TRICARE covers the full scope of pregnancy care, from your first prenatal visit through delivery and postpartum recovery. The specifics depend on your plan (Prime vs. Select), your sponsor’s status (active duty vs. retiree), and whether you use network providers. Here’s a breakdown of what’s included and what you’ll pay.
Prenatal Care
TRICARE covers routine prenatal office visits, lab work, and monitoring throughout your pregnancy. If you’re on TRICARE Prime as an active duty family member and stay in-network, your cost for these visits is typically $0. Select plan holders and retiree families will have copays or cost shares depending on their specific group.
Ultrasound Coverage Has Limits
This is one area that surprises many TRICARE beneficiaries: TRICARE does not cover ultrasounds for routine screening or solely to determine the baby’s sex. Ultrasounds are only covered when there’s a specific medical reason, such as:
- Estimating gestational age
- Evaluating fetal growth
- Checking fetal well-being (biophysical evaluation)
- Investigating vaginal bleeding
- Evaluating a suspected ectopic pregnancy
- Confirming heart activity
- Diagnosing or evaluating multiple pregnancies (twins, triplets)
- Evaluating maternal pelvic masses or uterine abnormalities
In practice, most pregnant women will have at least one or two ultrasounds that fall under these categories. But if your provider orders a scan that doesn’t meet one of these criteria, you could be responsible for the full cost. Talk to your provider’s billing office beforehand if you’re unsure whether a particular scan will be covered.
Genetic Testing and Screening
Non-invasive prenatal testing (NIPT), the blood draw that screens for chromosomal conditions like Down syndrome, is covered only for high-risk pregnancies. You’ll also need prior authorization before the test is performed. If your pregnancy is considered low-risk, TRICARE will not pay for NIPT, and you’d be responsible for the cost, which can run several hundred dollars or more out of pocket.
Labor, Delivery, and Hospital Stay
TRICARE covers medically necessary services during labor and delivery, including fetal monitoring, anesthesia, and any other care required during your hospital stay. Epidurals are specifically covered as part of the global maternity care benefit, so you won’t face a separate authorization hurdle for pain management during labor.
Cesarean sections are covered when medically necessary. If you choose an elective C-section for personal reasons rather than a medical indication, you may be responsible for some of the costs.
The standard covered hospital stay is a minimum of 48 hours after a vaginal delivery and 96 hours (four days) after a C-section. Complications can extend the stay, and TRICARE will continue covering medically necessary care.
What You’ll Pay for Delivery
Your out-of-pocket costs vary significantly based on your plan and sponsor status. Here’s how the main groups break down for an in-network hospital delivery:
Active Duty Family Members
On TRICARE Prime, hospital delivery costs $0 in-network. On TRICARE Select, you’ll pay either a flat per-day rate (around $24.50 per day or $25 per admission, whichever is more) or a per-admission fee of $79, depending on your enrollment group. Going out of network on Prime triggers point-of-service fees, and out-of-network Select charges run around 20% of the total cost.
Retirees and Their Families
On TRICARE Prime, you’ll pay $198 per admission for a hospital delivery regardless of network status. On TRICARE Select in-network, costs are higher: $250 per day or up to 25% of hospital charges (whichever is less), plus 20% of any separately billed services. Out-of-network Select costs jump to $1,345 per day or 25% of hospital charges, plus 25% of separately billed services. Staying in-network makes a significant financial difference for retiree families.
Birthing Centers and Home Births
TRICARE also covers delivery at birthing centers and at home. Active duty family members on Prime pay $0 in-network for birthing center delivery. Retiree families on Prime pay $79. Home births with a primary care provider cost $26 for retiree Prime members, or $38 on Select in-network.
Doula Services
TRICARE runs a Childbirth and Breastfeeding Support Demonstration program that covers certified labor doula services. To qualify, you must have TRICARE Prime, Prime Remote, or Select, be at least 20 weeks pregnant, plan to deliver outside a military hospital or clinic, and see a TRICARE-authorized provider for your birth.
The program covers up to six hours of visits with a certified labor doula, which can be split into 15-minute increments however you choose. You also get one untimed visit during the actual birth. This benefit is relatively new and not widely advertised, so it’s worth asking about if doula support interests you.
Breast Pumps and Breastfeeding Support
TRICARE covers breast pumps, breast pump supplies, and breastfeeding counseling at no cost for new mothers. Coverage isn’t limited to a specific manufacturer, brand, or model. You’ll need a prescription from a TRICARE-authorized provider that specifies whether you’re getting a manual or standard electric pump. Hospital-grade pumps require a referral and authorization through your regional contractor.
To avoid paying out of pocket, contact your regional contractor first to find a network provider or supplier. If you prefer to buy the pump yourself (including from online retailers), you can do that and file a claim for reimbursement afterward using DD Form 2642, along with a copy of your prescription and receipt. TRICARE pays up to a set amount for the pump and initial supply kit.
Postpartum Care
Postpartum follow-up visits are covered under the maternity care benefit. This includes the standard checkups in the weeks after delivery to monitor your recovery.
Enrolling Your Newborn
Your newborn is covered by TRICARE from birth, but only temporarily. If you’re stateside (including U.S. territories), you must register your child in DEERS within 90 days of birth. After day 90, claims for your child will be denied. If you’re stationed overseas, the window extends to 120 days.
Until your child is registered in DEERS, they won’t be enrolled in a TRICARE plan, won’t be eligible for care at a military hospital or clinic, and won’t be eligible for civilian health care coverage. This is one of the most time-sensitive steps after delivery, so it’s worth putting on your calendar well before your due date. You can register your newborn at your nearest ID card office with a birth certificate or birth verification letter from the hospital.