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Tricare Help: Tricare probably won't pay for tummy tuck

Apr. 29, 2014 - 09:31AM   |  

Q. I’ve had three children and have gained a lot of excess skin around my stomach that’s having an effect on my self-esteem. Does Tricare cover tummy tucks?

A. No, not for purely cosmetic reasons. Tricare covers only medically necessary procedures. As such, most forms of cosmetic surgery are not covered unless there’s an underlying medical reason for performing the surgery; a patient’s desire to improve his or her appearance is not enough.

This includes tummy tucks (abdominoplasty), as well as liposuction, for purely cosmetic reasons. Tummy tucks are covered only in conjunction with an abdominal or pelvic surgery when a doctor determines that the procedure would significantly contribute to the safe and effective correction or improvement of bodily function.

Q. I am a Navy retiree. My wife and I use Tricare Standard as a second payer to my employer-provided health care plan, which would terminate if I die. If I die before my wife, would she and dependent children (all DEERS-enrolled and Tricare-eligible) still have access to Tricare medical coverage, either Prime or Standard?

A. Yes, should you pass away before your wife, she and your children would remain eligible for all the normal Tricare options for which they are eligible now, as long as they are properly enrolled in the Defense Enrollment Eligibility Reporting System.

Your wife would remain eligible indefinitely as long as she did not remarry. But if she remarried, her Tricare eligibility under your sponsorship would be lost and could not be restored even if her subsequent marriage were to end in death or divorce.

Your children would remain eligible for as long as dependent children are normally eligible for Tricare. That is age 21, or age 23 if they are full-time college students. After age 23, they would be eligible for premium-based Tricare Young Adult until age 26.

Q. I’m a dependent spouse. Will Tricare cover some or all of the costs of corrective eye surgery, either LASIK or PRK?

A. No. Both LASIK and PRK are forms of refractive corneal surgery, which is not covered by Tricare.

Q. I am a dependent child for Tricare purposes. I just turned 22 and am not a full-time college student, but I am enrolled in Tricare Young Adult. How can I obtain proof of insurance for medical appointments?

A. You should have received an “enrollment” or “wallet” card when you signed up for TYA. That’s the only proof of insurance you need. However, if that’s not sufficient for a particular health care provider, you can request an “eligibility letter” showing proof of Tricare coverage from the Defense Manpower Data Center.

Details are here: That Web page also has information on how to obtain a new enrollment or wallet card if necessary.

Write to Include the word “Tricare” in the subject line and do not attach files.

Answers by RallyPoint

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