Does Tricare Cover Weight-Loss Surgery?
Key takeaways:
Tricare covers several weight-loss surgeries for eligible beneficiaries. These surgeries include gastric bypass, adjustable gastric banding, and sleeve gastrectomy.
To get coverage for weight-loss surgery under Tricare, you have to meet specific criteria, such as having a certain body mass index (BMI) and demonstrating that other weight-loss methods have been unsuccessful.
If you meet the eligibility requirements for coverage, you can then start the approval process with your primary care team and a bariatric surgeon who will help request a prior authorization.
Table of contents
Losing weight isn’t easy, and for some people, diet and exercise just aren’t enough. That’s where options like bariatric (weight-loss) surgery can help. These procedures change how the stomach and digestive system work to help people lose weight. However, they can cost several thousand dollars.
If you’re a Tricare beneficiary, you may have a number of options when it comes to weight management. Tricare helps cover certain weight-loss medications, such as Wegovy (semaglutide) and Zepbound (tirzepatide), if you meet certain requirements. And if you’re wondering whether Tricare covers weight-loss surgery, the answer is yes. But some procedures are excluded, and you must meet certain requirements.
Which weight-loss surgeries does Tricare cover?
Tricare covers several types of bariatric surgery. These procedures can be done through traditional, or open, surgery or a less invasive method called laparoscopy. But to qualify for coverage, you must meet certain requirements.
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Weight-loss surgeries covered by Tricare include:
Roux-en-Y gastric bypass (RYGB)
Stand-alone laparoscopic sleeve gastrectomy
Your out-of-pocket costs for bariatric surgery will depend on your specific Tricare plan and whether you use in-network healthcare professionals.
Does TRICARE cover bariatric surgery revision?
Yes, Tricare covers bariatric surgery revision in certain situations. A bariatric surgery revision is a procedure done to fix issues related to a previous weight-loss surgery.
If you develop complications, like a blockage, from your original procedure, Tricare may cover a surgery revision. Tricare also covers adjustments to bands that leak or slip and can’t be fixed without another surgery.
Tricare may also cover a repeat surgery if your first procedure didn’t work well enough, but only under specific conditions. You must have failed to lose at least 50% of your excess weight or get within 10% of your ideal weight 2 years after surgery. But to qualify, you must have followed all the original requirements, including keeping up with your nutrition and exercise plans. The repeat procedure must also be on Tricare’s approved list of procedures.
Tricare may cover weight-loss medications. But you must meet certain criteria, and coverage details depend on your plan.
After weight-loss surgery, you may need to take prescription medications. Use these tips to reduce your out-of-pocket prescription medication costs.
Considering Wegovy, Zepbound, or another GLP-1 medication for weight loss? Here’s what to know about insurance coverage for these medications.
Medicare doesn’t cover medications for weight loss. But you may still be able to get coverage for certain medications if you meet these requirements.
What are Tricare’s coverage requirements for weight-loss surgery?
Tricare will only cover weight-loss surgery if you meet certain requirements, such as:
Age: You must be at least 18 years old to get coverage. If you’re under 18, you must provide medical proof that your bones have stopped growing.
Unsuccessful weight-loss attempts: You must show that you’ve tried nonsurgical treatments without success. Tricare doesn’t pay for weight-loss programs like WW (formerly known as Weight Watchers) or Jenny Craig. But participating in these programs can count as proof of previous weight-loss attempts if you’re also working with a healthcare professional. Taking weight-loss medications only, even under a healthcare professional’s care, doesn’t count.
Body mass index (BMI): You must have a BMI of 40 or higher. If your BMI is between 35 and 39.9, you must also have at least one serious obesity-related health condition, such as Type 2 diabetes, high blood pressure, or a heart problem.
Which weight-loss procedures does Tricare not cover?
Before you book an appointment with a healthcare professional, it’s good to know which weight-loss options Tricare won’t cover. Tricare won’t pay for office visits solely for obesity treatment. Nutrition and diet counseling are not covered either, even if they’re part of a weight-loss plan.
