Tricare Maternity Benefit
By Tanecia
First thing first, CONGRATULATIONS on this exciting new chapter of your family’s life. Welcoming a new member of the family is a joyous occasion. And let’s be real the person growing this new little human being needs things to make the pregnancy and postpartum period as comfortable as possible. Navigating pregnancy and insurance and doctors’ appointments and etc. can be very overwhelming. There is so many moving parts to getting ready to bring a baby in to your home and provide for not only their basic needs but everything in between their wants and your wants for them. Hopefully, the information shared below about the Tricare Maternity Benefit will help you check one box off of your every growing to do list.
Question number 1: What is the Tricare Maternity Benefit and what does it cover?
A general overview of the Tricare Maternity Benefit can be found here and includes other links to answer any specific questions you might have. As with most insurance companies Tricare covers all “medically necessary” care during the pregnancy, labor and up to 6weeks postpartum (may be longer if complications arise). Which includes routine care and care related to any complications experienced during and after pregnancy. Routine care can include bloodwork, ultrasounds, electronic fetal monitoring, stress test, etc. If you end up with complications or have a high-risk pregnancy, other test and extra monitoring may be needed and are included in your benefit as they are deemed “medically necessary” for the health of you and or your baby.
During your first few months of pregnancy, you will, in a routine pregnancy, see your provider 1x monthly. As you move further along those visits will become more frequent moving to 2x a month and around 36ish weeks your appointments will become weekly. During those visits you may get more bloodwork done, have a few ultrasounds and other test utilized to track the health of you and your baby. One of my favorite appointments is the 20week appointment. Why is that appointment my favorite you may be asking? It’s because that appointment includes the “anatomy scan”. During that ultrasound the technician makes sure the fetus as 2 arms, legs, kidneys, etc. to include all of the appropriate anatomy. But that 20-week ultrasound is where you can find out the gender of the little bun you have been carrying in your oven.
Covered Necessities
Now to the fun/ practical side of it. Tricare like other insurances cover a breast pump with every pregnancy. Around the 28 weeks mark you can obtain a prescription from your provider. You can go through a company recommended by your provider office. Or if you already know the company you want to order from, your prescription can be sent to that company. Most companies have a form you can fill out on the website, and they will verify your information and tell you which pumps are covered at either no cost or which ones come with an upgrade fee. Tricare also has an option for you to buy your own pump and they will reimburse you up to a certain dollar amount. The specific information regarding what is needed for reimbursement can be found on the breastpump and supplies page.
On the same link above you will find information about ordering pumping supplies for the duration of your breastfeeding journey. Your initial pump will come with at a minimum the following components
- Breast pump
- Flanges
- Duckbill set (pump specific)
- Tubing
- Bottle (may or may not come with nipples and tops)
- Backflow protector (pump specific)
- User manual
Tricare covers 1 replacement set per pregnancy, which includes: Flanges, duckbills, tubing, bottles, and backflow protectors. Monthly supplies are also covered and can include breastmilk storage bags and a duck bill set. A few companies that work with Tricare include but are not limited to
Other items covered by Tricare with a valid prescription may include
- Compression socks
- Postpartum compression belt
- Maternity Support garment (belly band)
Postpartum support services covered by Tricare
includes Lactation Support provided by either an
– (IBCLC) Independent Board-Certified Lactation Consultant or
– (CLC) Certified Lactation Counselor
6 postpartum visits are covered post discharge in support of your feeding journey.
*PRO-TIP* If you find yourself exclusively pumping, have your provider write you a prescription for xxx amount of milk storage bags so that you aren’t coming out of pocket unnecessarily. For example, my first exclusively pumping journey I received a prescription for 240 bags per month since the 90bags originally covered by Tricare didn’t last me 8 days let alone a 30-day calendar month. My second pumping journey I received a prescription for 200 bags.
I hope you found this little overview helpful, and you were able to check one thing off of your ever growing, ever changing baby to do list. Until next time take care and I hope you will check out the topics covered in my blog.