Does Tricare really provide free breast pumps when you have a baby? Over the last several years there have been many questions, changes and confusion about this policy, which is why you may get some very well-meaning advice from fellow military spouses or companies who are working to make sure each pregnant woman knows what she's entitled to. But what’s real?
Here’s everything you need to know.
Who is eligible for a Tricare breast pump?
Breast pump coverage is available to all Tricare-eligible women who have a "birth event." For purposes of this coverage, a "birth event" means pregnancy and childbirth, or a legal adoption with the intention to personally breastfeed. You can get the breast pump and supplies before or after the delivery.
All Tricare plans are included, including Tricare Prime, Tricare Select, the US Family Health Plan and Tricare Reserve Select -- regardless of the sponsor's duty status.
What pumps are covered by Tricare?
Tricare covers different types of breast pumps, depending on the situation. All new mothers are authorized one manual or standard electric breast pump per birth event (birth or adoption).
When medically required, Tricare will cover an electric hospital-grade breast pump and supplies. Applicable situations include when the mother and child are separated by illness, or when the child is unable to breastfeed for medical reasons.
How much does Tricare cover?
Tricare covers supplies for 36 months after the birth event. Those include:
- Standard power adapters
- Tubing and tubing adaptors
- Locking rings
- Shield/splash protectors
- Two breast pump kits per birth event
Unfortunately, Tricare does not cover the supplies listed below, which we know are important and helpful:
- Breast pump batteries, battery-powered adapters and battery packs
- Breast pump cleaning supplies
- Garments and other products that allow hands-free pump operation
- Ice packs, labels, labeling lids and other similar products
- Nursing bras, bra pads, breast shells and other similar products
- Over-the-counter creams, ointments and other products that relieve breastfeeding-related symptoms or conditions of the breasts or nipples
What does Tricare cover for babies?
As far as supplies for the baby when breastfeeding, Tricare doesn't cover much. If it's medically necessary, it may cover more but, as a general rule, it covers bottles, bottle caps and storage bags to help feed the baby for the first three years.
It does not cover regular baby bottles, baby weight scales or traveling accessories such as backpacks or bags that, while make breastfeeding on the go easier, aren't medically necessary.
How do I get a free breast pump through insurance?
In order to have your purchase covered, you must get a prescription from a Tricare-authorized doctor, physician assistant, nurse practitioner or nurse-midwife.
Your prescription must specify a manual or standard electric pump, but it does not need to specify any certain brand, model or style. If you have a medical necessity for a hospital-grade pump, your medical provider must submit a referral and authorization to your regional contractor for approval.
If you're going to get your breast pump through a medical supply company or another network provider, make sure that the medical provider writing the prescription includes a diagnosis code.
When can you get a breast pump through Tricare?
Once you decide what kind of breast pump you want and your provider has written a prescription for it, it's time to go ahead and get it. Sometimes, you can walk into a store and buy it but, if not, you can order it online from a variety of places.
Here's the key: You don't have to wait until the baby is born. In fact, I encourage you to get the breast pump beforehand. As long as you are pregnant and have the prescription, you can order it.
Related: Your Tricare Free Breast Pump Questions Answered
Where can I get my Tricare breast pump?
There is no specific list of locations where you have to buy your breast pump. Your choices may depend on what type of pump you are authorized. You may purchase the pump at a civilian or military retail store or online business. These choices may require you to pay upfront and file a claim for reimbursement.
You can also get your pump from a medical supply provider that is authorized to provide benefits under Tricare. This may be necessary for a hospital-grade pump when medically required. Your regional Tricare management contractor can help you locate a provider. This option will allow the supplier to bill Tricare directly, so you won't have to file for reimbursement.
What else do you need to know?
- Under certain circumstances, Tricare will pay for a second breast pump if the first one becomes inoperable.
- Tricare will cover a converter or transformer, as necessary, to use covered breast pumps overseas.
- There is no dollar limit on how much Tricare will pay for standard electric breast pumps; but there may be a price limit on manual pumps. Check with your Tricare contractor for more information.
- You can get a second breast pump for a second birth event.
- Tricare will not pay for an extended warranty on a breast pump purchase.
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