Tricare coverage of breast pump — The Bump
Military Families

Tricare coverage of breast pump

Does anyone know if tricare prime covers any costs associated with breast pumps? I tried to search on the board but wasn't able to find an answer.

TIA
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Re: Tricare coverage of breast pump

  • Check out the FAQ for this board - answer is there.

    But since I'm answering anyway, generally, the answer is no. Even with the healthcare law changes, Tricare didn't change.

    Here is a post from awhile ago - check out the links in my response there.

    https://community.thebump.com/cs/ks/forums/thread/67756703.aspx

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  • Sometimes you can borrow one from WIC if you're eligible.

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  • Ha! Yea... No! I called tricare and they told me no. I wasn't too happy when I hung up.

     

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  • Sad thing is alot of people think because of this new change that all breast pumps are going to be covered.   Sad thing is most people dont know there has to be a reason for a breast pump to be covered.  A baby born premie, baby in the nicu or for other medical reasons.  The Dr has to write a medical reason down for a RX to get on.  Than sometimes its only going to be coverd for X amount of time.  Your best bet it just to call Tricare and talk to them.  This way you can know the rules. 

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  • imageIgoo0304:
    I think the general consensus is that it does not unless the baby has to be in the NICU. However, some MTFs will loan out pumps.

     

    This. If your baby has to be in the NICU they will let your rent one from them. At least that's how it is on Bragg.

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  • I am expecting to get "caught" anytime, but--Tricare covered our pump.  We bought it from the hospital and it was wrapped up in the hospital bill.  We were never billed separately for it by the hospital and the rest of the finances are wrapped up, so--I'm assuming they covered it without meaning to.  If you're going to buy it anyway and your hospital sells them, it's worth a shot (and we got a discount anyway!).
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  • imageIgoo0304:
    I think the general consensus is that it does not unless the baby has to be in the NICU. However, some MTFs will loan out pumps.

    This, they will only cover it if your child(ren) are in the NICU and even then you must go through their 'dealer' and if you don't you have to submit a claim to be backpaid the rental. Your OB must write a referral to rent a hospital grade pump. Trust me, its been a huge headache.

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  • https://www.triwest.com/en/beneficiary/tricare-benefits/knowledgebase-archive/newborn-and-newly-adopted-care-benefits/

    This is directly from the Tricare website re: newborn care entitlements/coverage for Prime.

     

    " Breast pumps

    Heavy-duty hospital grade electric breast pumps, including services and supplies related to the use of the pump, are covered for mothers of premature infants Pumps may be covered after discharge from the hospital if medically warranted and accompanied with a doctor's prescription Authorization is required Cost-shared as Durable Medical Equipment (DME) upon discharge Pumps for personal convenience are not covered. Manual breast pumps and basic electric breast pumps are also not covered. "

    Breast Pump

    • Heavy-duty hospital grade electric breast pumps, including services and supplies related to the use of the pump, are covered for mothers of premature infants
    • Pumps may be covered after discharge from the hospital if medically warranted and accompanied with a doctor's prescription
    • Authorization is required
    • Cost-shared as Durable Medical Equipment (DME) upon discharge
    • Pumps for personal convenience are not covered. Manual breast pumps and basic electric breast pumps are also not covered.
     

     

  • I was on standard and in the triwest region, but I got my pump covered. I think the LC at the hospital wrote it up (or got an MD to write it up) as medically necessary. I didn't have a premie and my baby wasn't in the NICU, she just thought it might be helpful early on while we were still working on the latch. Maybe I just got lucky, I don't know, but it's worth asking about when you're in the hospital. If they won't cover it you can always go out and get one (or rent one) after the baby is born.
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