Navigating Tricare Coverage for Maternity Care

Tricare Maternity Coverage: What To Know

Congratulations. You have discovered that you are expanding your family, but you need help navigating the military insurance system and don’t know where to turn.

Dr. Nicola Cherry of The Children’s Clinic of Klamath is a board-certified pediatric doctor and native of Klamath Falls, OR. She helps military families navigate Tricare military insurance coverage during maternity care.

What Is Tricare?

Tricare is the official coverage of United States military families, whether active or retired. Coverage is available to eligible individuals and families in the United States and internationally and extends to medical, dental, and vision. 

What To Know About Tricare’s Maternity Coverage

Depending on where you live, inside or outside the United States, your insurance plan may cover all of your prenatal care during pregnancy under Tricare. There are different plans and coverages. All care is coordinated through a Primary Care Manager (PCM).

• Tricare Prime -
  United States—The facility will cover all care if you live near a military hospital or an accepted civilian center. Those who don’t live near a military hospital will find a facility that accepts Tricare. Living outside the US means receiving care through the military hospital or getting preauthorization from your PCM to an authorized facility.
• Tricare Remote -
  United States—According to The Children’s Clinic of Klamath in Klamath Falls, OR, military family care would be coordinated through your PCM to the military hospital. If you don’t live near a military hospital, you will get preauthorization for care through your regional controller to an approved facility. Internationally - Your regional call center will coordinate all your care.
• TRICARE Select, TRICARE Reserve Select (TRS), TRICARE Retired Reserve (TRR), and Continued Health Care Benefit Program (CHCBP) - United States—You can seek care from any Tricare-authorized facility without preauthorization. You will have lower out-of-pocket expenses. If you go out-of-network, your fees will be higher, and you must file reimbursement claims. 

Internationally, you can use any authorized Tricare facility but must pay for services upfront and file all claims for reimbursement yourself. Certain territories can charge you over the fee allowance for Tricare, and you are responsible for payment.

During childbirth, all medically necessary costs are covered, including anesthesia and necessary cesarian sections. If a C-section is your choice, you must pay some charges.

Your insurance will cover a hospital stay of two days for a natural birth and three days for a C-section. Learning how your insurance works makes your pregnancy and birth smoother and stress-free.

Call Us for Help with Military Family Care

Call Dr. Cherry at her practice, The Children’s Clinic of Klamath, in Klamath Falls, OR, at 541-884-1224, and we will help your military family with prenatal care.