Babies! Aren’t babies amazing? The miracle you have been waiting for is on the way! Being a new parent (or even a 3rd or 4th time parent) can be an adventure. It doesn’t help when you now have to navigate how to pay for it all.
TRICARE changes frequently so be sure to always be double checking what is covered and what is not. If you want to learn more about TRICARE Prime and Select and their basic info, be sure to check out my post on the Basics for Every MILSO to know. Here are some highlights that carry over into Maternity and , there are a few certain things you can always know.
Groupings
TRICARE now has enrollment benefits and costs based on two things: What plan you are enrolled into and WHEN you enrolled. Depending on the when, you land in either Group A or Group B. These groups affect your enrollment fee and out of pocket expenses.
Group A refers to active-duty members and their families who have been in before Jan. 1, 2018. Group B includes those who joined the military (and their families) after Jan. 1, 2018.
Remember what group you are in! This is important, I promise.
Maternity Care
If you yourself are pregnant, this next bit will deal with what is covered during your pre-natal, delivery and post natal care. What is covered/your out of pocket expenses will once again depend on the TRICARE plan you are enrolled in.
TRICARE Prime Plan
You must get a referral from your primary care manager (PCM) before seeking care related to your pregnancy. You MAY NOT self-refer, even for pregnancy. Many people have trouble later about this. Your PCM will need to confirm your pregnancy and then will refer you to an Obstetrician or Gynecologist.
- Every attempt will be made to refer you to a military hospital or clinic.
- If that is not available, your PCM will refer you to a network provider for the duration of your pregnancy.
- After your baby is born, you’ll continue to get postpartum care for up to six weeks.
- For any care UNRELATED to your pregnancy or post-partum care, while you are pregnant (i.e. if you have a cold, or need a refill on medications), you will need to contact your PCM to schedule a separate appointment.
- There is NO out-of-pocket expense for Network Providers.
Beneficiaries Using All Other Plans
You can visit any TRICARE-authorized provider for your pregnancy-related care. An authorized provider will need to be certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network for pregnancy care. You can find a list of providers HERE.
- Try to find a network provider first—you’ll pay less out-of-pocket
- For specifics, check out your specific Co-Pay and Cost Share
- After your baby is born, you’ll continue to get postpartum care for up to six weeks.
- If you need care for other issues while you are pregnant (if you have a cold or sprain your ankle, for example), contact your PCM to schedule an appointment.
Labor and Delivery
TRICARE covers medically necessary services during your labor and delivery. To be medically necessary, it needs to be appropriate, reasonable, and adequate for your condition. This may include:
- Anesthesia
- Monitoring
- Other services required
- Cesarean section if you need it (elective c-sections may require you to pay out-of-pocket for some of the costs).
Where you will deliver usually depends on your TRICARE plan. This could be a:
- Military hospital (Common for TRICARE Prime)
- Civilian hospital (Mostly available for other TRICARE plans)
- Office-based or freestanding facility
You also have options for the type of provider who delivers your baby. You and your doctor will make these decisions at your prenatal visits. Possible providers include
- Obstetrician
- Family practice doctor
- Certified nurse midwife
Length of Stay
Typical stays after a vaginal delivery in the hospital is at least 48 hours, and it goes up to 96 hours after a cesarean section. If you have complications (i.e. pre-eclampsia, loss of blood, etc), you may stay longer. I has Pre-eclampsia with my first and my blood pressure wouldn’t go down within the first 48 hours, so they kept me two extra days, and we paid nothing more than out co-pays.
Breast Pumps, Supplies and Counseling
Many women choose to breastfeed their new baby. Whether breastfeeding for 3 days or 3 years, TRICARE provides new moms with the supplies needed to make the experience easier.
I have taken advantage of this for each of my three babies and not only was I able to get my breast pump sent right to my door, but I also had pumping supplies auto-shipped to my door for months following their birth. There are some important points you need to know and they are all AMAZING!
- It does not matter what TRICARE plan you are using OR your sponser’s status.
- TRICARE covers breast pumps, breast pump supplies and breastfeeding counseling at no cost for new mothers, including mothers who adopt an infant and plan to breastfeed.
- All TRICARE-eligible female beneficiaries with a birth event. A birth event includes a pregnant beneficiary or a female beneficiary who legally adopts an infant and intends to personally breastfeed.
- You can get these items before or after delivery.
What’s Covered:
- Standard power adapters
- Tubing and tubing adaptors
- Locking rings
- Bottles
- Bottle caps
- Shield/splash protectors
- Storage bags Let’s just take a moment to say THANK YOU!
- Up to 2 breast pump kits per birth event (AMAZING!!!!)
TRICARE doesn’t cover (unless part of a breast pump kit):
- Breast pump batteries, battery-powered adapters, and battery packs
- Regular “baby bottles” (bottles not specific to pump operation), including associated nipples, caps, and lids
- Travel bags and other similar carrying accessories
- Breast pump cleaning supplies
- Baby weight scales
- Garments and other products that allow hands-free pump operation
- Ice packs, labels, labeling lids, and other similar products
- Nursing bras, bra pads, breast shells, and other similar products
- Over-the-counter creams, ointments, and other products that relieve breastfeeding related symptoms or conditions of the breasts or nipples.
How to get supplies:
As a mother-to-be, you can get breast pump supplies before delivery or up to 3 years (36 months) after the birth event. The 3-year period starts on the child’s birth date or the date of the legal adoption. Remember, birth event includes adoption or birth of a child from the beneficiary herself, and they plan to be breastfed.
- You will need a prescription from your TRICARE-authorized healthcare provider.
- The prescription must specify electric or manual: it does NOT need to specify a specific brand.
- If you’re going to get your breast pump from a network provider or durable medical equipment supplier, ask your provider to include a diagnosis code on your prescription.
- You can get your pump one of two ways:
- Contact your regional contractor to find a supplier (does not require payment up front). I found an online supplier (based in VA) for my son and then we moved to CA 6 weeks after his birth: they continued to send me supplies for months later, all covered by TRICARE).
- You can pay for it up front at retail stores, online suppliers (i.e. Amazon), Post, Base or Station Exchanges and the Commissary. (keep your receipt and then you can file a claim for reimbursement).
Congratulations!
This is such an exciting time for you and your family! No matter how your family is expanding, TRICARE has some amazing benefits and you will want to take advantage of them. A new baby can bring sleepless nights and a whole lot of joy: no need to worry about the rest of it.
