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Expecting a Child? Here’s How TRICARE Covers Maternity Services 

TRICARE is here to help you get the care you need during pregnancy. As you get ready to welcome your child, here’s some information about how TRICARE covers maternity services.

 

During your pregnancy 

 

If you think you’re pregnant, make an appointment with your primary care doctor right away. This will help make sure you get regular prenatal care.  Prenatal care is the care you receive during pregnancy, up until delivery. 

Prenatal checkups may include screenings and ultrasounds to monitor your baby’s health and development. These checkups also allow you to ask  questions and stay on track with your own health, since there can be many health changes during pregnancy. You’ll also use these visits to find out your  due date and make a plan to deliver your baby. 

As outlined in the TRICARE Maternity Care Brochure, your rules for getting maternity care and delivering your baby are based on: 

These factors will determine the type of birthing facility you can use (military hospital, civilian hospital, birthing center, or planned home birth). You can  decide if you’ll have an obstetrician, family practice provider, or certified midwife deliver your baby. Your TRICARE plan will dete rmine if you  need referrals or pre-authorization for care. Keep in mind that you must see a TRICARE-authorized provider. There may be limitations on some services  overseas. 

 

During labor and delivery 

 

TRICARE covers medically necessary labor and delivery services. These include anesthesia, monitoring, and cesarean sections, if needed. If you choose to  have a cesarean section for personal reasons, you may have to pay for some of the costs. Usually, you’ll stay in the hospital for at least 48 hours after a  vaginal delivery and 96 hours after a cesarean section. If you have complications, you may stay longer. 

 

After childbirth 

 

TRICARE covers at least two postpartum visits after your baby’s birth—and more, if your provider thinks you need them. 

Planning to breastfeed? TRICARE covers breast pumps and breast pump supplies at no cost for all new moms. You can buy certain breast pumps and file a  claim for reimbursement. Contact your TRICARE contractor for more information. 

TRICARE also covers breastfeeding counseling from a certified lactation counselor or consultant at no cost. You can get breastfeeding counseling during an  inpatient maternity stay, follow-up outpatient visit, or a well-child care visit. You can also get counseling at up to six outpatient visits. 

You may be able to get additional services from certified non-medical labor doulas, lactation consultations, and lactation counselors as part of  the Childbirth and Breastfeeding Support Demonstration (CBSD). The CBSD is available if you have TRICARE Prime or TRICARE Select and meet certain  criteria. Currently, the CBSD is only available in the U.S. But it will expand overseas on Jan. 1, 2025. 

 

Understanding costs 

 

How much will you pay for maternity care? It depends on who you are and your TRICARE plan. Active duty service members (ADSMs) and their families  enrolled in TRICARE Prime have no costs for maternity care. TRICARE Prime beneficiaries who aren’t ADSMs can also use the point-of-service option to  self-refer to any TRICARE-authorized provider. 

However, you’ll pay more out of pocket when you use the point-of-service option. ADSMs can’t use the point-of-service option. All other beneficiaries pay  applicable deductibles, copayments, and cost-shares. Check the Compare Costs tool to see how much you’ll pay for covered maternity services. 

 

Coverage for your child 

 

Children of sponsors will have TRICARE coverage at birth. This coverage lasts for 90 days in the U.S. and 120 days overseas. You must register your  newborn in the Defense Enrollment Eligibility Reporting System (DEERS) during this time. If you don’t register your child in DEERS during this time,  TRICARE will deny claims for your child starting at 91 days old in the U.S. and 121 days old overseas. 

What happens after your child is registered in DEERS? It depends on their sponsor’s status. 

  • Children of active duty service members are automatically enrolled in TRICARE Prime or TRICARE Select, based on their location. You have 90  days from the auto-enrollment date to change your child’s plan, if eligible. 
  • Children of retirees aren’t automatically enrolled in TRICARE. You must enroll your child in a plan within 90 days of birth in the U.S. or 120  days of birth overseas. 
  • Children of sponsors eligible for TRICARE Reserve Select and TRICARE Retired Reserve aren’t automatically enrolled in TRICARE. You must  enroll your child in a plan within 90 days of birth in the U.S. or 120 days of birth overseas.

 

 

*For more informastion, visit TRICARE at the Defense Health Agency’s website, or visit their M:M Expert Blog Page.



 

Author

  • The Defense Health Agency is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to Combatant Commands in both peacetime and wartime. Their mission is to provide a medical benefit commensurate with the service and sacrifice of more than 9.6 million active duty personnel, military retirees and their families.

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