Certain nonsurgical procedures, like gastric balloon treatments, which involve a balloon being placed in the stomach to make a person feel full, are not covered. Gastric wrapping is also excluded. Open gastric banding, a traditional surgery that involves making a large incision and placing a band around the stomach, isn’t covered either. But Tricare does cover gastric banding done laparoscopically.
Tricare won’t cover any unlisted or experimental weight-loss procedures.
How can I get Tricare to cover weight-loss surgery?
If you have Tricare and are looking for help with weight loss, here’s five things you can do to get started:
Talk to your primary care team. Start by booking a visit with your primary care team. You can discuss your weight-related concerns and decide if a referral (depending on your Tricare coverage) to a bariatric surgeon makes sense. Make sure your care team is in your plan’s network to avoid surprise out-of-pocket costs.
Work with a bariatric surgeon. Generally, a bariatric surgeon will review your medical history, determine if you’re a good candidate for surgery, and discuss your options. They’ll gather documentation of your unsuccessful weight-loss attempts and proof that weight-loss surgery is medically necessary.
Complete any required evaluations. You may need to meet with a dietitian, mental health professional, or other specialists as part of the medical necessity documentation process. These evaluations help make sure surgery is the right choice for you.
Request prior authorization. Your surgeon’s office will submit paperwork to Tricare asking for prior authorization. This will include all supporting documents, like medical records, evaluation results, and a letter of medical necessity explaining why the surgery is needed. Having thorough documentation increases your chances of approval.
Wait for a decision. After your paperwork is submitted, Tricare will review your case. This process can take some time. If approved for coverage, your care team will help you schedule the surgery and walk you through the next steps. If your request is denied, your surgeon’s office can help you understand why and file an appeal, if needed.
Frequently asked questions
Yes, Tricare covers some injectable weight-loss medications, such as Wegovy and Zepbound. But you must meet certain criteria, and your prescriber must submit a prior authorization form to Tricare.
Tricare covers weight-loss surgery for eligible beneficiaries. This includes both service members and their eligible family members (i.e., spouses and children). All beneficiaries must meet the necessary requirements for coverage approval.
Tricare covers panniculectomy (excess skin removal surgery) if it’s medically necessary. To qualify, you must have had an approved weight-loss surgery. You must have kept the weight off for 6 months or more, and have extra skin that’s causing issues like infections, pain, or difficulty moving. Also, the skin removal surgery must take place at least 18 months after your weight-loss procedure. Tricare won’t cover skin removal after weight loss when it’s done only for cosmetic reasons.
The bottom line
Tricare covers several weight-loss surgeries. These include gastric bypass, sleeve gastrectomy, and adjustable gastric banding. To qualify, you must meet certain requirements, like having documentation of unsuccessfully trying other weight-loss methods and a qualifying body mass index (BMI). Tricare may also cover surgery revision if your first procedure caused complications or didn’t lead to enough weight loss.
Tricare won’t cover certain procedures like gastric balloons or experimental surgeries. To get coverage for weight-loss surgery, start by talking to your primary care team. Then, work with a bariatric surgeon to gather the required paperwork and request prior authorization.
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References
American Society for Metabolic and Bariatric Surgery. (n.d.). Adjustable gastric band.
American Society for Metabolic and Bariatric Surgery. (n.d.). Biliopancreatic diversion with duodenal switch.
American Society for Metabolic and Bariatric Surgery. (n.d.). Roux-en-Y gastric bypass.
American Society for Metabolic and Bariatric Surgery. (n.d.). Sleeve gastrectomy.
Johns Hopkins Medicine. (n.d.). Gastric balloon for weight loss.
Jung, Y. (2017). Role of endoscopic gastroplasty techniques in the management of obesity. Clinical Endoscopy.
MedlinePlus. (2024). Vertical banded gastroplasty.
Sachs, D., et al. (2023). Panniculectomy. StatPearls.
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Tricare. (2024). Do I need a referral for care?
Tricare. (2025). Active duty service members and families.
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Tricare Policy Manual. (2021). Surgery for morbid obesity. Health.mil.
