Coverage for plastic surgery is limited, and many cosmetic procedures are not covered at all under Tricare.
Those types of surgeries are covered only when they are to restore function, correct a serious defect, restore the body form after a serious injury, improve appearance of a severe disfigurement or after a medically necessary mastectomy, according to Tricare officials. Very specific criteria is used to determine if cosmetic surgery will be a covered benefit, officials stated in an e-mailed response to a query from Stars and Stripes.
The key to ensuring coverage for a specific procedure, officials said, is to contact a Tricare service center before undergoing any cosmetic surgery performed by a civilian provider. If not covered, the patient will be responsible for 100 percent of the surgery costs, including those arising from complications and follow-up care.
Some military treatment facilities (MTFs), especially those overseas, might not have the capability to treat some complications that can arise from cosmetic surgery, officials said.
“For example,” Tricare officials said, “most of our MTFs do not have the approved scope of practice to remove silicone or saline breast implants that were not originally covered by Tricare. Problems with breast implants may include damage, hardening, leaking and immune problems. These problems are considered unfortunate outcomes resulting from initial non-covered surgery.”
In such a case, officials said, the patient would have to seek care in the civilian sector and would be responsible for all costs. If the decision is made to remove a breast implant at a military facility, officials said, the procedure would carry a charge similar to that in a civilian facility.
For cosmetic surgeries that are covered, Tricare officials said the patient must purchase any cosmetic implants or supplies, but they are not charged a surgical fee.
