Women's Health and TRICARE: Coverage, Costs & Referrals | TRICARE.com

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## Is it covered? Yes, TRICARE covers a comprehensive range of women’s health services, including preventive screenings, maternity care, and gynecological treatments. Most services are covered when provided by a TRICARE-authorized provider and deemed medically necessary.

## What TRICARE covers TRICARE’S women’s health coverage is divided into preventive care, reproductive health, and surgical interventions. Coverage includes:

* **Preventive Screenings:** Annual well-woman exams, cervical cancer screenings (Pap tests and HPV testing), and breast cancer screenings (3D mammography is now a permanent benefit). * **Maternity Care:** Prenatal care, delivery, and postpartum care (up to six weeks). This includes coverage for midwives and doulas under specific pilot programs. * **Contraception:** Most FDA-approved methods, including IUDs, contraceptive implants, injections, and tubal ligation. As of 2026, many contraceptive services have eliminated cost-shares for certain beneficiaries. * **Breastfeeding Support:** Breast pumps (one per birth event), pump supplies, and lactation counseling. * **Menopause Management:** Hormone replacement therapy (HRT) and management of symptoms. * **Mental Health:** Screening and treatment for postpartum depression and other female-specific health concerns.

**What is NOT covered:** * Elective abortions (except in cases of rape, incest, or life-endangerment). * Non-medically necessary cosmetic surgery. * Reversal of tubal ligation (unless medically necessary).

## Costs Costs for women’s health services depend on the beneficiary's plan and sponsor status (Group A or Group B). Below are the 2026 cost-sharing estimates:

* **TRICARE Prime:** $0 for preventive services and well-woman exams. No copays for most services if seen at a Military Treatment Facility (MTF) or with a referral. * **TRICARE Select (Active Duty Family Members):** $0 for preventive services at in-network providers. Specialty office visits (e.g., OBGYN) vary by plan year—check TRICARE.mil for 2026 rates (typically $30-$50). * **TRICARE Select (Retirees/Families):** Annual deductibles apply. Outpatient specialty visits typically involve a fixed copay (e.g., ~$50-$65) or a 20-25% cost-share. * **TRICARE For Life:** Medicare is typically the primary payer. TRICARE acts as secondary, often resulting in $0 out-of-pocket costs for Medicare-covered women's health services.

## Pre-authorization & referrals * **TRICARE Prime:** A referral from your Primary Care Manager (PCM) is required for specialty care, such as seeing an outside gynecologist or infertility specialist. However, you do **not** need a referral for the first two "well-woman" exams per year. * **TRICARE Select:** Referrals are generally not required for women’s health specialists. You can manage your own specialty care by seeing any TRICARE-authorized provider, though using "Network" providers will lower your costs. * **Prior Authorization:** Required for specific procedures like hysterectomies (if not for cancer) or certain surgical treatments for pelvic health.

## Where to get care How you find care depends on your location: * **Military Treatment Facilities (MTF):** The first stop for Prime enrollees. * **East Region:** Contact **Humana Military** to find an in-network OBGYN or specialist. * **West Region:** Contact **TriWest Healthcare Alliance** (the current West regional contractor as of 2025). * **Pharmacy:** For prescriptions (birth control, HRT), use **Express Scripts** for home delivery or retail network pharmacies.

## Sources 1. [TRICARE.mil: Women's Health Services](https://www.tricare.mil/HealthWellness/WomensHealth) 2. [TRICARE Policy Manual 6010.63-M: Maternity Care](https://manuals.health.mil/) 3. [DHA: Preventive Services Policy](https://health.mil/) 4. [Humana Military & TriWest Provider Directories](https://www.tricare.mil/FindDoctor/AllProviderDirectories)