Maternity (Pregnancy) Care

Maternity (or pregnancy) care is all of the medical services related to conception and delivery. This includes:

• Prenatal care
• Labor and delivery
• Postpartum care (generally for six weeks after delivery)
• Treatment of any complications

TRICARE covers all medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. pregnancy care, but there are some limitations.

Prenatal Care

Prenatal care is the care you receive from the time you find out you’re 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.

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.

Antepartum Services

TRICARE covers the following services to determine the health of the baby or if you have a high-risk pregnancy:

• Amniocentesis
• Cordocentesis
• Chorionic villus sampling
• Fetal stress test
• Electronic fetal monitoring

Ultrasounds

Doctors often perform ultrasounds at different times during pregnancy for different reasons. TRICARE covers 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 doesn’t cover maternity ultrasounds for routine screening or to determine the sex of the baby. If you have questions about coverage, contact your regional contractor.

Labor and Delivery

TRICARE covers medically necessary services during your labor and delivery. This includes 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 C-section instead of vaginal delivery for personal reasons, you may be responsible for some of the costs.

Facilities and Providers

Usually, your TRICARE plan determines the type of birthing facility you’ll use (military or civilian hospital, office-based or freestanding facility, etc.). You also have different options for the type of provider who delivers your baby (obstetrician, family practice provider, certified nurse midwife, etc.). You and your provider will make these types of decisions during your prenatal visits.

Length of Stay

Usually, you’ll stay in the hospital for a minimum of 48 hours after a vaginal delivery and 96 hours after a C-section. Complications may require a longer stay.

Postpartum Care

Postpartum care is the care you receive after your baby is born to ensure your body is healing properly. TRICARE covers a minimum of two postpartum visits. More visits will be covered if you had complications or if your provider thinks it’s needed.