Maternity (Pregnancy) Care
Maternity (or pregnancy) care is all of the medical services related to conception and delivery including:
- Prenatal care
- Post-partum care (generally for six weeks after delivery)
- Treatment of any complications
TRICARE covers all medically-necessary pregnancy care, but there are some limitations.
Prenatal care is the care you receive from the time you find out your pregnant until you deliver your baby. As soon as you think you may be pregnant, schedule an appointment with your primary care provider. Depending on your health plan option, this may be your assigned primary care manager (PCM).
Regular appointments with your doctor are important to make sure you and your baby are healthy. At the first appointment, you'll find out the due date and explore your health history. Frequent prenatal visits allow you to follow the progress of your pregnancy and your baby's development and give you the opportunity to ask questions along the way.
While all medically-necessary prenatal care is covered, there are some limitations.
TRICARE covers the following services to determine the health of the baby or if you have a high-risk pregnancy:
- Chorionic villis sampling
- Fetal stress test
- Electronic fetal monitoring
Doctors often perform ultrasounds at different times during pregnancy for different reasons. TRICARE will cover ultrasounds used to:
- Estimate gestational age
- Evaluate fetal growth
- Conduct a biophysical evaluation for fetal well-being
- Evaluate a suspected ectopic pregnancy
- Define the cause of vaginal bleeding
- Diagnose or evaluate multiple gestations
- Confirm cardiac activity
- Evaluate maternal pelvic masses or uterine abnormalities
- Evaluate suspected hydatidiform mole
- Evaluate the fetus's condition in late registrants for prenatal care
TRICARE does not cover maternity ultrasounds for routine screening or to determine the sex of the baby. If you have ANY questions about coverage, please contact your regional contractor.
Labor and Delivery
TRICARE covers medically-necessary services during your labor and delivery including anesthesia, fetal monitoring, and other services required for your care during your stay. TRICARE will cover cesarean section when needed. If you choose to have a cesarean section instead of vaginal delivery for personal reasons, you may be responsible for some of the costs.
Usually, your TRICARE plan determines the type of birthing facility you will use (military or civilian, office-based or freestanding, etc.). You also have different options for the type of provider who delivers your baby (obstetrician, Family practice provider and or Certified nurse midwife, etc.). These types of decisions will be made by you and your provider during your prenatal visits.
Length of Stay
Usually, you will stay in the hospital for a minimum of 48 hours after a vaginal delivery and 96 hours after a cesarean section. Complications may require a longer stay.
Post-partum care is the care you receive after your baby is born to ensure your body is healing properly. TRICARE covers a minimum of two post-partum visits. More visits will be covered if you had complications or if your provider thinks it's needed.
This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.
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Last Updated 6/18/2020