If you're expecting a child and have TRICARE health coverage, you're likely aware that your insurance covers breast pumps and breast pump supplies. You're probably also aware that many women have expressed difficulty in the process. Below we've shared everything you need to know to receive your breast pump with ease! We answer who is covered, what is covered, when it is covered, and how to do it all.
WHO: First, are you eligible for coverage? Great news! This coverage applies to all TRICARE-eligible pregnant beneficiaries or female beneficiaries who legally adopts an infant and intends to personally breastfeed.
WHEN: You can get breast pump supplies before delivery, starting at 27 weeks, or up to 3 years after the birth event. The 3-year period starts on the child’s birth date or the date of the legal adoption.
WHAT: TRICARE covers the following:
- One breast pump kit per birth event
- Standard power adapters: 1 replacement per birth event, and not within 12 months of the breast pump purchase date
- Tubing and tubing adapters: 1 set per birth event
- Locking rings: 2 every 12 months
- Bottles: 2 replacement bottles and caps/locking rings every 12 months following the birth event
- Bottle caps: 2 every 12 months after the birth event
- Storage bags: 90 bags every 30 days following the birth event
- Valves/membranes: 12 for each 12 months following the birth event
- Supplemental Nursing System (SNS): 1 per birth event when a physician prescribes
- Nipple shields/splash protectors: 2 sets (2 shields/set) per birth event when a physician prescribes
TRICARE doesn’t cover (unless part of a breast pump kit):
- 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, and labeling lids
- Nursing bras, bra pads, and breast shells
- Over-the counter creams, ointments, and other products that relieve breastfeeding related symptoms or conditions of the breasts or nipples
HOW: So how do you get a breast pump?
You will first need to get a prescription from your provider who must be a TRICARE-authorized physician, physician assistant, nurse practitioner, or nurse midwife. The prescription must show if you’re getting a basic manual or standard electric pump. If you are getting your breast pump from a network provider or durable medical equipment supplier, your prescription must include a diagnosis code.
Next, follow the process from your military clinic or hospital or contact your regional contractor to find a network provider or supplier. Alternatively, if you don’t mind paying up front for the breast pump and receiving a reimbursement later, go to a TRICARE-authorized provider to purchase. Save your receipt.
Last, file a claim by completing DD Form 2642. Attach a copy of the prescription and receipt and mail to your TRICARE claims processor. Your regional contractor will then mail you a check.. If you use a network provider or supplier, you don’t have to file a claim as they will complete all your necessary paperwork.
TRICARE does not have a specific approved provider list for breast pumps but it is important to ask your provider if they accept TRICARE insurance prior to making your purchase. TRICARE pays up to a set amount for a breast pump and initial breast pump kit. Rates may change annually (As of March 2019, the rates are $312.84 stateside or $500.55 overseas to include shipping). TRICARE coverage isn’t limited to a specific breast pump manufacturer, brand, or model number.
We hope these tips lead you well on your well to getting your breast pump! Go forth and conquer moms!