TRICARE covers most inpatient and outpatient care that is medically necessary and considered proven. However, there are special rules or limits on certain types of care, while other types of care are not covered at all. The beneficiary liability for covered services is determined by the program option the beneficiary is using (TRICARE Prime, TRICARE Prime Remote [TPR], TRICARE Prime Remote for Active Duty Family Members [TPRADFM], TRICARE Standard, TRICARE Extra, or TRICARE For Life [TFL]). See the TRICARE Program Options section for specific beneficiary liability information.
In this section, the TRICARE-covered services are highlighted, and specific details about some of the more complex benefits are included.
This section is not intended to be all-inclusive.
For additional information or specific questions about TRICARE-covered services, contact Humana Military Healthcare Services, Inc. (Humana Military) at
1-800-444-5445 or review the TRICARE Policy Manual, TRICARE Reimbursement Manual, and TRICARE Operations Manual at the
TRICARE Manuals page. You can also review the
TRICARE Provider News publication for regular articles about benefits and program changes.
Some military treatment facilities (MTFs) may offer services or procedures that are not covered by TRICARE. Beneficiaries should contact their local MTF for more information about these services. Additionally, the Military Medical Support Office (MMSO) may authorize services for active duty service members (ADSMs) that are not regular TRICARE benefits. As long as the advance authorization is in place, providers will be paid accordingly.
This chapter outlines:
