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Tricare help: Will Tricare cover a tummy tuck?

Aug. 30, 2012 - 06:01PM   |   Last Updated: Aug. 30, 2012 - 06:01PM  |  
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Q. I'm an active-duty soldier currently deployed to Afghanistan. My wife has not been herself since our baby was born a little over a year ago. She has tried different supplements and workout systems but is still unhappy about the way her stomach looks. Would Tricare cover a tummy tuck for her?

A. Tricare will cover a tummy tuck and most other forms of reconstructive surgery only when a doctor determines such a procedure to be medically necessary. In the specific case of a tummy tuck, Tricare will cover it only if the procedure is performed in conjunction with an abdominal or pelvic surgery that a medical doctor determines would significantly contribute to safe and effective correction or improvement of bodily function.

Tummy tucks for cosmetic reasons as well as surgeries such as nose jobs, face-lifts, hair transplants and liposuction cannot be covered by Tricare.

Q. I retired from active duty in 2007, and my wife and I have been using Tricare Standard since then. I am 60 years old, and my wife is 55. I have been considering upgrading to Tricare Prime or Tricare for Life for both of us, since Standard alone doesn't cover all of our medical needs. Would there be an advantage to changing to Prime or TFL?

A. Every individual's situation is different, so it's impossible for an outsider to say which Tricare option is best for you and your wife. One thing is for sure, though: You're not eligible for Tricare for Life, and you will not become eligible until you turn 65 and become eligible for Medicare.

That said, your choices boil down to Tricare Prime or Tricare Standard. You mention in your note that Standard is not meeting all of your needs, but there are reasons to stay with it: Standard offers the broadest choice of health care providers, is widely available, has no enrollment fee, and allows beneficiaries to also use Tricare Extra.

Extra is an option for Tricare Standard beneficiaries who want to save on out-of-pocket expenses by making appointments with a Tricare Prime network provider.

Also, because Standard does not assign primary care managers, beneficiaries generally can refer themselves for specialty care.

Standard does charge annual deductibles.

Under Tricare Prime, you have fewer out-of-pocket costs, but your choice of providers is more limited. You must select a primary care manager within the Tricare network who will provide and/or coordinate your care, maintain your health records and refer you to specialists.

Prime has no deductible but does charge an annual enrollment fee. Also, Prime is not as widely available as Standard; if you live in an area where Prime is not available, Standard may be your only option.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com. In email, include the word "Tricare" in the subject line and do not attach files. Get Tricare advice anytime at www.militarytimes.com/tricarehelp.

Answers by RallyPoint

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