Vet News: TRICARE Offers Choices for Maternity Care, Family Health Care

In planning for maternity care, military families have a choice between TRICARE Standard or enrolling in TRICARE Prime. Beneficiaries whose first prenatal visit occurs on or after Dec. 28 will have more health care choices with TRICARE.

Recent changes in TRICARE regulations allow beneficiaries with TRICARE Standard to choose a civilian provider for maternity care, even if they live close to a military treatment facility (MTF).

"Having the ability to choose between TRICARE Prime and TRICARE Standard is a very attractive benefit choice for many. But there are additional financial costs that families need to consider," said Lt. Cmdr. Gina Savini, program manager for the Perinatal Advisory Board at the Bureau of Medicine and Surgery. "Beneficiaries need to understand all the financial implications when they disenroll from TRICARE Prime and convert to TRICARE Standard. They need to keep in mind that any health care, other than maternity care, is going to require cost shares (co-pays). There may also be charges for maternity care related to inpatient hospitalization in civilian facilities."

Savini went on to explain the basic differences.

TRICARE Prime uses military providers and hospitals, and a network of civilian providers and hospitals. In some locations, beneficiaries can choose either a military or a civilian healthcare provider as a primary care manager.

This provider takes care of routine outpatient medical problems and check-ups. If in-hospital or specialty care is required, including maternity care, the patient must go to an MTF if the services are available. In most cases, expectant mothers with TRICARE Prime must have their prenatal care and deliver their babies in an MTF. There are no yearly deductibles and the co-payments within the civilian health care provider network tend to be less than TRICARE Standard.

Under the new law, a woman whose first prenatal visit occurs on or after Dec. 28 may choose a civilian doctor or midwife for prenatal care, and have her baby in a civilian hospital under TRICARE Standard. This benefit is available even if she lives near an MTF where maternity care is provided. TRICARE pays the expenses for prenatal care, labor and delivery, and post-natal care. However, there are co-payments involved. The amount varies based on length of stay in the hospital and the sponsor’s status.

In choosing civilian maternity care, a family must disenroll from TRICARE Prime and convert to TRICARE Standard. Switching to TRICARE Standard means not being able to re-enroll in TRICARE Prime for a period of one year unless the sponsor is in paygrade E-4 or below. During this time, patients needing medical attention, other than maternity care, will be subject to out-of-pocket expenses, such as deductibles and co-payments.

"Once a family converts to TRICARE Standard, all standard cost shares are applicable. So for example, if a patient is pregnant and requires care for a broken leg or pneumonia, something not related to the pregnancy, the family would be required to pay cost shares for health care, and that can be significant,” said Savini. “Each family needs to consider all the factors and make the best choice based on their family’s needs."

Active-duty women will continue to obtain their maternity care at MTFs.

SOURCE: VNIS