TRICARE Adds A New Coverage For Babies

Julie Provost

5 years ago

New TRICARE Coverage for Babies

Table of Contents

TRICARE has added a new coverage for babies. They will now be covering some or all of the cost of breast milk for those in need of the milk for their new baby. Here is what you need to know:

When Will TRICARE Cover the Breast Milk?

TRICARE will cover banked donor breast milk under certain conditions and situations. If an infant is critically ill, if the mother’s breast milk isn’t available, or if there simply isn’t enough milk being made, using banked donor milk can be an option.

With TRICARE, the infant will need to have one or more of these conditions:

Being born at a very low birthweight, under 1,500g, having gastrointestinal issues, diagnosed with FTT (Failure-to-Thrive,) having a formula intolerance, having Infant Hypoglycemia, having Congenital Heart Disease, if they have had a pre-or-post organ transplant, or if they have another serious health condition when the use of the banked donor milk is medically necessary.

In addition to at least one of those above, the mother’s milk needs to be contraindicated, unavailable because of a medical or psychological condition, or available but lacking in quantity, or quality to meet the baby’s needs.

What Needs To Be Done To Receive This Coverage?

In order to receive your breast milk, a TRICARE-authorized provider will have to prescribe the banked donor breast milk, as well as manage the infant’s care. Know that each prescription is only good for 30 days, that it will have to show the amount and frequency of feedings, that families can only get up to 35 ounces a day, and coverage can be up to age 12 months, as long as it is medically necessary and appropriate.

Where Can I Buy the Breast Milk? Anywhere I Want?

No, you will have to go through a HMB, which is a human milk bank that is accredited by the Human Milk Banking Association of North America (HMBANA.) The HMBANA issues safety guidelines on processing human donor milk for member banks, to include locations outside of the US.

So basically, breast milk from non-HMBANA accredited milk banks, or peer-to-peer donations, sales, or other sources will not be covered.

What Is Covered When It Comes to the Cost of Breast Milk?

TRICARE reimbursement will cover the donor milk screening and processing charges. The breast milk itself is free of charge, but the charges are there to help protect and assure the safety and quality of the banked breast milk.

So, Will I Have to Pay Anything Out-of-pocket for Banked Donor Breast Milk?

Your costs will depend on your beneficiary category and provider type. Costs will also vary based on when you receive the breast milk as well. For example, if you are receiving it as a part of an inpatient stay. For those who receive the breast milk on an outpatient basis, copayments or cost-shares are the same as other outpatient medical supplies. You will also pay based on if your milk bank is a network provider or not.

You also might have to pay for the breast milk out-of-pocket and then submit a claim for the reimbursement.

Where Can I Go to Find Out More Information?

Donor milk banks that are accredited by HMBANA – https://www.hmbana.org/find-a-milk-bank/

TRICARE copays and cost-shares – https://tricare.mil/Costs/Compare.

Banked Donor Breast Milk- https://tricare.mil/CoveredServices/IsItCovered/BankedDonorMilk