TRICARE Coverage for Wounded, Ill, and Injured Service Members and Their Caregivers
If you were wounded or became ill or injured on active duty, your care is a top priority for the Military Health System. Many programs and benefits are available to help you. To make sure you and your family get the health care services you need, you should know how your TRICARE benefits work. Warrior Care also helps service members recover, reintegrate, and transition to civilian life.
How you get your health care depends on your current military status. This means your benefits depend on whether you’re an active duty service member (ADSM), National Guard or Reserve member, or retired service member.
Active Duty Service Members
If you’re an ADSM, you have one of the following health plans. Your primary care manager coordinates your care.
- TRICARE Prime
- TRICARE Prime Remote
- TRICARE Overseas Program (TOP) Prime
- TOP Prime Remote
- You may also qualify for a variety of other programs. These may be offered through the Department of Defense, your military service branch, or the Department of Veterans Affairs (VA). Caregivers of service members injured in the line of duty may qualify for special benefits, like respite care.
National Guard and Reserve Members
- If you were on active duty orders for more than 30 days when you became wounded, ill, or injured, and you’re still on active duty, your benefits are the same as an ADSM. This is true as long as you stay on active duty. If you’ll require additional care for your injury after your active duty period ends, your unit should initiate an in-line-of-duty (in-LOD) determination. This should take place before you leave active duty. LOD care isn’t available for family members. You may also be eligible for combat veterans care through the VA.
- If you were on active duty for 30 days or less when you became wounded, ill, or injured, you may qualify for in-LOD care. You should see your unit to start the appropriate documentation as soon as possible after you initially seek treatment.
Retired Service Members
- If you’re a retired service member with a service-connected injury or illness, you may qualify for benefits through TRICARE or the VA.
Benefits for Injured Service Members
TRICARE provides the benefits listed below for those who qualify for them. These health care services are beyond your basic TRICARE coverage. If you’re a homeboundTRICARE considers you homebound if you can’t leave your home without a lot of effort. injured service member, you and your caregivers may also receive additional benefits.
- Home health care supplies and services. This includes prosthetic devices and supplies. Keep in mind that TRICARE covers only one permanent prosthesis at a time. This doesn’t apply if you require bilateral prostheses.
- Training, rehabilitation, special education, and assistive technology and services
- Institutional care and associated transportation
- Respite care for the primary caregiver
You may also qualify for benefits through other federal agencies. You can find the latest benefit resources and information listed in the Wounded, Ill, and/or Injured Compensation and Benefits Handbook. You can also call your regional contractor, care coordinator, or beneficiary counseling and assistance coordinator to help find you services. If you’re overseas, you can visit a TRICARE Service Center. Keep in mind that some services may be limited or unavailable overseas.
TRICARE covers respite care for primary caregivers of ADSMs and National Guard and Reserve members who are injured in the line of duty. Respite care is short-term rest for caregivers. These caregivers help a person navigate daily living. Care must be provided by a TRICARE-authorized home health agency. You also need pre-authorization from your regional contractor and the approving authority for the ADSM. That authority is the Defense Health Agency—Great Lakes, or your referring military hospital or clinic.
If you’re a caregiver, you can use the Caregiver Resource Directory to find resources as well.
Remember that you need to keep your information in the Defense Enrollment Eligibility Reporting System (DEERS) up to date, so you don’t miss important information and enrollment deadlines. Especially after you experience a Qualifying Life Event, like retiring or separating from active duty, make sure that you update DEERS.
Last Updated 6/23/2020