of care is covered?
While I can’t help you with the first two, after going through two pregnancies/deliveries as a military wife, I can help you with the last one and my best advice is this: If you are on Tricare Prime, switch to Tricare Standard! Here’s why:
1. You can see any doctor you want (within the network) and still be covered.
When I first got pregnant, I wanted my maternity care to be with someone I felt safe with, not with whoever the nearest military hospital had available. This became an even more important factor with my second pregnancy when I was opting for a VBAC and needed a supportive doctor. In both cases, I found an in-network civilian practitioner (the first was certified nurse midwife, the second was an OBGYN) by searching this website. The care I received in both cases was incredible despite having difficult deliveries both times. I didn’t have to worry that my babies would be delivered by “whoever was on call” when I went into labor.
Switching to Tricare Standard also enables you to seek out a civilian doctor whose birth practices are in line with the vision you have for your own pregnancy and delivery. For instance, my second delivery ended up being two weeks past my due date and 44 hours long, but it was all worth it to get the VBAC I wanted. Allowing a pregnancy to proceed naturally in those circumstances is highly unusual even with many civilian OBGYNs, so I know I would not have gotten the delivery I longed for if I had stuck with Tricare Prime and delivered at the Naval Hospital rather than seeking out a doctor who had experience in line with the delivery I desired.
2. The coverage for pregnancies goes beyond the normal Tricare Standard coverage.
I actually choose to remain on Standard beyond my pregnancies because waits at MTFs, the chaotic referral process, and negative experiences with disengaged military providers has left me disillusioned with military health care. Typically, this means I pay a percentage with each visit we pay to civilian providers. While the cost is usually very low with network providers, it can definitely add up.
However, pregnancy coverage on the Tricare Standard plan is a pleasant exception to the rule.
As long as your civilian network provider is filing the billing properly (it must be billed under your ‘global maternity’ plan, not as individual visits), you should only have to pay a small fee for the hospital stay after your delivery, and pay absolutely nothing for your prenatal and delivery care even while seeing a civilian doctor! So what does that look like realistically?
With my first son I had an unplanned c-section followed by a four-day stay in the hospital. The bill was well over $30,000, but we paid a mere $71 for the entire thing. With my second, we were in the hospital for one night following a two day VBAC delivery and paid just $24. Not bad!
The only thing to keep in mind with this factor is whether or not you will require non-pregnancy related medical attention while on Tricare Standard. If you have to seek out a civilian doctor for care not related to your pregnancy, you may have to pay a percentage. Personally, I have never received a bill that was more than $200 even when I had to see specialist, and the average cost-share bill that I have received is usually between $18-45. Remember, the catastrophic cap for the year on Tricare Standard is $1000, which is less than what some people pay for health coverage on a monthly basis. For information on what is and isn’t covered during your pregnancy, see this Tricare fact sheet.
3. You can go back to Tricare Prime 3 months after you deliver.
When you switch to Tricare Standard, you can’t switch back to Tricare Prime for one year. However, looking at that in terms of your pregnancy means that you can be back to receiving all your care at the MTF under Tricare Prime just three months after your delivery (And will you really be scheduling many doctors appointments in the first three months of postpartum sleep-deprived madness? I thought not).
While I’m certainly not an expert on the inner working of the Tricare billing system, overall I’ve never been sorry that I switched to Tricare Standard during my pregnancies (or otherwise!). Your pregnancy is unique, and your prenatal care and delivery should speak to that. Tricare Standard is, in my opinion, the best option for military wives to receive the individualized and attentive prenatal/delivery care they deserve.