TRICARE Coverage for Pregnancy & Maternity Care
Overview
TRICARE provides comprehensive maternity coverage from preconception through postpartum care. This includes all prenatal visits, ultrasounds, lab work, delivery (vaginal and cesarean), and postpartum follow-up care. Active duty family members receive most pregnancy care at $0 out of pocket.
Treatment Options Covered by TRICARE
- Preconception counseling and planning
- Prenatal office visits (all routine visits covered)
- Ultrasounds and prenatal screening tests
- Genetic screening and counseling
- Labor and delivery (vaginal and cesarean)
- Epidural and anesthesia
- Hospital stay (48 hours vaginal, 96 hours cesarean)
- Postpartum visits and screening
- Breastfeeding support and breast pump coverage
- Newborn care and first pediatric visits
How TRICARE Covers Pregnancy & Maternity Care
TRICARE covers all medically necessary maternity care with no separate maternity rider needed. Coverage includes preconception planning, prenatal care, delivery, and postpartum care. Breast pumps are covered (manual or electric). Active duty members receive care through their MTF or civilian provider with referral.
Coverage by Plan
TRICARE Prime
All prenatal visits, delivery, and postpartum care at $0 for ADFMs. Active duty members seen at MTF. Referral required for civilian OB if not at MTF.
TRICARE Select
Covered with standard cost shares. Outpatient prenatal visits at network cost share. Inpatient delivery subject to per-day charges. ADFMs: lower cost shares than retirees.
TRICARE For Life
Not typically applicable (age 65+), but late pregnancies via surrogacy/adoption would have standard Medicare + TFL coverage for any medical needs.
Estimated Costs
| Scenario | Estimated Cost |
|---|---|
| Prenatal visits (Prime ADFM) | $0 |
| Vaginal delivery (Prime ADFM) | $0 |
| Cesarean delivery (Prime ADFM) | $0 |
| Prenatal visits (Select ADFM, network) | $0 for E1–E4, copays for E5+ |
| Delivery (Select ADFM, network) | $25/day inpatient |
| Breast pump | $0 (covered as preventive) |
Authorization Requirements
Routine maternity care does not require prior authorization. High-risk pregnancy services, non-emergent cesarean, and extended hospital stays may require notification or authorization.
Network & Provider Notes
TRICARE covers both OB/GYN and certified nurse midwife care. Prime members need a referral for civilian obstetric care. Select members can self-refer to any TRICARE-authorized OB/GYN.