No-Cost Tube Tying Surgeries Will Be Available for Some Through Tricare Next Year, But Not Vasectomies

Army doctor discusses contraception options with a patient while a nurse prepares for an exam at the CPT Jennifer M. Moreno Primary Care Clinic, Fort Sam Houston, Texas, Oct. 20, 2021. (U.S. Army photo by Jason W. Edwards)
An Army doctor discusses contraception options with a patient at the CPT Jennifer M. Moreno Primary Care Clinic, Fort Sam Houston, Texas, Oct. 20, 2021. (U.S. Army photo by Jason W. Edwards)

Military family members, reservists and some retirees covered by Tricare will be able to get the female sterilization surgery known as tubal ligation from civilian doctors at no cost starting Jan. 1, the Defense Health Agency confirmed.

Vasectomies, though, will still come with a copay, the agency added.

"Ensuring our beneficiaries have timely and affordable access to reproductive healthcare, including a full range of contraceptive services, is a top priority for the Military Health System," Defense Health Agency spokesperson Peter Graves said in an emailed statement to

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Tubal ligation, colloquially known as "tube tying," is a form of permanent birth control where the fallopian tubes are cut, tied or otherwise blocked to prevent eggs from traveling from the ovaries and sperm from fertilizing the eggs.

The procedure, which has been offered for Tricare beneficiaries with a copay, will be covered without cost sharing as a "clinical preventive services benefit" starting in 2023, according to an update to the Tricare coverage manual published Friday. Active-duty service members could already get tubal ligations at no cost at military hospitals, but service members have anecdotally reported facing military doctors reluctant to perform the procedure.

The new benefit will be offered to enrollees in Tricare Prime, the equivalent of an HMO, and Tricare Select, the equivalent of a PPO. Beneficiaries with Tricare Young Adult, the plan for adult children ages 21 to 26; Tricare Reserve Select, the plan for eligible reservists and family members; and Tricare Retired Reserve, the plan for retired reservists under age 60, will also be eligible.

Tricare for Life, a supplemental plan for retirees with Medicare, may still be subject to cost-sharing, as will procedures conducted by out-of-network providers, according to the updated manual.

Covering tubal ligations without a cost share aligns Tricare with Department of Health and Human Services guidance on what contraception is considered women's preventative health services under the Affordable Care Act, Graves said.

Conversely, vasectomies, which cut off the tube that carries sperm to semen, are not considered preventative services under the Affordable Care Act, Graves added.

The Affordable Care Act, also known as Obamacare, requires private insurers to cover contraception, including tubal ligations, without cost sharing, but that does not apply to Tricare. For example, military family members and retirees still have a copay for birth control pills.

While Graves did not mention abortion, the change in coverage for tubal ligation comes amid a fierce national debate fueled by the Supreme Court's June decision to overturn Roe v. Wade, the 50-year precedent that guaranteed abortion rights.

Tricare is barred by law from covering abortions except in cases of rape, incest or where the life of the mother is endangered by the pregnancy, but in the wake of the Supreme Court ruling, Democratic lawmakers have been pushing the Pentagon on service members' access to abortion and reproductive care more broadly.

At a hearing on abortion in July, Pentagon officials highlighted that Tricare is eliminating copays for intrauterine devices, a type of birth control inserted into the uterus, in 2023 and vowed to expand contraceptives counseling. Eighteen military treatment facilities already have walk-in contraception clinics, and the department plans to expand that to all facilities, testified Seileen Mullen, acting assistant secretary of defense for health affairs.

"So a woman or a man could come up, get counseling and decide what contraceptive they need that day," she said.

-- Rebecca Kheel can be reached at Follow her on Twitter @reporterkheel.

Related: Lawmakers Want the Pentagon to Waive Tricare Copays on Birth Control Services

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