TRICARE Updates Coverage for Breastfeeding Supplies, Services

4/9/2019

TRICARE recently revised coverage regarding breastfeeding supplies and services. The policy now clarifies the specific types of breast pumps and supplies covered. The updated policy also added coverage for two additional breastfeeding supplies. TRICARE continues to cover breast pumps, breast pump supplies, and breastfeeding counseling at no cost for new and adoptive mothers. However, new limits and exclusions apply.

“The new changes enhance and modernize the TRICARE benefit,” said Elan Green, acting chief of the Health Plan Design Branch for TRICARE Health Plan at the Defense Health Agency. “We encourage breastfeeding, which has been shown in multiple studies to have significant benefits for the child. These changes will continue to ensure TRICARE supports mothers who choose to breastfeed their children.”

Here are the updates:

  • TRICARE added a payment cap for manual and standard electric breast pumps. All related supplies needed for the operation of the breast pump are included in the cap amount. As of March 2019, TRICARE pays $312.84 for stateside and $500.55 for overseas. For more about these rates, visit health.mil.
  • TRICARE put limits on the amount and frequency of replacement supplies. You’ll need a new prescription from your health care provider for replacement supplies over the new limits. The prescription must be specific to the supplies needed. Visit the TRICARE website for a list of covered breast pump supplies.
  • TRICARE reduced the number of covered breast pump kits from two to one per birth event. The delivery and all parts and supplies needed for the operation of the breast pump are included in the payment rate for the initial breast pump. The breast pump kits may not be separately reimbursed.
  • TRICARE added coverage for one supplemental nursing system and two sets of nipple shields per birth event. A birth event starts at the 27th week of pregnancy (third trimester), birth of a child prior to 27 weeks, or the legal adoption of an infant by a woman who personally plans to breastfeed. A TRICARE-authorized provider must prescribe these supplies.

“Beneficiaries continue to have choices and access to care that best meets their individual and family needs,” Green said. “These updates also ensure the best use of health care resources, as well as reduce potential waste.”

Regional contractors are in the process implementing this new benefit and will begin accepting banked donor milk authorizations and claims by the end of May 2019.

Learn more about TRICARE coverage of breast pumps and supplies.

Last Updated 4/16/2019