How to Find What Your TRICARE Plan Covers
Are you familiar with all the ways TRICARE covers you? TRICARE offers comprehensive coverage to help you get and stay healthy. This year, get familiar with what’s covered. Knowing what services are and aren’t covered will help you avoid unexpected out-of-pocket costs.
“If you’re new to TRICARE or have changed plans recently, use TRICARE resources to learn what services TRICARE covers and get an idea of how much you’ll pay,” said Elan Green, chief of the Medial Benefits and Reimbursement Section for the TRICARE Health Plan with the Defense Health Agency. “If you’re still unsure about your coverage, you can always check with your provider or TRICARE contractor before you get any service.”
Read below for resources to help you figure out what TRICARE covers when it comes to health, dental, and pharmacy services.
Will TRICARE cover this? TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. A good place to check is the What’s Covered tool on the TRICARE website. You can search an expansive database of covered services by keyword or category. For health care services and supplies, you’ll find information on TRICARE coverage, coverage limits, and exclusions. From this tool, you can also find links to help you book an appointment, check your plan’s costs, and learn about pre-authorization or referrals.
Depending on your beneficiary category, you may be eligible to purchase dental coverage through the TRICARE Dental Program (TDP) or Federal Employees Dental and Vision Insurance Program (FEDVIP). If you’re an active duty service member, you’re covered by active duty dental benefits. Your covered dental services depend on which plan you have. Select “Dental Care” from the What’s Covered drop-down or hamburger menu or visit www.tricare.mil/dental for more information on your options.
If you have TDP, you can also go to the TDP website for a chart that provides an overview of your TDP covered services and cost-shares. And you can download the TRICARE Dental Program Handbook to find more detailed information on covered services.
If you’re enrolled in a FEDVIP dental plan, you can explore what your plan covers on the BENEFEDS website. Follow the instructions on how to get to your plan’s coverage details.
Did you know your TRICARE benefit includes pharmacy coverage? If you want to learn about prescription drug categories or find the best way to fill your prescriptions, select “Pharmacy” from the What’s Covered drop-down or hamburger menu or visit www.tricare.mil/pharmacy. This page can also link you to the costs tool, so you know what you’ll pay for your prescriptions depending on your beneficiary category and the type of drug you’re prescribed. If you want to check if TRICARE covers a specific drug, search the TRICARE Formulary. For more detail on how your pharmacy coverage works, check out the TRICARE Pharmacy Program Handbook.
Mental Health Care
If you have questions about what TRICARE covers related to mental health, go to the Mental Health Care section. From there you’ll find links to covered treatments, costs, and how to get mental health services or substance use disorder treatment. Due to the COVID-19 pandemic, TRICARE expanded coverage to include several telehealth services for mental health.
Don’t forget you can also call your TRICARE contractor if you have any questions about what your plan covers. Learn about your TRICARE benefit and take command of your health.
Last Updated 6/8/2022