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News | Jan. 25, 2024

Explore What TRICARE Covers

By TRICARE Communications

TRICARE offers comprehensive coverage to help you get and stay healthy. Knowing what’s included in this coverage can help you make the most of your benefit and avoid unexpected costs.

Here’s how to find out about your TRICARE coverage for medical and pharmacy services.

Find covered health services

You can use the Covered Services tool to find what your TRICARE health benefit covers.

“The Covered Services tool is the best way to see if and how TRICARE covers a particular health care service or medical supply,” said Robert Agnello, deputy chief of TRICARE Digital Communications. “You can search by keyword or choose from a list of categories to see what’s covered.”

The tool is easy to find and use. Follow these steps to get started:

  1. Click “What’s Covered” on the navigation bar at the top of every tricare.mil page.
  2. Scroll down to search for covered services by keyword or by category.
  3. Click “Search” to see a table of results. The table will show if a health care service is covered. To learn more about how a service is covered and if there are limitations, click “More.”

TRICARE covers services that are medically necessary and considered proven. To be medically necessary means it’s appropriate, reasonable, and adequate for your condition. To be proven means it’s safe and not considered experimental.

There are special rules or limits on certain services, and some services are excluded. You can check out the Exclusions page for more information. Remember, the Covered Services tool and the exclusions list aren’t all inclusive.

Do you have TRICARE For Life (TFL)? Before you get care, see what Medicare covers and what TRICARE covers. Generally, you’ll have lower out-of-pocket costs when you follow Medicare’s rules for getting care. Learn more about getting care with Medicare and TFL.

See if your prescription is covered

TRICARE health plans include prescription drug coverage. TRICARE also covers certain over-the-counter drugs when prescribed by your provider. To see how TRICARE covers a specific drug, follow these steps to use the TRICARE Formulary Search tool:

  1. Type the drug name and strength in the search box.
  2. Beneath the search box, fill in the fields from the dropdown menus.
  3. Click “Search” to see information about the drug.

The information you’ll see will include the drug’s coverage details and limitations. You’ll also see your copayment for that drug. Copayments are based on your beneficiary status, the drug category, and where you fill your prescription, as described in the TRICARE Pharmacy Program Overview Fact Sheet.

Knowing what TRICARE does and doesn’t cover can help you make the most of your benefits and avoid unexpected costs. If you’re still unsure about your coverage, ask your provider or call your regional contractor before you get care. Once you know what TRICARE covers, make sure you know your plan’s rules for getting care. Go to Getting Care to learn more.

Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions, and create your personalized profile to get benefit updates, news, and more.
 

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