Because it is relatively new coverage, there is a lot of confusion about Tricare coverage for breast pumps.
The good news is that Tricare covers breast pumps and related supplies.
Who Is Eligible?
Breast pump coverage is available to all Tricare-eligible females who have a "birth event." For purposes of this coverage, a "birth event" means a pregnancy and childbirth, or a legal adoption with 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, Tricare Reserve Select -- regardless of the sponsor's duty status.
What Is Covered?
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.
Tricare also covers the following supplies for 36 month after the birth event:
- Standard power adapters
- Tubing and tubing adaptors
- Locking rings
- Bottles and bottle caps
- Shield/splash protectors
- Storage bags
- Two breast pump kits per birth event.
Tricare does not cover:
- Breast pump batteries, battery-powered adapters, and battery packs
- Regular "baby bottles" (Bottles not specific to pump operation), including associated nipples, caps, and lids
- Travel bags and other similar carrying accessories
- Breast pump cleaning supplies
- Baby weight scales
- 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
The Process for Having Your Purchase Covered
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 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 are going to obtain your breast pump through a medical supply company or other network provider, make sure that the medical provider writing the prescription includes a diagnosis code.
Where To Get Your Breast Pumps
There is no specific list of 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 store. These choices will require to you to pay up-front and file a claim for reimbursement.
You can also get your pump from a medical supply provider to who 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 If You Already Made A Purchase?
This coverage is retroactive to December 19, 2014. If you purchased a breast pump and paid out-of-pocket, you can send a claim for reimbursement. You'll have to get a prescription and submit your itemized receipt.
There are a ton of little nuances to the coverage.
- 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. 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.
Tricare coverage for breast pumps is great news for breastfeeding mothers and those who might need the help of a pump to breastfeed their babies. I am so thrilled for this coverage!