Is It Covered?

Search the A-Z list for a list of covered services. Your coverage and out-of-pocket costs may vary based on who you are and your health plan option.

Bariatric Surgery

TRICARE covers the following open or laparoscopic bariatric surgical procedures:

  • Roux-en-Y gastric bypass
  • Vertical banded gastroplasty
  • Gastroplasty (stomach stapling)
  • Adjustable gastric banding (i.e., adjustable LAP-BAND®)

All of the following conditions must be met to qualify:

  • You're at least 18 years old or you must provide documentation of completion of bone growth.
  • You were unsuccessful with non-surgical medical treatments for obesity. Your medical records must show your failed attempts.
    • Diet programs, such as Weight Watchers®* and Jenny Craig*, are acceptable methods of dietary management, as long as there are monthly clinical visits with your doctor and medical documentation of your participation and your progress throughout the course of the dietary program. *These programs are not covered by TRICARE.
    • Physician-supervised programs made-up of only weight-loss medication management, do not meet this requirement.
  • You have proof of one of the following:
    • A body-mass index greater than or equal to 40 kilograms per meter squared (kg/m2); or
    • A body-mass index of 35-39.9 kg/m2 with one clinically significant comorbidity, including but not limited to, cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, Pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension.

TRICARE doesn't cover the following services:

  • Office visits solely for the treatment of obesity
  • Non-surgical procedures for treatment of obesity
  • Nutrition and diet counseling
  • Biliopancreatic bypass (jejunoileal bypass, Scopinaro procedure)
  • Gastric bubble or balloon
  • Sleeve gastrectomy
  • Gastric wrapping/open gastric banding
  • Unlisted procedures

Active Duty Service Members

Bariatric surgery represents a major and permanent change in your digestive system that requires strict adherence to a specific dietary regimen that may interfere with operational deployment. A history of bariatric surgery is already a bar to military service and receiving bariatric surgery while on active duty may be grounds for separation.

For more information, view the Health Affairs Policy 07-006.

Disclaimer:

This A-Z list of topics is not all inclusive. TRICARE covers most inpatient and outpatient care that is medically necessary and considered proven. However, there are special rules or limits on certain types of care, while other types of care are not covered at all.

Last Updated 9/12/2014