TRICARE-eligible military moms and spouses can receive breast pumps, breastfeeding supplies and lactation services for free via TRICARE under the newly revised lactation policy released today.
In the past there has been a lot of confusion and many questions surrounding TRICARE coverage of breast pumps, breastfeeding supplies and lactation services. Hopefully this post will clarify these questions and provide you with the information needed to purchase or rent a breast pump and/or see a IBCLC so you can continue to breastfeed and provide breastmilk for your baby.
TRICARE IS NOT INSURANCE
First, let’s be clear 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 up until the passage of the National Defense Authorization Act (NDAA) of 2015 (signed into law on December 19, 2014) TRICARE was 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 was the lack of breast pump coverage and lactation support. That has been fixed with the passage of the NDAA and the newly updated TRICARE Lactation Policy.
TRICARE LACTATION POLICY
Section 706 of the NDAA 2015 allows for “expanded coverage of breast pumps and supplies, as well as coverage of breastfeeding counseling”. What this means is that TRICARE is now required to provide coverage for breast pumps (manual and standard electric), breast pump supplies, and breastfeeding counseling. The coverage extends to all pregnant TRICARE beneficiaries, and any TRICARE eligible woman who legally adopts an infant and plans to breastfeed. These supplies and services are preventative in nature so any cost-shares and co-pays are waived for any supplies and services rendered after December 19, 2014. The effective date for this policy was December 19, 2014 and the new policy will be implemented July 1, 2015.
Let’s break the policy down further and look at it section by section:
- Hospital Grade pumps – Heavy duty hospital grade pumps and associated supplies are covered when required to initiate and maintain lactation for mothers and babies separated due to illness, or unable to feed directly from the breast due to medical complications (premature, multiples, cardiac/kidney issues, etc.), congenital anomalies (such as cleft palate/lip), induced lactation and relactation, or other medical conditions that prevent effective feeding at the breast. A prescription is required (from an authorized provider) and the hospital grade pump will be covered for as long as it is determined to be medically necessary.
- Manual and Standard Electric pumps – One (1) manual or standard electric pump is covered per pregnancy (or adoption) and includes all the necessary power adaptors, tubing, locking rings, bottles, caps, shields/flanges, and storage bags for up to 36 months. Up to two (2) pump kits specific to the pump manufacturer are also covered. A prescription from an authorized TRICARE provider is required for coverage of the breast pump and must indicate the type of breast pump prescribed (manual or electric). The breast pump and supplies must be obtained from a TRICARE authorized provider, supplier or vendor. This also includes civilian retail stores or pharmacies. When paying out-of-pocket reimbursement can be requested by submitting a claim form (DD 2642) and copy of the prescription for the pump along with an itemized receipt.
- Lactation Counseling – Up to six (6) individual outpatient lactation counseling sessions are covered and are in addition to any lactation counseling provided during an inpatient maternity stay. The outpatient lactation counseling sessions are covered ONLY when billed properly, it is the only service being provided, and it is rendered by a TRICARE authorized provider.
- Exclusions – There are always exclusions, here is what WON’T be covered under the new policy: breast pump adaptors and battery packs, regular baby bottles not specific to the breast pump, travel bags, breast pump cleaning supplies, hands-free bras, baby weigh scales, ice packs/coolers, nursing bras, breast shells, nursing pads, nipple shields, and over-the-counter breastfeeding creams or ointments.
COMPREHENSIVE BREASTFEEDING SUPPORT
So what does this new lactation policy mean for military breastfeeding moms and spouses? In a nutshell, this is a very comprehensive policy that is long past due. This policy covers everything a breastfeeding mother might need to be successful at providing breastmilk for her baby whether she is separated due to illness or work. Finally, hospital grade pumps are covered for medically related needs (not just preemies born before 36 weeks) and electric pumps are covered for military mothers returning to duty. In addition, lactation counseling is covered now, which is great because we all know that breastfeeding issues don’t just happen in the hospital! While there are still hoops to jump through, like requiring a prescription for the breast pump, and forms to fill out if you buy the pump at Target or Amazon, at least they are covered and you will be reimbursed.
If you are pregnant and looking for information about what type of breast pumps to buy I urge you to read “Choosing a Breastpump” for an extensive breakdown on what to look for in choosing the right breast pump 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.
Have questions about the new policy? Read this post “Your Top 20 TRICARE Lactation Policy Questions Answered“.
Looking for Resources about the new policy? Check out the TRICARE Lactation Policy for links to policy, claims form, handout and more!
What are your thoughts on the new TRICARE Lactation Policy? It is enough, too little, too much? What would you change, if anything? Leave a comment below.