The idea of welcoming a new baby into the world can be exciting and scary.
You’ve got so much to prepare for, hormones to handle, and the constant hustle and bustle of the military to worry about. One thing that shouldn’t be stressful is understanding your Tricare pregnancy coverage.
By reading this guide, you’ll learn what’s covered under Tricare before, during, and after your pregnancy. Keep reading to learn more.
Tricare Pregnancy Coverage
As a beneficiary, maternity care is covered before, during, and after pregnancy by Tricare Prime and Tricare Select. But what exactly does this cover involve? Are there co-pays? Are there circumstances that Tricare won’t cover? Keep reading to learn more about all the coverage details.
Tricare Prime vs. Tricare Select
Active-duty spouses have options when it comes to coverage:
When it comes to maternity care, there are some differences between Tricare Prime and Tricare Select.
Suppose you are covered under Tricare Prime and want maternity care. In that case, you must get your pregnancy confirmed by your primary care physician (PCM) before receiving any prenatal care from a military hospital or an in-network facility.
With Tricare Select, Tricare Reserve Select, Tricare Retired Reserve, and the Continued Health Care Benefits Program, you do not need a referral to begin prenatal care. All you have to do is find a network provider (if you don’t already have one) and call to schedule your first prenatal appointment.
Whether you are using Tricare Prime or Tricare Select, your first prenatal appointment (sometimes the second under Select) is when your doctor will:
- Collect your medical history
- Order labs
- Start scheduling future appointments
Tricare Pregnancy Coverage: How Much Does it Cost to Have A Baby With Tricare?
If you are enrolled in a Tricare Prime plan, there is no cost to you for medically necessary maternity care.
If you are enrolled in any other Tricare program, you may have copayments or cost-shares.
Generally, under Tricare Select, active-duty spouses or Tricare-eligible daughters will pay between $50 and $150.00 as a deductible, depending on the sponsor’s rank. For inpatient stays, the cost is about $14 a day.
Considering trying to get pregnant? Talk with your primary care physician and learn more about coverages from Tricare. Prenatal pills, for example, are covered under your Tricare plan.
Tricare Prenatal Coverage
Tricare defines prenatal care as the “care you receive from the time you find out you’re pregnant until you deliver your baby”.
They cover several services during pregnancy, including services to determine how healthy the baby is or if your pregnancy is considered high risk. These include:
- Chorionic villus sampling — cells from the placenta are check to see if they have any chromosomal abnormalities like Down syndrome.
- Amniocentesis — your doctor may recommend that a small sample of amniotic fluid be removed from your uterus for testing for fetal abnormalities like cystic fibrosis or spina bifida.
- Cordocentesis — during this procedure, an ultrasound transducer is used to find the fetus’s location and the umbilical cord on a monitor. Once located, a fetal blood sample is drawn from the umbilical cord to test for any possible fetal abnormalities.
- Fetal stress testing — after 34 weeks, this test may be done to check if your baby will stay healthy during labor contractions.
- Electronic fetal monitoring — continuously recording the heartbeat of the baby during labor.
Tricare also covers:
- High-risk or complicated pregnancies.
- Ultrasounds that are considered medically necessary — determining the sex of the baby is not covered under Tricare.
- Lactation counseling, a breast pump, and pumping supplies.
If you’re unsure about prenatal coverage, never be afraid to ask questions. Contact your Tricare provider with any concerns you may have.
Does Tricare Cover Midwives or Doulas?
If you would like to have a midwife during your pregnancy, it is an option under Tricare. In order for Tricare to cover the services, the midwife must be:
- Certified by the American Midwifery Certification Board — in some cases, midwife services may be covered by a registered nurse who is not CNM certified but is referred and supervised by a physician.
Lay midwives, Certified Professional Midwives, and Certified Midwives are not covered by Tricare.
Tricare Labor and Delivery Coverage
Hospital stays can get costly, especially when you’re having a baby; thankfully, Tricare pregnancy coverage includes all medically-necessary services like:
- Hospitalization for labor and delivery
- Anesthesia during labor and delivery
- Vaginal births
- Medically necessary cesarean births
- Postpartum care
- Other medically necessary services/treatments
Keep in mind that if you’ve chosen to have a cesarean section instead of a vaginal delivery for personal reasons, and it is not required, Tricare may bill you for some of the costs.
How Much of My Hospital Stay is Covered Under Tricare?
Your entire stay will be covered under Tricare as long as it is deemed medically necessary. If you are not enrolled in Tricare Prime, co-payments may be required.
NICU and pediatric critical care stays are also covered under Tricare.
Tricare Birthing Center Coverage: Are Birthing Centers an Option?
Tricare covers deliveries at birthing centers if:
- It is a Tricare-certified birthing center
- You are stateside
Tricare Home Birth Coverage
If you are considering a home birth, know that it may be covered by Tricare if you are stateside.
Tricare Prime members do not pay anything for home births as long as it is within the parameters of Tricare’s requirements. If you are a Tricare Select patient and choose to have a home birth, you may have to pay 20 percent of the allowable charges. For more information about Tricare home birth coverages, costs, and requirements, contact your regional contractor.
Tricare Postpartum Coverage
Under Tricare, a minimum of two postpartum visits with your doctor are covered. If you’ve had any complications, or your provider simply thinks you need more care, coverage will continue.
Tricare also covers treatment for postpartum depression and other postpartum related issues. Never be afraid to discuss any symptoms or issues you have postpartum with your physician as there are many resources available to you.
How Do I Enroll my Baby in Tricare?
For the first 60 days of your new baby’s life, he or she is covered as a Tricare prime beneficiary as long as one family member is enrolled in Tricare Prime. After the initial 60 days, any claims submitted for medical care will be processed under Tricare Standard.
As a parent, you have up to 90 days (120 days in stationed overseas) to enroll your child into the Defense Enrollment Eligibility Reporting System (DEERS). Still, we recommend you do it as soon as possible so that you don’t forget.
To enroll your baby in DEERS, a birth certificate and a DD1172 form should be submitted to your sponsor’s personnel office. The personnel office will also need your child’s social security number, but they understand that sometimes applying for and receiving a social security number isn’t a quick process.
Tricare Pregnancy Coverage: Key Takeaways
Although we cannot fully prepare you for parenthood, we can assure you that understanding your coverages will take some of the stress out of the new chapter you are in.
Whether you’re covered under Tricare Prime or Select, Tricare pregnancy coverage is not something that should cause you additional stress, as long as you have your bases covered. Being aware of coverages and discussing any concerns you have about coverage with your physician, or a Tricare representative can save you time — and sanity — so that you can enjoy this brand new chapter in life.