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News | April 23, 2024

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

By TRICARE Communications

Recently learned you’re expecting a baby? Congratulations! This is an exciting time for your family. But you may also have questions about how to get care for yourself during and after your pregnancy.

“‘Maternity care’ refers to the medical services related to pregnancy,” said Jeannine Pickrell, RN, director of Disease Management & Population Health at the Defense Health Agency. “It includes care before and after you have your baby, treatment of complications, and breastfeeding support.”

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 determine 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.

TRICARE 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.

Learn more about getting TRICARE coverage for your child.

TRICARE is here to help as you prepare to welcome your new baby into your family. Check out the TRICARE Maternity Care Brochure to learn more about covered maternity care services, costs, and guidelines for getting care.

Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions, and create your personalized profile to get benefit updates, news, and more.
 

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