Will TRICARE Prime Pay for In Vitro?

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 (IVF) treatments are not covered by any form of TRICARE, not even TRICARE Prime. However there are other options available to members for diagnosis and treatment of infertility problems, as well as for medical treatment facilities where IVF services can be obtained through medical-training programs.

Artificial Reproduction Technologies Are Not Covered by TRICARE

• 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.

TRICARE Covers Some Forms of Infertility Treatment

• 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.

Treatments Offered for Both Men and Women

• Treatments include hormonal treatment, antibiotics, human chorionic gonadotropin (HCG), radiation therapy or corrective surgery for both men and women. TRICARE also covers medically necessary treatment for erectile dysfunction caused by organic reason (not psychological reasons).

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.

What is Not Covered

• In addition to IVF, sterilization reversals and artificial insemination, TRICARE does not cover vasectomy reversals and gamete intrafallopian transfer (GIFT).

More About IVF Treatments and TRICARE

• Although TRICARE will not cover IVF treatments, TRICARE members can seek treatment at four different military treatment facilities (MTFs). The following MTFs conduct medical training programs in IVF. However, all costs at the MTF for services will be the responsibility of the beneficiary. The MTFs include Wilford Hall Medical Center in San Antonio, Texas; Tripler Army Medical Center in Honolulu, Hawaii; Walter Reed Army Medical Center in Washington, D.C.; and the Naval Medical Center in San Diego, California.