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An Eye on TRICARE Prime Vision Coverage (Article 5)

Maintaining excellent eye health begins with understanding and using the access you and your family have to top-notch vision care providers.

Given that TRICARE Prime enrollees have no copayment responsibilities for routine and clinical preventive eye examinations, there’s no reason why you shouldn’t utilize this benefit.

Active duty family members enrolled in TRICARE Prime are eligible for a routine eye exam every year in addition to clinical preventive exams every two years. TRICARE retirees and their families enrolled in TRICARE Prime are only eligible for clinical preventive eye exams every two years. (See chart below for more details.)

All vision care must be provided by TRICARE-authorized optometrists or ophthalmologists. You may receive preventive eye examinations from any network provider without a referral or authorization from your PCM or Humana Military.

If a network provider is not available, you may receive a preventive eye exam from a non-network provider with a PCM referral and authorization from Humana Military.

For more vision benefit information:

Annual Routine Eye Examinations
An evaluation of the eyes not related to a medical or surgical condition;
including but not limited to refractive services.

Beneficiary

Coverage 

TRICARE Prime

TRICARE Extra

TRICARE Standard 
Active duty family members One routine eye examination per year No copayment 15%
cost-share		 20% cost-share
Retirees, their
families and others		 Not covered Not covered
See Clinical Preventive Exams		 Not covered Not covered

Clinical Preventive Eye Examinations
Comprehensive screening for determination of vision on visual acuity, ocular alignment, and red reflux,
along with external examination for ocular abnormalities.
Infants* One eye and vision screening
from PCM at birth and 6 months		 No copayment 15%
cost-share		 20% cost-share
Children* (ages 3-6) One comprehensive eye exam from a specialist every 2 years** No copayment 15%
cost-share		 20% cost-share
Adults* and children over age 6 One comprehensive eye exam from a specialist every 2 years** No copayment Not covered Not covered
*Includes active duty family members, retirees, their families, and others. Recent retirees and their families enrolled in TRICARE Prime should note that the first preventive eye exam (routine or preventive) is available two years after the last eye exam performed as an active duty service member or active duty family member. The benefit does not start over upon retirement.
**Diabetic patients, at any age, should have comprehensive eye examinations at least yearly.

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Last Reviewed:  December 4, 2007