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Will Tricare Cover Your Boob Job?

Surgery (Stock image)
(Stock image)

It's one of the most talked about Tricare topics out there: How, exactly, can you get Tricare to pay for breast augmentation surgery or a "boob job."

The rumor mill on this one runs the gamut. Here are just a few of the "facts" I've seen over the last month or so floating around the internet:

- Tricare will pay for your "breast augmentation" if you tell your doctor you need it to fix your "self esteem" issues. Feeling down because you're small? Sad that age or children have left you saggy? No problem! Just tell your primary care doctor and he'll hook you right up.

- You can definitely score a free boob job at a military hospital because doctors need volunteers on which to practice.

- Tricare will automatically cover a boob job (and a variety of other lifts, tucks and fixes) if you get it after major weight loss caused by a "bariatric" (weight loss) surgery.

- You get one free plastic surgery while you're husband is Active Duty (kinda like you also get Army wife pay).

Some of these are kind of laughable. Some of them give you hope.

And I know you have heard about a friend of a friend who got free boobs because she had low self esteem. Or one that got practiced on.

But according to the Tricare public affairs office, free breast implants are probably not in your future.

Sorry.

Let's tackle the rumors one at a time:

But I really do have low self esteem!

Full disclosure: I would personally love it if this rumor was actually true.

But I think the Tricare spokesperson actually snorted when I asked him if "self esteem" could be a ticket to the plastic surgeon.

While there are always loopholes in this kind of thing, the policy is pretty simple:

"Tricare covers cosmetic, reconstructive and plastic surgery when determined to be medically necessary by a physician, not for psychological purposes such as 'self-esteem,'" Tricare officials said.

But would a doctor decide that "self-esteem" is a medical necessity? According to the doctors I talked to -- probably not, proving that life is, in fact, nothing like an episode of Nip/Tuck.

Still, that doesn't stop the rumors from going and going (and going) on this one. Every friend I mentioned this post to told me that had heard of someone who had free boobs because of self-esteem issues. But none of them actually knew that lucky person personally. Coincidence?

Help a military doctor out by being a boob job volunteer.

This is the only rumor that has a very small amount of validity to it. While it is not a guaranteed ticket to implant land, military plastic surgeons do need to perform a certain number of procedures each year to maintain their certifications.

However, as Andi reported in the article linked above, the waiting lists for those doctors at specific Army teaching hospitals is long, and priority is given to patients with problems that Tricare says they cover for sure, like help after a mastectomy.

I just lost a ton of weight. Now I get awesome boobs.

According to Tricare, the only time they cover plastic surgery after weight loss only when it meets a set of conditions. Here is what they said:

"The beneficiary's medical record documents a redundant skin fold or excessive skin that significantly interferes with mobility or causes a physical functional impairment such as uncontrollable inflammation and/or infection resulting in pain or ulceration. Physical functional impairment may also include problems with walking, skin integrity, or distortion of nearby body parts. Physical functional impairment excludes social, emotional and psychological impairments."

In English: If you don't have an actual health problem, they won't cover any plastic surgery after weight loss. And even if they do, it most likely won't include a boob job.

(But major congratulations to you on getting healthy!)

Where can I sign-up for my one free military wife plastic surgery procedure?

I can't even answer this one, except to say:

There is no such thing. Thank you.

So what "breast augmentation" does Tricare actually cover?

It's pretty simple: Tricare only covers boobs jobs that are medically necessary. For example, they are really unlikely to cover implants -- but if you needed a reduction because of "significant pain" they are likely to cover it without a fight, according to their site.

Here's what the public affairs folks told me:

"Tricare covers breast augmentation for the following reasons: 1) After one breast has undergone post-mastectomy reconstructive surgery the opposite breast may have an augmentation procedure to bring it into symmetry with the reconstructed breast.  2) Augmentation to correct any breast deformities or asymmetries related to a congenital anomaly."

Bonus Tricare plastic surgery coverage fact:

No, they don't cover "penile enlargements," either. But thanks for asking.

 

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