Will TRICARE Prime Pay for In Vitro?

In Vitro fertilization.
In Vitro fertilization. (Image: Kiyoshi Takahase Segundo/iStock/Getty Images)

TRICARE is the health care program for United States military members and their families. It covers active-duty service members, National Guard and Reserve members, retirees, their families, survivors and some former spouses. In-vitro fertilization treatments are not covered by any form of TRICARE, not even TRICARE Prime unless the person received a reproductive injury as a result of active duty.

Reproduction Coverage

Couples who cannot conceive naturally experience feelings of frustration and helplessness. TRICARE does provide coverage for health-care procedures relating to the diagnosis and correcting of any conditions causing the infertility, but it does not cover any form of artificial reproductive technology, including IVF. This is true for all forms of TRICARE coverage, unless the military member received an active-duty injury or experienced a service-related illness that resulted in infertility.

Infertility Treatments

TRICARE Prime and Standard members can seek coverage for infertility testing and treatment. TRICARE will apply appropriate cost shares for services and supplies to diagnose and treat a physical cause of infertility. Coverage includes diagnostic services to detect the illness or injury to the reproductive system for men or women. Although male-infertility treatments may require a cost share, most other infertility treatments and surgeries are covered for women.

Types of Treatment

Treatments for both male and female service members include semen analysis, chromosomal studies, immunologic and bacterial tests and hormonal treatment, such as human chorionic gonadotropin, antibiotic treatments, radiation therapy or corrective surgery for both men and women. TRICARE also covers medically necessary treatment for erectile dysfunction caused by organic reasons, not psychological ones.

Treatments for Men

Eligible men can seek health care coverage from TRICARE for pituitary disease, disorders of sperm transport or motility, hypothalamic disease and sexual dysfunction. Tests may include an analysis of semen and hormones, chromosomal and immunologic evaluations, sperm function tests and bacteriologic investigation. Related therapies may include hormone therapy, surgery, antibiotics, HCG and radiation therapy. It is important to note that treatment to reverse a previous surgical sterilization is not covered.

Treatments for Women

Eligible women can seek health care coverage from TRICARE for the required services and supplies to diagnose or treat injury or illness to the genital system. Also covered is infertility testing and treatment to correct physical causes. Artificial insemination is not a covered benefit.

IVF Treatments

For those active-duty service members who experienced an injury or illness that resulted in infertility or a loss of reproductive capabilities because of military service, TRICARE will cover in-vitro fertilization, egg and sperm retrieval, artificial insemination, cryopreservation and storage of embryos and blastocyst implantation. TRICARE does not cover surrogacy or fertility preservation, however. For more information, contact TRICARE directly to determine if you are eligible for this coverage, as there are rules and limits to coverage.

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