What Does TRICARE Cover? Full Benefits & Exclusions Guide

Military families often discover TRICARE’s limitations at the worst possible time: when a child needs braces, a spouse starts therapy, or a veteran wants to try acupuncture for back pain.

TRICARE exclusions aren’t a secret, but they’re often buried in the fine print that most people never read until they get a bill. Understanding what TRICARE covers, and what TRICARE exclusions exist, can save families thousands of dollars and a lot of frustration.

What Does TRICARE Cover?

TRICARE is the federal health insurance program for active duty service members, retirees, and their eligible dependents. Depending on the TRICARE plan you’re enrolled in, you’ll have access to a broad range of medical services, such as:

• Preventive care: Annual physicals, vaccines, well-child visits, and cancer screenings.
• Inpatient and outpatient care: Hospitalizations, surgeries, emergency room visits, and specialist appointments.
• Maternity care: Prenatal visits, labor and delivery, and postpartum follow-up.
• Mental health care: Inpatient and outpatient psychiatric care and substance use treatment.
• Prescription drugs: Covered through the TRICARE Pharmacy Program, with access to military pharmacies, retail pharmacies, and the TRICARE mail-order program.
• Durable medical equipment: Wheelchairs, crutches, prosthetics, and orthotics when medically necessary.
• Lab and diagnostic services: Blood work, imaging (X-rays, MRIs, CT scans), and pathology.

What Does TRICARE Not Cover?

TRICARE excludes a number of services, and it only covers treatment that’s considered “medically necessary.” Some of the most common TRICARE exclusions include:

• Cosmetic and elective procedures: Rhinoplasty, liposuction, hair restoration, and eyelid surgery for appearance are not covered. Even reconstructive surgery can be denied if TRICARE deems it cosmetic.
• Routine dental care: Standard cleanings, fillings, and orthodontics for dependents are excluded from most TRICARE plans.
• Routine vision care: Eye exams for glasses and contact lenses, frames, and contacts are not covered under standard TRICARE.
• Hearing aids: TRICARE covers diagnosis and treatment of hearing conditions, but generally doesn’t cover hearing aids for adult dependents.
• Custodial care: Long-term care in a nursing home or assisted living facility that is primarily for help with daily activities, not skilled nursing, is excluded.
• Most alternative therapies: Acupuncture, naturopathic medicine, massage therapy, and homeopathy are largely excluded, with limited exceptions.
• Weight loss programs: Bariatric surgery and medically supervised weight loss programs are typically not covered unless specific criteria are met.

TRICARE Out-of-Pocket Costs

TRICARE is one of the most affordable health care options for military families, but it’s only free if you’re on active duty. The cost of TRICARE for military families varies depending on your TRICARE plan and military status.

Does TRICARE Include Dental Coverage?

Standard TRICARE plans don’t include dental coverage for dependents (active duty service members receive dental care through military treatment facilities). Families who want dental coverage can enroll in the TRICARE Dental Program (TDP), which covers:

• Routine cleanings
• X-rays
• Fillings
• Root canals
• Oral surgery
• Tooth extractions
• Crowns
• Dentures
• Braces and orthodontia

Does TRICARE Cover Vision?

TRICARE doesn’t cover routine vision care, like eye exams or contact lenses, for any plan member. Active duty service members can access optometry services at military treatment facilities for readiness-related exams, but dependents and retirees are largely on their own.

Does TRICARE Cover Therapy?

TRICARE covers mental health and substance use treatment, including individual therapy, group therapy, inpatient psychiatric care, and medication management. Under TRICARE Prime, there are no copays for mental health visits at military facilities, and small copays for network civilian providers.

However, there are limitations for therapy coverage under TRICARE:

• Provider availability: Finding a TRICARE-accepting therapist in many parts of the country is difficult. TRICARE’s reimbursement rates are lower than many private insurers, so a significant number of licensed therapists don’t participate in the network. This can mean long waits or driving significant distances for covered care.
• Out-of-network costs: If you see a therapist who doesn’t accept TRICARE, you’ll pay out-of-pocket. TRICARE Select will reimburse a portion for non-network providers, but Prime will not.
• Marriage counseling: Couples therapy is covered when at least one partner has a diagnosable mental health condition being treated. Voluntary marital counseling without a clinical diagnosis is generally not covered.

Are Experimental Treatments and Alternative Care Covered?

TRICARE applies a strict “medically necessary and proven effective” standard. That means experimental and alternative treatments are often excluded by default. This includes:

• Acupuncture (with limited exceptions)
• Chiropractic care beyond what’s authorized at specific military facilities
• Naturopathy and homeopathy
• Most herbal or nutritional supplements
• Hyperbaric oxygen therapy for most conditions
• Experimental cancer treatments not yet approved by the FDA

One exception is clinical trials, which TRICARE does cover, as long as the trial is approved.

Does TRICARE Work Overseas?

TRICARE does work overseas, which is good news for service members and their families who want help paying for military healthcare costs abroad.

Active duty service members stationed overseas are automatically enrolled in TRICARE Prime Overseas, which provides coverage through the regional contractor.

Active duty family members, retirees, and eligible dependants living overseas can enroll in the TRICARE Select Overseas plan.

Retired National Guard and Reserve members under age 60 can get the TRICARE Retired Reserve Overseas plan, which also covers their family members.

These TRICARE plans cover emergency care anywhere in the world without prior authorization. For planned care, however, you must use TRICARE-authorized providers or get prior authorization for planned care. Typically, you pay upfront and submit a claim for reimbursement.

It’s important to consider that in some locations, the nearest TRICARE-authorized provider may be hours away, so finding care overseas isn’t always easy. Additionally, mental health care, dental care, and specialty care can be limited in remote overseas postings.

Supplemental Health Insurance Options for Military Families

If you want coverage for TRICARE coverage gaps, you might consider a supplemental insurance plan for the military. Here are some of the most common options that families choose:

• TRICARE Supplement Plans: Some private insurers offer TRICARE supplement plans that cover cost shares, deductibles, and some excluded services. Monthly premiums depend on age and plan, and they’re most valuable for families on TRICARE Select who have higher cost shares.
• TRICARE Dental Program (TDP): TDP is the official dental add-on plan, which is administered by United Concordia. It covers routine and preventative dental care in the U.S. and overseas.
• Commercial vision plans: If you want coverage for eye exams and glasses, you can consider enrolling in a standalone vision insurance plan from a provider like VSP or EyeMed. These plans aren’t affiliated with TRICARE.
• FEDVIP (Federal Employees Dental and Vision Insurance Program): Some TRICARE-eligible individuals can also access FEDVIP, which offers competitive dental and vision options through a federal marketplace.
• FSAs and HSAs: Active duty families can’t use health savings accounts (HSAs), but some retirees on high-deductible plans can. Flexible spending accounts (FSAs) through a spouse’s civilian employer can also help offset TRICARE cost shares and excluded expenses.

FAQ

Q: Does TRICARE cover pre-existing conditions?

Yes. TRICARE covers pre-existing conditions for all eligible plan members. Coverage begins when eligibility begins, with no waiting periods for pre-existing health issues.

Q: Can military spouses keep TRICARE after a divorce?

No, military spouses lose TRICARE eligibility after divorce unless they meet the “20/20/20 rule”: the service member served at least 20 years, the marriage lasted at least 20 years, and the two periods overlap by at least 20 years. Those who don’t qualify can purchase a temporary continuation of coverage for up to 36 months (called Transitional Survivor Coverage) but must pay full premiums.

Q: Does TRICARE cover weight loss surgery?

Bariatric surgery is covered under TRICARE, but it comes with strict criteria. You must have a BMI of 40 or higher (or 35+ with serious comorbid conditions), documentation of failed conventional weight loss attempts, psychological evaluation, and approval from a TRICARE-authorized bariatric program.

Q: What happens to TRICARE coverage when a service member separates?

Service members who separate before reaching 20 years of qualifying service lose TRICARE eligibility within 60 to 180 days, depending on their length of service. They may be eligible for a temporary continuation called the Continued Health Care Benefit Program (CHCBP) for up to 18 months. However, the premiums are typically very expensive.

Q: Is TRICARE accepted everywhere?

While TRICARE has a broad network, it’s not accepted everywhere. Many civilian providers, including some dentists and therapists, don’t accept TRICARE. Before you see a healthcare provider, make sure to call ahead to verify that your TRICARE plan is accepted.

Q: What TRICARE Plan Should I Choose?

The right TRICARE plan mostly depends on your military status. If you’re not sure which plan to choose, you can use the Plan Finder tool on the official TRICARE website.