What Maternity Benefits Does Tricare Offer?

Tricare is a comprehensive insurance plan that covers prenatal care, delivery, post-partum care, and any complications that may arise for the mother or child. It covers all medically-necessary services during labor and delivery, including anesthesia, fetal monitoring, and other required care during the stay. TRICARE will cover cesarean sections when needed.

The Maternity Care Brochure is a resource for information about maternity care services, costs, guidelines for getting maternity care, and newborn coverage. It covers medically necessary labor and delivery services, including anesthesia, monitoring, and cesarean sections, if needed. TRICARE also covers epidural anesthesia for pain management during delivery and medically necessary maternity ultrasounds.

The coverage includes obstetric visits throughout the pregnancy, fetal ultrasounds, management of high-risk or complicated pregnancies, and hospitalization for labor. TRICARE’s coverage includes prenatal care, delivery, postpartum care, and any complications that arise for the mother or child. If optional coverage is desired, additional coverage options are available.

What does TRICARE cover for babies?

TRICARE covers well-child care from birth to age 5, including routine services like newborn care and vaccinations. During the Month of the Military Child, the Military Health System is sharing resources to support the health and well-being of military children of all ages. For more information on QLEs and coverage for newborns, visit the Giving Birth and Adopting page. The TRICARE Maternity Care Brochure provides information to help prepare for the birth of your child.

What items does TRICARE cover for pregnancy?

TRICARE covers medically necessary labor and delivery services, including anesthesia, monitoring, and cesarean sections. Patients may have to pay for some costs if they choose a cesarean section. Hospital stays are usually 48 hours after vaginal delivery and 96 hours after a cesarean section, with longer stays if complications occur. TRICARE also covers at least two postpartum visits post-birth, if needed.

How much does TRICARE cover for birth?

Tricare beneficiaries have access to a comprehensive range of maternity services, including prenatal care, delivery, postpartum care (typically six weeks after delivery), and any potential complications that may arise. The financial obligation associated with these services encompasses the costs of admission, birth center fees, home delivery, and newborn care. Furthermore, the active duty sponsor and retiree or retiree sponsor are eligible to utilize these services.

How does TRICARE work for pregnancy?

Your PCM will refer you to a military hospital or clinic if available, or a network provider if not. Postpartum care for up to six weeks is provided after your baby is born. If you need care for other issues during pregnancy, contact your PCM to schedule an appointment. If you use any other plan, you can visit any TRICARE-authorized provider, which is licensed by a state, accredited by a national organization, or meets other medical community standards.

There are two types of TRICARE-authorized providers: Network and Non-Network. To save money, try to find a network provider first. Postpartum care continues for up to six weeks after your baby is born.

Does TRICARE cover breast milk?

Banked donor milk is a limited TRICARE benefit that covers up to 35 ounces per day per infant when medically necessary. It must come from a milk bank accredited by the Human Milk Banking Association of North America (HMBANA). No approval from HNFS is required, but beneficiaries must obtain a prescription from a doctor managing their infant’s treatment. The initial prescription is valid for 30 days, and coverage may be extended through 12 months with a new prescription.

If the HMBANA-accredited milk bank files a claim, it must include a copy of the prescription and supporting medical documentation. If purchased from a non-network provider, the claim must also include the prescription.

Does TRICARE pay for diapers?

It should be noted that diapers are not included among the items covered under the basic TRICARE benefit. However, they may be covered under the Extended Care Health Option (ECHO), as detailed on the ECHO Benefits page.

How many ultrasounds does TRICARE cover?

Tricare covers ultrasounds when deemed medically necessary by a healthcare provider. Pregnancy-related ultrasounds typically cover one per trimester, while non-pregnancy-related ultrasounds are covered based on the medical condition being investigated or treated. Consult your healthcare provider to document the medical necessity of the ultrasound in your medical records and submit a prior authorization request to Tricare. Understand the type of Tricare plan you have, as different plans may have varying requirements for ultrasound coverage.

Tricare Prime enrollees may require a referral or prior authorization for ultrasounds not performed within their primary care network, while those with Tricare Select may have more flexibility in choosing providers.

What pregnancy items are covered by insurance?

The insurance plan provides coverage for a range of reproductive health services, including birth control pills, prenatal classes, HIV counseling, HIV screening, genetic testing for Down syndrome, gestational diabetes testing, and maternal compression garments. Nevertheless, JavaScript is either disabled or blocked by extensions, and your browser does not support cookies.

Does TRICARE pay for epidural?

TRICARE covers various services and supplies related to maternity care, including epidural anesthesia for pain management during delivery, medically necessary maternity ultrasounds, authorized birthing centers, emergency cesarean sections, prenatal vitamins, home delivery, birth control, and postpartum depression. However, it does not cover noncoital reproductive procedures, maternity ultrasounds not medically necessary, off-label use of FDA-approved drugs, home uterine activity monitoring (HUAM), lymphocyte or paternal leukocyte immunotherapy for recurrent spontaneous fetal loss, salivary estriol test for preterm labor, personal comfort items after delivery, care provided after loss of TRICARE eligibility, over-the-counter prenatal vitamins, birthing classes, doulas, and pregnancy support belts.

The coverage is limited to what would have been provided for vaginal delivery. It is important to be aware of conditions that can lead to postpartum depression and to consult Benefits A-Z for information on surrogacy.

Does TRICARE cover epidural?

TRICARE covers various services and supplies related to maternity care, including epidural anesthesia for pain management during delivery, medically necessary maternity ultrasounds, authorized birthing centers, emergency cesarean sections, prenatal vitamins, home delivery, birth control, and postpartum depression. However, it does not cover noncoital reproductive procedures, maternity ultrasounds not medically necessary, off-label use of FDA-approved drugs, home uterine activity monitoring (HUAM), lymphocyte or paternal leukocyte immunotherapy for recurrent spontaneous fetal loss, salivary estriol test for preterm labor, personal comfort items after delivery, care provided after loss of TRICARE eligibility, over-the-counter prenatal vitamins, birthing classes, doulas, and pregnancy support belts.

The coverage is limited to what would have been provided for vaginal delivery. It is important to be aware of conditions that can lead to postpartum depression and to consult Benefits A-Z for information on surrogacy.

Does TRICARE pay for a midwife?

The TRICARE program provides coverage for midwifery services provided by a certified nurse midwife (CNM), who must be certified by the American Midwifery Certification Board and state-licensed. Nevertheless, a registered nurse who is not a certified nurse midwife (CNM) may be provided with a referral and supervision by a physician. It should be noted that TRICARE does not provide coverage for services provided by lay midwives, certified professional midwives, or certified midwives.