FALLS CHURCH, Va. –
Is leaving home for care a challenge? TRICARE covers solutions that make it easier to get the care—and drugs—you may need. Your TRICARE
plan may cover certain
in-home health services and
pharmacy home delivery options. This gives you flexibility and convenience in your care.
“Many beneficiaries, including those using TRICARE For Life don’t realize they may be eligible for home health services or pharmacy home delivery,” said Dorina Rosario, RN, case management subject matter expert at the Defense Health Agency.
Keep reading to learn more.
What does TRICARE cover?
TRICARE may cover:
TRICARE covers these services as part of its home health care benefit. They’re covered when they’re prescribed by a provider and medically necessary. They’re provided through a TRICARE-authorized home health agency.
Important: These services require pre-authorization before you get them. Keep in mind, you may be charged separately for durable medical equipment, prosthetics, and specific drugs.
To qualify, you must:
- Be homebound (as certified by your provider)
- Need skilled, medically necessary care on a short-term basis
- Have a referral and a care plan
Do you have TFL? Medicare is the primary payer for most home health services (unless you live overseas). TRICARE is the secondary payer to limit your out-of-pocket costs.
Do you need medically necessary home health care beyond the services mentioned above? Check out the Extended Care Health Option Home Health Care program. This benefit is only available to ECHO registered members in the U.S. and U.S. territories.
Does TRICARE cover hospice care at home?
Hospice is a program of care and support if you’re terminally ill. The focus is on comfort, not on curing an illness.
TRICARE covers hospice care in the U.S. and U.S. territories if you get a referral and pre-authorization.
Some hospice care can be delivered in a hospital or nursing facility. But TRICARE also covers home hospice care. This includes:
- Supportive services, including pain control and counseling services
- Home health aide services
- Personal comfort items
There are four levels of hospice care. Two can be delivered at home, including:
- Continuous home care
- Routine home care
Visit Hospice Care to learn more.
What about TRICARE Pharmacy Home Delivery?
TRICARE Pharmacy Home Delivery is a convenient option for getting your long-term or maintenance medications delivered directly to your home. This program is managed by the TRICARE Pharmacy Program contractor,
Express Scripts. This program offers:
- 90-day supplies for most maintenance medications
- Free standard shipping
- Automatic refill reminders
- Lower out-of-pocket costs for some drugs
This benefit is available to all eligible TRICARE beneficiaries. This includes those with TFL, as described in the TRICARE Pharmacy Program Overview Fact Sheet. (Note: You aren’t eligible for the TRICARE Pharmacy Program if you have coverage through the US Family Health Plan.) Make sure a TRICARE-authorized provider writes your prescriptions and that the medications are on the TRICARE Formulary.
How to get started
- Home health care: Talk to your provider. They’ll determine if you qualify and refer you to a TRICARE-authorized provider.
- Hospice care: Discuss your options with your provider and request pre-authorization from your TRICARE contractor.
- TRICARE Pharmacy Home Delivery: Register online or sign in to your Express Scripts account. You can transfer eligible prescriptions and set up pharmacy home delivery. (Note: You can also register by phone or mail. Visit How to Register for Home Delivery to learn more.)
Whether you need short-term nursing help or your medications delivered to your door, TRICARE covers services that help meet your health needs. Learn more about home health care.
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