Tricare and Infertility

I have been getting asked a lot lately what TRICARE(military health insurance) covers and doesn't cover. A lot of people have this misconception that TRICARE pays for everything. While that is true in most cases, when it comes to infertility that is not the case.

I am going to quote the TRICARE website for this next portion, then I will be breaking it down with my experience.

TRICARE may cover some types of assisted reproductive services. The services must be medically necessary and combined with natural conception.

Services that may be covered includes:

• Diagnosis and treatment for an illness or injury of the male or female reproductive system. This includes correcting any physical cause of infertility
• Care for erectile dysfunction only from physical causes
• Diagnostic services including:
  • Semen analysis
  • Hormone evaluation
  • Chromosomal studies
  • Immunologic studies
  • Special and sperm function tests
  • Bacteriologic investigation

Your regional contractor may require preauthorization. Check with the contractor prior to receiving assistive reproductive services.

TRICARE doesn’t cover:

• Artificial or intrauterine insemination
• Any costs related to donors and semen banks
• Reversal of tubal ligation or vasectomy
• Care for erectile dysfunction from psychological causes, including:
  • Depression
  • Anxiety
  • Stress
• Non-coital reproductive procedures, services or supplies, including:
  • In vitro fertilization
  • Gamete intrafallopian transfer
  • Zygote intrafallopian transfer
  • Tubal embryo transfer

Exceptions for Seriously Ill or Injured Service Members, Male or Female

If you are a service member who:

• Is on active duty
• Had a serious illness or injury on active duty
• Lost natural reproductive ability due to that illness or injury
• Have a lawful spouse

Then the following services may be available:

• Sperm retrieval
• Egg retrieval
• In vitro fertilization (IVF)
• Artificial insemination
• Blastocyst implantation
• Cryopreservation and storage of embryos

The following is not included:

• Fertility preservation
• Surrogacy

If you receive care or medication in the civilian sector, participating network providers must be used if available. Preauthorization for every IVF cycle is required.

So in my experience TRICARE covers anything dealing with Timed Intercourse. This includes any medications that you need as well as all the doctors appointments. However the moment you move to the next stage TRICARE is out. So for us they are still covering the medication that I require to help me ovulate but they are not covering IUI. So that part is out of pocket for us. The price for that can rang from $400 on up to thousands depending on your location and doctors office. We are extremely lucky when it comes to our price (sorry I am not going to give that away) but I will say that in hindsight we could be paying out our asses. The bad part is if it doesn't work we pay again the next month. I wish that there was some sort of guarantee but of course there isn't. I mean i understand why we don't get money back due to its not like they can reuse most of the medical equipment that is used and our Doctor is giving his time to do this.

Now if we lived near an MTF IUI as well as IVF would be discounted. Our closest one is over 5hrs away. Although we could get permissive TDY to go, however the fact that we go to the doctors multiple times a month it really isn't in our best interest for us to go to the MTF.

There are only 5 MTFs within the TRICARE network.
Military Treatment Facility (MTF)
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