Those who have had a baby while on civilian health insurance will be quick to remind anyone on Tricare just how lucky they are not to have to pay so much out of pocket. For maternal care and childbirth, insured Americans paid an average of $4,559 in 2015, an increase of 49% since 2008, according to a study by Health Affairs. For Tricare beneficiaries, the cost is very close to zero, but some decisions may come with an out-of-pocket bill.
Tricare Select, Prime and Overseas
The amount it costs to have a baby will depend on the type of Tricare coverage you have. It's important to note, however, that pregnancy is not considered a "qualifying life event" that allows you to switch coverage from Prime to Select outside of the open enrollment period in the fall. Relocations and marriages are qualifying life events; a full list is available online.
Tricare's coverage includes prenatal care, delivery, postpartum care and any complications that arise for mother or child. If you have optional or special ultrasounds, such as one that can reveal the sex of a baby, that is not covered. During delivery, anesthesia is covered as well as anything medically necessary. Tricare also covers the hospital stay for mother and child, even if complications require either of them to stay longer than a few days.
Related: New Babies and DEERS
Enrollment in Tricare Prime and Tricare Select are free for active-duty family members, and you can read more information on the co-pays or fees for which Tricare Select users are responsible. For an active-duty family on Tricare Prime, there should be no out-of-pocket costs. For a pregnancy covered by Select, fees are about $25 a day for birthing centers, home delivery and hospital stays for in-network providers. For out-of-network providers, the cost is up to 20% for home delivery.
Having a baby overseas may incur additional fees, such as for parking while in Europe and obtaining a certificate of birth abroad, local birth certificates and a passport. A local birth certificate may be required if your child is born in a civilian hospital while stationed overseas.
Does Tricare Cover Home Births?
Tricare covers most options for delivery. The most common are military hospitals, civilian hospitals and birthing centers, which can be approved by Tricare for delivery.
Birthing centers are covered by Tricare -- but only for low-risk pregnancies, natural childbirth procedures and immediate newborn care. If you have a high-risk pregnancy, you will not be authorized to deliver at a birthing center. A high-risk pregnancy is determined by your provider for a variety of reasons, some of which are being over 35, being pregnant with multiple babies or having a history of pregnancy complications, according to the Mayo Clinic.
Planned home births are a possibility, depending on your location. They are not covered overseas, for example. There are additional referral and prior authorizations required before planning a home birth as well as fees that you are responsible for covering. You also want to check your state regulations regarding home births. For example, a midwife licensed in Georgia cannot attend a home birth unless they are a certified nurse midwife. And whether home-birth midwifery is permitted or covered by Tricare may vary state-by-state.
Are Midwives or Doulas Covered by Tricare?
If you'd rather see a midwife than an obstetrician for your pregnancy and delivery, Tricare covers that as long as they are licensed by the state and certified by the American Midwifery Certification Board. If your doctor's office has a midwife who doesn't meet these certifications, they can work under the doctor's supervision.
Many military spouses and service members may be interested in using a doula during delivery. A doula is not a healthcare professional but provides support through medical experiences, including birth, miscarriage or stillbirth. A doula’s fees will not be covered by Tricare.
Does Tricare Pay for Surrogacy?
For beneficiaries interested in pursuing surrogacy, Tricare covers some things. If the surrogate mother is a Tricare beneficiary and has a contract with the parents, the coverage is the same. That coverage includes pregnancy, birth, postpartum care and any complications that may arise.
For more information or specific questions, visit Tricare’s website, where you can find the appropriate phone number for your region.
This article was updated to reflect the impact of state law on home-birth midwifery.
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