TRICARE High-Risk Pregnancy Coverage & Costs (2026) | TRICARE.com

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## Quick answer TRICARE covers all medically necessary care for high-risk pregnancies, including specialized monitoring, frequent ultrasounds, and visits to Maternal-Fetal Medicine (MFM) specialists. Coverage depends on your specific plan (Prime vs. Select), but active duty family members typically have zero out-of-pocket costs for prenatal care and delivery at network facilities.

Details

### Specialist Referrals and Maternal-Fetal Medicine (MFM) If your primary OB/GYN determines your pregnancy is high-risk—due to factors like pre-existing diabetes, hypertension, multiples (twins/triplets), or advanced maternal age—they will refer you to a Maternal-Fetal Medicine specialist. * **TRICARE Prime:** You must obtain a referral from your Primary Care Manager (PCM) to see an MFM specialist to ensure the costs are covered. * **TRICARE Select:** You do not need a referral to see a specialist, but staying in-network significantly reduces your out-of-pocket costs.

### Covered High-Risk Services TRICARE covers specific diagnostic and monitoring tools required for high-risk pregnancies, provided they are medically necessary: * **Targeted Ultrasounds:** While standard pregnancies usually receive two routine ultrasounds, high-risk cases may require frequent "level II" or anatomy scans. * **Fetal Non-Stress Tests (NST):** Covered when indicated for complications like gestational diabetes or decreased fetal movement. * **Genetic Testing:** TRICARE covers amniocentesis, chorionic villus sampling (CVS), and certain NIPT (Non-Invasive Prenatal Testing) screenings if the mother is over 35 or has other risk factors. * **Inpatient Hospitalization:** If bed rest or constant monitoring is required at a hospital, this is covered under the standard inpatient benefit.

### Costs for 2026 Costs are determined by the sponsor’s status and the specific TRICARE plan: * **Active Duty Family Members (ADFMs):** Under both Prime and Select, there are typically $0 copays for maternity care (including high-risk specialist visits) when using network providers. * **Retirees and others (Group A):** For 2026, those on TRICARE Select may pay a per-visit copay for specialist office visits or a package price for global maternity care, depending on whether the provider is in-network. * **Point of Service (POS):** If you are on TRICARE Prime and see a high-risk specialist without a referral, you will be subject to Point of Service charges, which include a $300 deductible and 50% cost-sharing.

### Regional Management * **East Region:** Managed by Humana Military. * **West Region:** Managed by TriWest Healthcare Alliance. * **Travel Reimbursement:** If a high-risk specialist is located more than 100 miles from your primary care location, you may be eligible for the Prime Travel Benefit.

## Who this affects * **Active Duty Service Members:** Required to use Military Treatment Facilities (MTFs) or referred civilian specialists. * **Active Duty Family Members:** Covered under Prime, Select, or TRICARE For Life. * **Retirees and their families.** * **National Guard and Reserve members:** Covered when on active duty orders or enrolled in TRICARE Reserve Select (TRS).

## Sources * **TRICARE.mil:** [Maternity Care Overview](https://www.tricare.mil/maternity) * **Humana Military (East):** [Specialty Care Referrals](https://www.humanamilitary.com) * **TriWest Healthcare Alliance (West):** [Provider Network and MFM Care](https://www.triwest.com) * **Defense Health Agency (DHA):** [TRICARE Policy Manual](https://manuals.health.mil)