tricare: prime or standard?

Alright mil-parents. I know you’re out there. I have a dilemma, and I could use your advice…

Our baby is planning to make her debut in about seven weeks, and I already feel like a bad mom. Every time I go to my OB (which is kind of all the time, since I am pregnant with post-ablation, euthyroid Graves Disease), she asks me if I have found a pediatrician yet. My answer has thus far been, “Uhhhhhhhhhhh…..no?” (Side note: I have been under the impression that after your baby is born, you enroll them in DEERs and then they get assigned to a military pediatrician in family medicine. End of story.) “Well, you’re really going to want to get one like yesterday, because otherwise, after she is born, she’ll just get assigned to a resident in the hospital for her first check-up. I mean…the residents are supervised by a pediatrician, but….” Then she gives me a look at that says, “But we both know that residents chop newborns up into pieces, slather them in syrup and eat them for breakfast, sooo….”

Message received. Figure out way to get pediatrician prior to our helpless newborn being eaten alive by new residents. I’m on it.

So. Here I am researching how to get our child, whom we obviously want the best possible post-natal care for (especially since she is at increased risk for hyper and/or hypothyroidism at birth due to my disease), a pediatrician that we trust and can afford.

I call Tricare who tells me that in the first 60 days of life, the baby will be covered for any services rendered by anyone, anywhere. Sometime before that 60 days is over, we must register her with DEERs and she will then be assigned a pediatrician (probably at the on-post family medicine clinic) aka Tricare Prime. If we choose to find our own pediatrician, we’ll have to enroll her in Tricare Standard. According to Tricare, this means we’d be responsible for a $150 annual deductible and 15% of all doctor bills (with an in-network provider).

What I’d like to find out from you guys is this:

  • Are your children on Tricare Prime or Tricare Standard?
    • Likes/dislikes
  • If we go Standard, how much could we expect to pay monthly for our baby’s first year of well/sick child visits, vaccinations (which I will also be researching- perhaps a post for another day), medications, etc?
    • What if she needs to stay in the NICU at birth? Will we be responsible for those bills if she is already registered in Standard?
  • If we go Standard, should we wait until the 60 day period to declare that status with Tricare, so that her first 60 days are covered regardless?
  • What am I not thinking of here that I should be thinking of?
Inquiring moms want to know…

Comments

  1. I am in the midst of making this very decision too. Butttttttt…. my kid is already almost at the 60-day limit. So. Hm. I need to get on this huh?

    Molly saw the on-call pediatrician when she was born. To me, it’s not like they’re doing brain surgery, so I don’t really care who checks her out first. Sam is on Prime, but we go to a different clinic than the one on post, so it feels like we’re seeing a private peds Dr. We’re technically not supposed to go there anymore since we moved on-post, so that’s why I’m waffling on what insurance to put Molly on. I wanna keep going to our current clinic, but I don’t want them to find us out and send us on-post. 😉 This probably doesn’t make any sense.

    ANYWHO. If you have a peds doc that you like or trusted friends could recommend, I’d go Standard. Probably worth it just to avoid the hassle of going to a doc on-post. But if you end up going Prime, you could find a military doc you like too! Sam saw military docs at our last (tiny) station and I LOVED his doc there. Wish I could have brought her with us here. Even talking it out here, I’m still not sure where we’re going to take Molly. LOL I know, I am so much help here.. Sorry! I’d go with recs from friends and talk to people who’ve gone on-post to peds docs there.

    Oh, and the NICU at birth question- that should all be covered under whatever Tricare you’re on. Babies are covered under your policy until they’re 60 days old. First 60 days are covered regardless. Once you get your baby his/her SS#, your husband can register her in DEERS and then you can pick which Tricare you wanna register her under.

    I hope that was all more helpful than it was confusing. 🙂

  2. I have heard that Tricare prime is the best option if you want to choose your doctors but if you really don’t care to pick then go with standard. So I guess it all depends on whether you want to choose who your pediatrician is. Hope this helps

    • I think it might be the other way around (I could totally be wrong)…but I think it’s Standard gives you the option to select your own provider.

  3. I would think that the Doctor you like the best would dictate the type of insurance you should enroll baby Wilhelm in. See if you can make an appointment with some pediatricians in each plan and go for a pre-birth interview to discuss your concerns about the possible complications you are concerned about.

    This is the same process you would do if you were not in the military. Interview and choose who you would like to take care of your daughter.

    You might have to pay for the consultation, but you will have the peace of mind that you already know what to expect from the pediatrician.

    • I’ve been leaning toward Standard anyway, because of our daughter’s potential high-risk. We got recommendations from my OB for pediatricians in the area. But before interviewing anyone, I just wanted to make sure I had all the details for sure about the policy, from people who are currently using it.

      Thanks for the advice!

      PS- I tried checking out your profile to see if you blog too, but there’s nothing on there. Mind if I ask who this is?

  4. My husband is in the Reserves so I know it’s different for us, but while he is on active duty orders we get Tricare for the kiddos. Our daughter was born while he’s been deployed, we chose tricare standard. We had a few reasons for this…one because we don’t live near post so that makes it a little more difficult for us, and two I LOVE our pediatrician and she doesn’t take prime, so that made it pretty easy for us. I agree with PMSWatchout, choose your peditrician and that will most likely help you choose your plan.
    Also, from what I have heard from Tricare all of the babies well care visits are coverd 100% even on standard, but I would double check that too.
    I hope this helps. I love being on standard and being able to choose who we see. 🙂 Good Luck!

    • I’ve heard similiar from some of my friends, about the well-baby visits and vaccines being covered. That would be great, if its true! Thanks for the advice, Kathryn!

      Choosing my pediatrician means that I choose Standard (the plan that requires additional payments from us). And I’ve been thinking that’s how we’d like to/need to go. I just wanted to firm up some of the deets about the coverage. I think this whole thing requires a follow up call with Tricare…

      I’ll let you guys know if I learn anything earth shattering.

  5. Hi I am new follower from the blog hop. My husband is in the reserves also so I can’t give you exact advise but we do have Tricare Reserve insurance. We pay a deductable and then 15% of visits (except well visits – I’m pretty sure those are covered.) Most ped’s offices have a set fee for visits (unless you need lab work or anything like that.) You can always call them and find out how much they are so you can get an idea of how much you will end up paying. My kids’ pedi’s fee is $50 so we end up paying around $7 per visit.

    • Good idea, Megan! As I start calling around for “interviews,” I’ll make sure to ask about visit fees so that I can estimate a little more accurately. Thanks for the tip!

  6. hello, totally late on this here, but we are Tricare Prime. I’ve actually had all three of my children seen by whoever is there the first time around. We’ve survived, no baby casualties with syrup – maple, chocolate or otherwise. I’ve never paid for a thing. Well baby and vaccines are covered. sometimes you have to assure the doctor’s office they are and say things like, “yes, i’ll pay for it on the off chance” and the like. Before we were certain about it (or before they did, like five years ago) – I honestly can’t remember which here lol – we went to the Health Department and got shots for free, in and out no biggie. Any other Prime questions hit me up chica!!

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