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Here’s what TRICARE covers for pregnancy and birth

Before TRICARE, we had a decent insurance plan through my husband’s job but we still ended up having to pay about $1,000 for my oldest son’s birth. My next two babies were born after he joined the military and our costs were very minimal. When my son was born in Germany, we paid a total of $50, which was so I could have a private room one of the nights that I was there.

When it comes to TRICARE and pregnancy, a lot of spouses have questions.  Can you have more than one ultrasound? Can you go with a midwife? Do they cover all of your visits?

Here is a run down of what TRICARE covers for birth and pregnancy:

Pregnancy

TRICARE does cover all medically necessary pregnancy care. . .with some limitations. The type of plan you have can also determine what is covered.

Prenatal care is covered and is considered from the time you find out you are pregnant until you deliver your baby. When you suspect you might be pregnant, your first step is making an appointment with your primary doctor.

During your pregnancy, TRICARE will cover antepartum services to determine the health of your baby or if you have a high-risk pregnancy. These would be an Amniocentesis, Chordocentesis, Chorionic villus sampling, fetal stress tests, and electric fetal monitoring.

TRICARE will cover ultrasounds depending on the reason you need one. While they do cover such things as estimating gestational age, evaluating fetal growth, and defining the cause of vaginal bleeding, they do not cover them for routine screenings or to simply determine the sex of your baby.

They do cover prenatal vitamins with a prescription through the TRICARE Pharmacy program. They do not cover over-the-counter vitamins.

If you are on TRICARE Prime, you must get a referral from your Primary Care Manager (PCM). They will try to to get you seen at a military hospital or clinic for your pregnancy. If they can’t do this because of location or space, your PCM will refer you to a network provider. If you need to be seen during your pregnancy for any non-pregnancy related issues, you would still go to see your PCM.

You will be able to be seen by a midwife if they are a Certified Nurse Midwife, certified by the American Midwifery Certification Board and the state you’re in. TRICARE does not cover services by a lay midwife, Certified Professional Midwife, or a Certified Midwife.

TRICARE does cover prenatal screenings. These include but are not limited to HIV, Hepatitis B, and RH incompatibility. All screenings will be discussed at your prenatal appointments.

Labor and Delivery

Your TRICARE plan will determine where you give birth and what they will cover. While we were on TRICARE Prime when I was pregnant in Germany, I gave birth at a German hospital because our Army post did not have the facilities on base.

TRICARE does pay for C-sections when they are needed, but this is not always the case for elective C-sections.

There will be different options based on your provider. You will be able to discuss your options with your OB, midwife, or family practice depending on who you are seeing during your pregnancy.

Post-Partum Care

Post-partum care is the care you receive after your baby is born to make sure that your body is healing properly. TRICARE covers a minimum of two post-partum visits. More will be covered if you have complications or if you provider thinks that you need to be seen more than that.

Surrogacy

TRICARE’s coverage for surrogacy is limited. They do pay for services and supplies related to maternity care, which will also include antepartum care and complications if any arise for a surrogate mother. She would need to be a TRICARE beneficiary and have a contractual agreement with the adoptive parents. The medical expenses that are outlined in the agreement would be covered under primary coverage. TRICARE will pay second after the surrogate mother is able to seek reimbursement from the adoptive parents.

Abortion

TRICARE only covers abortions that are a result of rape or incest or if the mother’s life is in danger by carrying to term.

By Julie Provost

Julie Provost is an associate editor at Military One Click and a National Guard spouse. She can be reached at julie@militaryoneclick.com.

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