TRICARE Maternity Coverage & Costs (2026 Guide)
*Disclaimer: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense or the official TRICARE program. For official policy and enrollment, visit TRICARE.mil.*
## Is it covered? Yes. TRICARE covers all "medically necessary" maternity care, including prenatal care, delivery, and postnatal care. This coverage applies to all TRICARE plans, though your out-of-pocket costs and provider options will vary based on your specific plan and sponsor status.
## What TRICARE covers TRICARE’s maternity benefit is comprehensive, covering the mother from the confirmation of pregnancy through postpartum recovery. According to the Defense Health Agency (DHA), covered services include:
* **Prenatal Care:** Routine office visits, ultrasounds (when medically indicated), and screening tests (e.g., gestational diabetes, group B strep). * **Delivery Services:** Hospitalization or birthing center fees, anesthesia (including epidurals), and professional fees for the obstetrician or certified nurse-midwife. * **Postpartum Care:** Follow-up exams for the mother for up to six weeks after delivery. * **Special Services:** * Cesarean sections (when medically necessary). * Lactation consultant services (up to six individual sessions per birth event). * Breast pumps and supplies (standard electric pumps are covered at no cost for new mothers). * **Newborn Care:** Routine hospital nursery care and the initial pediatric exam.
**What is NOT covered:** * Elective or non-medically necessary ultrasounds (e.g., "keepsake" 3D/4D videos). * Midwife services provided by someone who is not a TRICARE-certified provider. * Doula services (except under the specific "Childbirth Support Provider" pilot program in select locations). * Private hospital rooms (unless medically necessary).
## Costs Maternity costs are determined by your plan type and whether the sponsor is Active Duty (ADFMs) or a Retiree family member.
* **TRICARE Prime (All tiers):** $0 out-of-pocket for all covered maternity services, provided you follow referral rules and use network providers. * **TRICARE Select (Group A, ADFMs):** No cost-share for most prenatal and postnatal care from network providers. For delivery, you may pay a small per-day hospital fee or a fixed copay (2026 rates vary—check TRICARE.mil for current nominal fees). * **TRICARE Select (Group B/Retirees):** Subject to annual deductibles. Once met, retirees typically pay a cost-share for hospital delivery (e.g., approximately 20-25% of the negotiated rate). * **TRICARE For Life:** TRICARE acts as the secondary payer to Medicare for maternity care (though rare, this applies to certain dependents).
*Note: If you use a non-network provider under TRICARE Select, your costs will be significantly higher due to balance billing.*
## Pre-authorization & referrals * **TRICARE Prime:** You must visit your Primary Care Manager (PCM) first to confirm the pregnancy and obtain a referral to an OB/GYN or midwife. If you wish to see a specialist outside of your Military Medical Facility (MTF), authorization from your regional contractor (Humana Military or TriWest) is required. * **TRICARE Select:** No referral or prior authorization is required for routine maternity care. You can book directly with any TRICARE-authorized provider. * **Specialty Services:** Prior authorization may be required for certain specialized tests (like genetic testing/amniocentesis) regardless of plan type.
## Where to get care * **Military Hospitals:** If you are enrolled in Prime and live near a Military Treatment Facility (MTF), you will likely receive care there. * **Network Providers:** Use the "Find a Doctor" tool on the regional contractor websites: * **East Region:** [Humana Military](https://www.humanamilitary.com/) * **West Region:** [TriWest Healthcare Alliance](https://www.triwest.com/) (Effective Jan 1, 2025) * **Overseas:** Contact [International SOS](https://www.tricare-overseas.com/) for a list of approved local providers.
## Sources 1. [TRICARE.mil: Maternity Care](https://tricare.mil/CoveredServices/IsItCovered/MaternityCare) 2. [TRICARE Policy Manual 6010.63-M: Chapter 4, Section 18.1 (Maternity Care)](https://manuals.health.mil/) 3. [DHA: Breast Pumps and Supplies Policy](https://tricare.mil/breastpumps)