**This is an older post — please visit UPDATED TRICARE LACTATION POLICY: WHAT IS COVERED AND WHAT ISN’T or YOUR TOP 20 TRICARE LACTATION POLICY QUESTIONS ANSWERED for up-to-date information**
There is a lot of confusion and many questions surrounding this topic. Does Tricare cover breastpumps? If so, what kind of breastpump? Does Tricare cover breastpumps for active duty mothers or only for spouses? Does Tricare offer breastpumps under the ACA (Affordable Care Act)? And the list goes on. Hopefully this post will clarify these questions and provide you with the information needed to secure a breastpump so you can continue to provide breastmilk to your little one.
TRICARE IS NOT INSURANCE
Let’s set the facts straight from the get-go. Tricare is NOT health insurance. Let me repeat that: Tricare is NOT health insurance. Tricare is a benefit of serving in the military much like the use of commissary and exchange are benefits. Therefore Tricare is not mandated or required to offer breast pumps to breastfeeding mothers under the Affordable Care Act. In fact, the entire military health care system was specifically excluded from the ACA by law. While Tricare is largely viewed as a comprehensive health care program, there are disparities between the military plan and the ACA’s requirements of private insurers and state exchanges. One of those disparities is the lack of breastpump coverage and lactation support.
TRICARE BREASTFEEDING SUPPORT
To date Tricare has offered very little in the way of breastfeeding support for either active duty mothers or spouses. Until the passage of the 2015 NDAA Tricare has only covered hospital-grade breast pumps for premature infants born before 34 weeks (to both active duty mothers and spouses). There has been no lactation-related support, such as seeing an IBCLC once discharged home from the hospital, offered at all. And even seeing an IBCLC within the hospital is hit-or-miss depending on whether the MTF has one on staff or not. According to the Tricare website (“Is It Covered?” ) as of Jan 1st, 2015:
TRICARE may cover electric hospital-grade breast pumps for premature infants who meet certain criteria. The breast pump may be covered for use in the hospital, and in certain cases, if the physician can prove medical necessity, for home use.
TRICARE doesn’t cover:
Electric hospital-grade breast pumps for convenience
Basic electric breast pumps
Manual breast pumps
And according to the Tricare Provider Handbook (page 60, dated June 2013):
Breast pumps: Heavy-duty, hospital-grade electric breast pumps (including services and supplies related to the use of the pump) for mothers of premature infants are covered. An electric breast pump is covered while the premature infant remains hospitalized during the immediate postpartum period. Hospital-grade electric breast pumps may also be covered after the premature infant is discharged from the hospital with a physician-documented medical reason, such as the inability to breast feed. This documentation is also required for premature infants delivered in non-hospital settings. Breast pumps of any type, when used for reasons of personal convenience (e.g., to facilitate a mother’s return to work), are excluded even if prescribed by a physician. Manual breast pumps and basic (non- hospital grade) electric pumps are also excluded.
It should be noted that some breastfeeding mothers, active duty and spouses alike, have been successful at obtaining breastpumps for their infants through Tricare. Oftentimes this is due to the individual doctor who writes a prescription for a breastpump (and the mother then takes it to an outside pharmacy), or an unknowing Tricare representative that mistakenly approves the breastpump. In other cases the MTF has a breastpump loan program that is separate from Tricare altogether. Some active duty mothers have had luck obtaining a breastpump and supplies via the Veterans Administration (VA). However, do not be mislead into believing that because one individual was lucky in getting Tricare to ‘cover’ a breastpump that that means that the policy has changed, it has not. Breastpumps and lactation support are NOT a covered item yet (as of Jan 1st 2015).
It quite literally takes an act of Congress to make any changes to Tricare. Whether those changes are for providing eyeglasses or breastpumps, Congress must approve any changes made to the Tricare Health System. To bring Tricare into line with the ACA regarding breast pumps and lactation support, Congress must pass legislation specifically making those changes. At the time of this update (Jan 16th 2015) legislation introduced by Rep Lois Capp (D-CA) and Sen Claire McCaskill (D-MO) has PASSED in both the House (H.R. 4355 Section 703) and Senate (S 2410 Section 704) for inclusion in the 2015 National Defense Authorization Act. The 2015 NDAA was signed into law by the President on December 22, 2014. The law took effect Jan 1st, 2015.
