By Lizann Lightfoot
TRICARE insurance for military family members and dependents covers medical procedures that are deemed necessary for the patient’s physical or mental wellbeing. Some procedures are more likely to be approved when located overseas or at certain duty stations, so it is possible to see some unlikely items covered on a case-by-case basis. But we are guessing you didn’t know all the facts about TRICARE’s coverage for some of these conditions.
We’ve all heard the rumors that a military spouse can get a free elective plastic surgery once during a service member’s career. The truth is that TRICARE will cover some elective surgeries, but a doctor must first deem them medically necessary. For example, most military hospitals no longer offer elective breast augmentation (implants) unless it is to repair damage after a mastectomy, restore tissue after an accident, or to fix a birth defect. There are stories where hospitals have approved elective surgeries for cosmetic reasons, but in most of those cases, either it was an active duty female service member, a doctor signed off on medical necessity due to self-esteem issues, or the hospital doctors needed patients on which to practice their skills. This all depends on the hospital location, staff, and case-by-case situations.
TRICARE’s policy of covered services clearly states that “TRICARE covers services that are medically necessary and considered proven… TRICARE covers cosmetic, reconstructive and plastic surgery to improve the physical appearance of a beneficiary only under the following circumstances:
- Correction of a birth defect (includes cleft lip)
- Restoration of a body form following an accidental injury
- Revision of disfiguring and extensive scars resulting from neoplastic surgery (i.e., surgery that removes a tumor or cyst)
- Reconstructive breast surgery following a medically necessary (To be medically necessary means it is appropriate, reasonable, and adequate for your condition) mastectomy
- Reconstructive breast surgery due to a congenital anomaly (birth defect)
- Liposuction when medically necessary
- Panniculectomy (tummy tuck) performed in conjunction with an abdominal or pelvic surgery when medical review determines that the procedure significantly contributes to the safe and effective correction or improvement of bodily function.”
Bottom line: You may be able to get plastic surgery procedures covered by TRICARE, but you will first have to suffer, then jump through some hoops, and finally get approval from both a doctor and a TRICARE representative.
Mental health services
During our last deployment, one of my children started acting out at school and displaying anger management issues. We went through a series of evaluations with the school and the pediatrician until we were finally referred to a pediatric psychologist off base. I wanted to help my child adjust and cope with deployment, but I was concerned about the cost of weekly trips to a mental health professional. I was relieved to discover that TRICARE would cover the visits. In fact, TRICARE covers individual or group therapy sessions up to two 60-minute sessions per week.
- Applied Behavior Analysis
- Autism Spectrum Disorder
- Cognitive Rehabilitation Therapy
- Collateral Visits
- Drug Testing
- Eating Disorder Treatment
- Electroconvulsive Therapy
- Emergency Inpatient Hospital Services
- Family Therapy
- Gender Dysphoria
- Medication Assisted Treatment
- Partial Hospitalization
- Psychological Testing
- Psychotropic Drugs
- Residential Treatment Facility Care
- Substance Use Disorder Treatment
- Telemental Health Services
- Therapeutic Services
- Transcranial Magnetic Stimulation”
There are a number of services, therapies, and counseling methods that are not covered by TRICARE. You will have to get a referral from your doctor for an approved service for it to be covered.
For dependents and family members, TRICARE will cover eye exams every year for active duty families and every two years for all other beneficiaries, but will not cover corrective contact lenses or glasses. TRICARE will cover one pair of glasses or contact lenses if they are specialty items prescribed for very particular medical conditions.
No, TRICARE will not cover laser hair removal, which is generally considered a cosmetic procedure. Nor will they cover hair transplants to replace hair that has been lost. However, TRICARE will cover one wig per person if a doctor certifies that their hair loss is caused by a malignant disease, such as cancer. The wig is covered as long as the patient has not previously received a wig from the US government.
To learn about more unlikely procedures that TRICARE will pay for, visit the portion of their website called Is It Covered? You can then search by procedure or by medical condition to get a more detailed answer.
Correction: The original post incorrectly stated that active duty families receive one eye exam every two years. Active duty families receive one eye exam every year; all other beneficiaries receive an eye exam every two years. The post is updated to reflect the correct information.
Lizann Lightfoot is an associate editor at Military One Click and a Marine Corps spouse. She can be reached at firstname.lastname@example.org.