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Covering Bariatric Surgery with TRICARE

Doctor with a stethoscope writing something on a piece of paper

Bariatric surgery is a major decision, and if you’re covered under TRICARE health insurance, it’s important to understand which procedures are approved and what criteria must be met. TRICARE offers coverage for several types of weight loss surgery, but the requirements are strict, and not every service or procedure related to obesity is included.

Which Bariatric Procedures Are Covered?

TRICARE covers several bariatric procedures, including:

  • Roux-en-Y gastric bypass
  • Vertical banded gastroplasty
  • Gastroplasty (stomach stapling)
  • Adjustable gastric banding 
  • Sleeve gastrectomy (including stand-alone laparoscopic sleeve gastrectomy)
  • Biliopancreatic diversion (with or without duodenal switch) for patients with a BMI ≥ 50

These procedures are only considered when they are deemed medically necessary and meet all program guidelines.

What Are the Eligibility Requirements?

To qualify for bariatric surgery under TRICARE, you must meet all of the following:

  • Be at least 18 years old, or submit medically verified completion of bone growth for those under 18 years old
  • Have medical documentation showing that non-surgical weight loss efforts have been unsuccessful
    • Programs such as Weight Watchers or Jenny Craig paired with monthly doctor visits and documented progress, are acceptable
    • Programs that rely only on weight-loss medications do not qualify
  • Meet one of the following BMI-related criteria:
    • BMI ≥ 40
    • BMI between 35–39.9 with at least one comorbidity, such as:
      • Cardiovascular disease
      • Type 2 diabetes
      • Obstructive sleep apnea
      • Pickwickian syndrome
      • Hypertension
      • Coronary artery disease
      • Obesity-related cardiomyopathy
      • Pulmonary hypertension

What Isn’t Covered by TRICARE?

Some services and procedures are not covered, including:

  • Office visits for obesity treatment alone
  • Non-surgical weight loss treatments
  • Nutrition and diet counseling
  • Biliopancreatic bypass (jejunoileal or Scopinaro procedures)
  • Gastric balloon or bubble
  • Gastric wrapping and open gastric banding
  • Unlisted or experimental procedures

It’s important to review your plan’s exclusions and speak with your TRICARE representative if you’re unsure whether a procedure is covered.

Additional Notes for Active Duty Service Members

If you are an active duty service member, be aware that bariatric surgery is considered a permanent change to your digestive system and may affect your eligibility for deployment or reenlistment. In some cases, undergoing surgery while on active duty may result in separation from service. These restrictions are detailed in Health Affairs Policy 07-006.

How to Get Started

Before taking the next step, here’s how to prepare:

  • Review your TRICARE plan to confirm your eligibility and benefits
  • Work with the VIPSurg team and previous providers to gather medical records showing failed weight loss attempts and any qualifying comorbidities
  • Confirm that your proposed procedure is one of the covered options
  • Keep detailed documentation and stay in close communication with TRICARE throughout the process

Questions? We’re Here to Support You

Our team is familiar with TRICARE’s requirements and can assist you in preparing documentation, submitting paperwork, and navigating coverage decisions. If you need help getting started or have questions about your specific situation, VIPSurg is here to help.