Fertility Coverage Misconception: Tricare

So ever since starting treatment and sharing our story I have been asked so many times as to why we had to pay out of pocket since we have tricare. Well that's the misconception tricare doesn't cover everything, in fact there is a lot more that they don't cover than what they do cover. Even though I did a post awhile ago that touched on this topic, I decided it's time to try to help break down this misconception.

So let's start with what the tricare website states on this topic:

        

I am going to break this down for you to make it a bit easier to understand. 

•Tricare covers all diagnostic testing that is required to come to a diagnosis, this includes both parties. 

•Tricare covers all oral medications required for timed intercourse(ti) and some injectable(not all). 

You can do TI as many times as you want there is no "cap", however at some point your doctor will advise you that it is time to move on. At which time 90% of the treatment tricare has now high tailed it out of covering your treatment

You might remember that I did a post on what our next course of action was after TI didn't work and I explained what it was, if you don't you can click here. 

So you are now knee deep into a new treatment plan which includes Intrauterine Insemenation (IUI)

•Tricare covers oral meds

•Tricare does not cover the sperm wash

•Tricare does not cover injectables

•Tricare does not cover the actual "procedure"

•Depending on how your doctor runs their office tricare can cover the appointments and diagnostic testing and monitoring for those cycles (they did for ours). Some doctors offices once you get to IUI, they stop billing insurances and do a "package deal" type of thing, so if this is how your doctors office works you have to pay for everything. 

So let's say this treatment plan didn't work for you either.... the next step is IVF.  Which can cost 20 thousand plus. Sorry to say it but tricare is gone you are on your own. Now you are probably thinking Jane Doe had it covered and only paid half. Here's the huge misconception on this one. Tricare DID NOT cover it, I know shocker. There are 5 Military Treatment Facilities(MTF) within the tricare network: 

Walter Reed Army, Washington, DC
Wilford Hall Air Force, San Antonio, TX
Balboa/Point Loma Naval, San Diego, CA
Tripler Army, Hawaii
Madigan Army, Ft. Lewis, WA

These facilities have a government grant that covers treatment, it is not covered through tricare in any way shape or form. With this grant the medication is covered and you only pay half if not less (depending on location) for everything else. Getting into these facilities can be difficult depending on location. Each location has a set number of patients they take per fiscal year and they split that up into cycles. So there can be a rather long wait list. There have been people to be lucky and get right in and others that are waiting years. 

I hope this clears up a lot of misconceptions for people. 

Edited on 10/21/2016

I have had a few questions from viewers so I thought I would add the answers in to this post. 

•Tricare does not cover seragency. That is all out of pocket for you. If this is a route you are taking please make sure you educate yourselves on the laws for the state in which this is taking place. 

• Tricare does not cover egg/sperm adoption. 

You might have seen in the news that Tricare covers cryobank storage fees if your spouse is deploying. To clarify this is a pilot program it has NOT come into play yet. People had to apply to be apart of this program. The pilot will last roughly 2yrs and then from there they will come up with the final perameters and then it will either take effect or they will stop doing it. 

You might have also seen that the VA will cover one round of ivf if the military member has a combat related injury. This is true however please know there is a difference between combat injury and service related injury(which they won't cover ivf for this). There is also a long road on getting a combat related injury for fertility treatment documented. It is not something that happens over night. In some cases it has taken years.