Weight loss surgery is a major medical procedure, and it isn’t cheap. Fortunately, many health insurance plans, including Tricare, cover some or all of the costs associated with weight loss surgery. However, the amount of coverage and the types of surgeries covered will vary from plan to plan. Here, we’ll discuss what you need to know about Tricare weight loss surgery coverage in 2023.
What is Tricare?
Tricare is a health insurance program for U.S. military members, retirees, and their families. It is administered by the U.S. Department of Defense and provides coverage for medical expenses and other health care services. Tricare provides coverage for a broad range of medical and health services, including preventive care, hospital stays, medical equipment, and certain types of weight loss surgery.
Does Tricare Cover Weight Loss Surgery?
Yes, Tricare does cover certain types of weight loss surgery. However, it is important to note that not all types of weight loss surgery are covered. Tricare covers weight loss surgery if it is deemed medically necessary. This means that the surgery must be recommended and approved by a medical professional in order to be eligible for coverage. Additionally, the type of surgery must be approved by Tricare, and it must be performed by a provider that is in-network with Tricare.
What Types of Weight Loss Surgery Does Tricare Cover?
Tricare covers many types of weight loss surgery, including gastric bypass, lap band, and gastric sleeve surgery. Tricare also covers some non-surgical weight loss programs, such as behavioral therapy and nutrition counseling. However, Tricare does not cover any type of cosmetic or bariatric surgery, such as liposuction or tummy tucks.
How Much Does Tricare Cover for Weight Loss Surgery?
The amount of coverage provided by Tricare for weight loss surgery depends on the type of plan you have and the type of surgery you are having. Tricare Standard and Extra plans cover 80% of the cost of the surgery, while Tricare Prime covers 100%. Additionally, Tricare Prime members may have some additional cost-sharing, such as deductibles or copayments. It is important to note that Tricare does not cover the cost of any pre- or post-operative care, such as medications or physical therapy.
Does Tricare Cover Weight Loss Surgery for Dependents?
Tricare does cover weight loss surgery for dependents, but the coverage may vary depending on the type of plan the dependent is enrolled in. For example, Tricare Prime covers 100% of the cost of weight loss surgery for dependents, while Tricare Standard and Extra cover 80%. Additionally, dependents may have to pay additional cost-sharing, such as deductibles or copayments.
What Are the Requirements for Tricare Weight Loss Surgery Coverage?
In order to be eligible for Tricare coverage for weight loss surgery, you must meet certain criteria. First, the surgery must be deemed medically necessary by a physician. Additionally, the type of surgery must be approved by Tricare and performed by a provider that is in-network with Tricare. You must also have been enrolled in Tricare for at least six months prior to the surgery. Finally, you must meet any applicable Tricare cost-sharing requirements, such as deductibles or copayments.
Conclusion
Tricare is a comprehensive health insurance program that covers a variety of medical services, including certain types of weight loss surgery. However, the amount of coverage and the types of surgeries covered will vary from plan to plan. In order to be eligible for Tricare coverage, the surgery must be deemed medically necessary and performed by a Tricare-approved provider. Additionally, there may be cost-sharing requirements, such as deductibles or copayments, that must be met in order to receive coverage.