Prenatal care is important, and we strongly recommend that those who are pregnant, or who anticipate becoming pregnant, seek appropriate medical care. TRICARE Prime, TPR, and TPRADFM cover all necessary maternity care, from your first obstetric visit through six weeks after your child is born, including:
- Obstetric visits throughout your pregnancy
- Medically necessary fetal ultrasounds
- Hospitalization for labor, delivery, and postpartum care
- Anesthesia for pain management during labor and delivery
- Medically necessary cesarean section
- Management of high-risk or complicated pregnancies
Newborns are covered separately. To ensure your newborn is covered by TRICARE, you must register your child in DEERS at a uniformed services ID card-issuing facility and enroll your child in TRICARE Prime or TPRADFM within 60 days after birth or adoption. For more information, see “Having a Baby or Adopting a Child” in the Changes to Your TRICARE Coverage section of this handbook.
The following services are not covered by TRICARE:
- Fetal ultrasounds that are not medically necessary (e.g., to determine your baby’s sex), including three- and four-dimensional ultrasounds
- Services and supplies related to noncoital reproductive procedures (e.g., artificial insemination)
- Management of uterine contractions with drugs that are not FDA-approved for that use (i.e., off-label use)
- Home uterine activity monitoring and related services
- Unproven procedures (e.g., lymphocyte or paternal leukocyte immunotherapy for the treatment of recurrent miscarriages, or salivary estriol test for preterm labor)
- Umbilical cord blood collection and storage, except for patients who undergo umbilical stem cell transplantation for a covered transplant
- Private hospital rooms
Maternity Ultrasounds
TRICARE covers medically necessary maternity ultrasounds that may be needed to:
- Estimate gestational age due to unknown date of last menstrual period, irregular periods, size/date different by greater than two weeks, or pregnancy while on oral contraceptive pills (Confirmation of estimated gestational age is not a medically necessary indication.)
- Evaluate fetal growth when the fundal height growth is significantly greater than expected (more than 1 cm per week) or less than expected (less than 1 cm per week)
- Conduct a biophysical evaluation for fetal well-being when the mother has certain conditions (e.g., insulin-dependent diabetes mellitus, hypertension, systemic lupus, congenital heart disease, renal disease, hyperthyroidism, prior pregnancy with unexplained fetal demise, multiple gestations, post-term pregnancy after 41 weeks, intrauterine growth retardation, oligohydramnios, polyhydramnios, preeclampsia, decreased fetal movement, isoimmunization)
- Evaluate a suspected ectopic pregnancy
- Determine the cause of vaginal bleeding
- Diagnose or evaluate multiple births
- Confirm cardiac activity (e.g., when heart rate is not detectable by Doppler and/or suspected fetal demise)
- Evaluate maternal pelvic masses or uterine abnormalities
- Evaluate suspected hydatidiform mole
- Evaluate the condition of the fetus in late registrants for prenatal care
A physician is not obligated to perform ultrasonography on a patient who is low risk and has no medical indications.
Some providers offer patients routine ultrasound screening as part of the scope of care after 16–20 weeks of gestation.
TRICARE does not cover routine ultrasound screening. Only maternity ultrasounds with valid medical indications that constitute medical necessity are covered by TRICARE.
Getting Maternity Care
As soon as you think you may be pregnant, visit your PCM. If your PCM is not an obstetrician, he or she will refer you to one. You may see the same provider throughout your pregnancy, depending on the circumstances and provider availability, or request a change at any time. If you relocate to a new region during your pregnancy, you must transfer your enrollment to your new region and select a new PCM. You are encouraged to obtain copies of your health care records from your PCM before relocating. For more information on transferring your TRICARE Prime enrollment, see “Moving” in the Changes to Your TRICARE Coverage section.
Maternity care services may require referrals and prior authorizations. Refer to the
TRICARE Maternity Care fact sheet for additional information.
If your PCM is at an MTF, you should receive maternity care from the MTF. If you are not located near an MTF or MTF care is unavailable, your PCM will refer you to a civilian network provider. All beneficiaries, except ADSMs, may use the POS option to self-refer to an obstetrician; however, higher out-of-pocket costs will apply. ADSMs who are pregnant at the time of release from active duty should contact their local Beneficiary Counseling and Assistance Coordinator to determine if maternity care is available through the MTF.
For continued maternity care, ADSMs who are pregnant at the time of release from active duty may choose to:
- Work through their service (unit personnel and MTF administrative channels) to establish ongoing eligibility for care within the MTF
- Receive transitional TRICARE coverage for health care services through the Transitional Assistance Management Program (TAMP), if they are eligible
- Enroll in the Continued Health Care Benefit Program (CHCBP), if they qualify
Visit
TRICARE's Transitional Assistance Management Program to learn more about TAMP. CHCBP is administered by Humana Military Healthcare Services, Inc. For CHCBP details, visit Humana Military's
CHCBP portal.
To ensure your newborn is covered by TRICARE, you must register your child in DEERS at a uniformed services ID card-issuing facility and enroll your child in TRICARE Prime or TPRADFM within 60 days after birth or adoption. For more information, see “Having a Baby or Adopting a Child” in the Changes to Your TRICARE Coverage section of this handbook.
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