This new mandate, as part of the NDAA 2015, requires Tricare to provide, “Breastfeeding support, supplies (including breastpumps and associated equipment), and counseling … as appropriate during pregnancy and the postpartum period.” Tricare must still revise the policies and provide the updated information to providers and representatives. Officials with Tricare do not have an estimate on when the revised policy will be released. “Until the policy has been developed to address what Tricare ‘will and will not’ provide under this benefit, and it has been approved, these services and supplies are still not covered,” said Kevin Dwyer, a Tricare spokesman. There are also questions as to what exactly Tricare will cover in the way of breastfeeding supplies and services. It is up to each Tricare region (West/United Healthcare, North/HealthNet and South/Humana) to determine what they will cover. And like other insurers under the ACA, Tricare can decide that a manual breastpump is sufficient coverage or they can choose to offer a hospital-grade pump. Only time will tell. In the meantime the Tricare spokesman suggests that, “Beneficiaries should save receipts for supplies purchased (after Dec. 2, 2014) in case they can be reimbursed once the policy is approved.” Keep in mind that reimbursement is NOT guaranteed. Read more here.
(Updated Feb 19th 2015) From the TRICARE Facebook Page:
TRICARE Update: Breastfeeding Supplies
Following passage and signing of the National Defense Authorization Act for 2015, the Defense Health Agency and the TRICARE Health Plan are actively developing a plan to allow TRICARE to cover these important breastfeeding supplies and services for new mothers. We expect to complete the new policy within the next few months. Some key aspects of this effort include determining what type or types of breaspumps are covered, how they are provided by TRICARE authorized providers, and how providers are paid for these supplies and services.
TRICARE will notify beneficiaries once the policy has been approved. If they would like to receive up-to-date TRICARE benefit information, they can sign up at TRICARE.mil/subscriptions.
Until this new policy is complete, TRICARE beneficiaries should save their receipts for breastpumps, and breastfeeding supplies and services. Coverage for these services and supplies may be retroactive to December 19, 2014, the date the 2015 NDAA became law. However, a prescription is necessary and the services and supplies must be purchased from a TRICARE authorized provider (the types of providers will be outlined in the TRICARE Policy Manual). Also, regular Durable Medical Equipment cost-sharing is applicable when purchasing a breastpump.
BREASTFEEDING SUPPORT OPTIONS
So what ARE your options for obtaining a breastpump and lactation support while on active duty? Until Tricare updates the coverage policies to include lactation services and breastpumps there are a few options. The best but most expensive option to obtain a breastpump is to visit your local lactation consultant (IBCLC) where you will receive both personal, hands-on help with choosing the right breastpump for your situation, and also any information and on-going support you need for returning back to duty at the end of your 6 week convalescent leave. The next best option is a big-box store such as Babies R Us or Target to purchase a breastpump off the shelf. You may also order a pump from internet retailers such as Amazon. Another option is to contact your local Veterans Administration office to see if you qualify for a breastpump (and other supplies such as nursing bras and pads through their maternity services). Finally, if you qualify, WIC is always an option for obtaining a breastpump as well. Which ever you choose, please be sure to read “Choosing a Breastpump” for an extensive breakdown on what to look for in choosing the right breastpump for your situation. Also be sure to take a look at “Choosing Your Breastfeeding Helper” for excellent information on the differences between the various kinds of lactation support available to you.
It is a sad state of affairs that Tricare, for many years, didn’t see fit to cover breastpumps and lactation support for the women who serve their country and are giving the breast for baby and country. According to Tricare, working has been considered a ‘personal convenience’ and so did not qualify for a breastpump, which is absolutely ridiculous. It is a no-brainer that offering breastpumps in line with the ACA is the best course of action for Tricare. Now that the NDAA has been passed and signed into law, Tricare will be required to cover breastpumps and lactation services which will make it easier for military mothers to provide their breastmilk, thereby reducing illnesses and absenteeism, while also increasing morale and retention. It is a win-win for the military and mothers alike. Let’s hope Tricare gets their act together and revises their coverage policies ASAP!
On February 11, 2015 the local news station in Hampton Roads, VA (home to numerous military bases) ran a short piece on the lack of coverage and upcoming changes. You can view the video below:
What has your experience been with obtaining a breastpump for your return to work? Should Tricare be required to cover breastpumps for ALL military beneficiaries? Leave a comment below!