FALLS CHURCH, Va. –
You may know someone who uses a wheelchair or walker to get around, or a glucose monitor for their diabetes. These items are just a few of many useful items that TRICARE covers as
durable medical equipment.
“Durable medical equipment is a major part of managing health conditions at home, work, and in daily life, and TRICARE covers a wide range of products,” said Jennifer Stankovic, health systems specialist, TRICARE Health Plan, at the Defense Health Agency. “It’s a good idea to understand your TRICARE plan’s coverage of DME.”
Keep reading to learn more about how TRICARE covers DME.
Q: What is DME?
A: TRICARE defines DME as an item that can handle repeated use, has a medical purpose, is not usually helpful to someone who isn’t sick or injured. A few examples of DME are:
Q: When does TRICARE cover DME?
A: TRICARE only covers DME when it’s prescribed by a provider. The DME must:
- Help a body part work better, or to keep your condition from getting worse
- Help you function as well as possible
- Help you have the right level of performance and quality for your condition
TRICARE covers most breast pumps and breastfeeding supplies at no cost for new and expecting mothers.
Your regional contractor will either rent or buy your DME depending on its cost and your needs.
Q: Does TRICARE cover DME repairs, replacements, and maintenance?
A: TRICARE may cover repairs for DME you own. TRICARE covers DME replacement if:
- There’s a change in your physical condition
- The DME is damaged costs more to fix than to replace
- The DME no longer works and can’t be fixed
- The U.S. Food and Drug Administration says it no longer meets safety standards
You’ll need a prescription from your TRICARE-authorized provider for a replacement. TRICARE may also ask for other medical information, or documentation showing why the DME needs replacement.
TRICARE only covers regular maintenance like testing or cleaning the machine, when the manufacturer requires an expert to service the DME.
Q: How does TRICARE For Life cover DME?
A:If you have TRICARE For Life coverage, your plan follows
Medicare’s rules for getting DME, unless you live overseas (outside the U.S. and U.S. territories). Ask your DME supplier if they
participate in Medicare, since you’ll pay less if they do.
Note: TRICARE doesn’t cover certain non-medical equipment like bath rails or safety beds, but they may be covered by Medicare.
Check out Medicare.gov for more on DME coverage, including where to find DME equipment and suppliers.
Q: What kind of equipment doesn’t TRICARE cover?
A: TRICARE doesn’t cover equipment if:
- It has extra deluxe or luxury features. You may be able to choose to pay the extra cost for these features yourself.
- It isn’t just for medical use. For example, humidifiers, electric air cleaners, or smart watches.
- You could get the same equipment from a military hospital or clinic, if you’re enrolled at one.
- It’s provided for free by a facility where you’re a patient.
Q: What will I pay for DME under TRICARE?
A: Cost-sharing for DME varies depending on your TRICARE plan.
Network providers and suppliers often cost you less out of pocket than non-network providers and suppliers. Go to
TRICARE Health Plan Costs to look up your TRICARE plan’s cost-shares for DME.
Q: Where can I find more information?
A: If you have questions about what DME is covered, visit
TRICARE Covered Services. This list of covered services and supplies isn’t all-inclusive. If you have questions about coverage and costs or you need help finding a provider or supplier, call your TRICARE
regional contractor.
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