Does TRICARE cover weight loss surgery?
Quick Answer
TRICARE covers bariatric surgery for BMI 40+ or BMI 35+ with comorbidities, requiring documented weight loss attempts, psychological evaluation, and pre-authorization.
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Key Takeaways
- BMI criteria must be met
- Documented weight loss attempts required
- Psychological evaluation needed
- Pre-authorization required
Detailed Answer
TRICARE covers bariatric/weight loss surgery under specific criteria:
Eligibility Requirements
- BMI 40 or higher, OR
- BMI 35+ with serious obesity-related conditions
- Failed supervised weight loss programs
- Psychological evaluation completed
- Surgical candidate per evaluation
Covered Procedures
- Gastric bypass
- Sleeve gastrectomy
- Gastric banding (less common now)
- Revision surgery in some cases
Required Steps:
1. Physician referral/recommendation 2. Documented weight loss attempts (typically 6 months) 3. Nutritional counseling 4. Psychological evaluation 5. Pre-authorization from TRICARE 6. Medical clearance
Cost
- Active duty: No cost
- Prime: Standard copays
- Select: Standard cost-shares
- Plus pre/post surgery care costs
Follow-Up Care
- Nutritional counseling covered
- Psychological support
- Lab work and monitoring
- Potential body contouring NOT covered
Helpful Tips
- Start with primary care referral
- Document all weight loss attempts
- Follow program requirements closely
Related TRICARE Terms
What do most military families add to their TRICARE coverage?
Supplemental health insurance is the most common addition — it covers dental, vision, and out-of-pocket costs that TRICARE leaves uncovered. Life insurance and a legal will are also highly recommended.
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