Changes to TRICARE's Contraceptive Care Coverage

Friday, October 14, 2022

To increase patients’ access to contraception, TRICARE has made changes to contraceptive care coverage.

What changed?

Effective July 28, 2022, well-woman exams may include medical contraceptive consultations and services without cost-shares or copayments. Medical contraceptive services include long-acting reversible contraceptive (LARC) services such as placing and removing intrauterine devices (IUD) and subdermal contraceptive rods, administering contraceptive shots and measuring/fitting and training on use of diaphragms.

Effective Jan. 1, 2023, female permanent contraception (tubal ligation) will be covered without cost-shares or copayments.

These changes will roll out in two phases.

What and when are the roll-out phases?

• Phase 1: Copayments and cost-shares for LARC services rendered on or after July 28, 2022, will be waived beginning Nov. 1, 2022.
  
• Phase 2: Copayments and cost-shares for tubal litigation, when performed by TRICARE-authorized network providers, will be waived beginning Jan. 1, 2023. Cost-shares and copayments may still apply for tubal ligations performed by out-of-network providers.

What about copayments and cost-shares before implementation dates?

Patients will pay copayments or cost-shares for services received between July 28, 2022, and the applicable implementation date. After the relevant implementation date, patients can call customer service at 1-844-866-WEST (1-844-866-9378) to request that their claims be reprocessed as preventive care and that cost-shares and copayments be reimbursed.

Where can I learn more about TRICARE’s contraceptive coverage?

Visit our Birth Control page and www.tricare.mil/birthcontrol page for more information on TRICARE’s birth control coverage.

Where can my TRICARE patients go for more information?

Please direct your TRICARE patients to www.tricare.mil/birthcontrol and www.tricare.mil/costs for benefit and cost details.