Does TRICARE Cover Prosthetics? (2026 Rates & Rules) | TRICARE.com

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## Quick answer Yes, TRICARE covers prosthetic devices and prosthetic supplies when they are prescribed by a physician to replace or support a missing or non-functioning body part. Coverage generally includes artificial limbs, eyes, and certain breast prostheses, provided they are medically necessary and obtain any required prior authorizations.

Details

TRICARE coverage for prosthetics is comprehensive but hinges on the definition of **medical necessity**. TRICARE typically covers the most cost-effective device that meets the patient’s functional needs.

### What is Covered * **Artificial Limbs:** Includes legs, arms, and hands. * **Artificial Eyes:** Coverage for both the device and the fitting. * **Breast Prostheses:** Covered following a mastectomy or for certain congenital anomalies. * **Initial Training:** TRICARE covers the professional services required to train the beneficiary on how to use the prosthetic. * **Repair and Replacement:** TRICARE covers the repair of a prosthesis if it remains cost-effective compared to replacement. Replacement is covered if the device is lost, irreparably damaged, or if the beneficiary’s physiological condition changes (e.g., growth in a child or change in the residual limb).

### Costs and Plan Variations (2026 Rates) As of 2026, costs for prosthetics depend on your beneficiary category and plan type:

* **Active Duty Service Members (ADSMs):** $0 out-of-pocket for all medically necessary prosthetics. ADSMs have access to specialized "Advanced Rehabilitation Centers" within the Military Health System. * **TRICARE Prime (Retirees/Families):** Generally $0 out-of-pocket if seen at a Military Treatment Facility (MTF). If using a network provider, retirees may owe a copayment or cost-share once their deductible is met. * **TRICARE Select:** Beneficiaries usually pay a percentage (cost-share) of the allowed amount for durable medical equipment (DME) and prosthetics. For 2026, Group A retirees typically pay 20% of the TRICARE-allowed amount after meeting their deductible. * **Point of Service (POS):** If you use the POS option to see a non-network provider for a prosthetic without a referral, expectation of costs is significantly higher (usually a 50% cost-share).

### Exclusions and Limitations TRICARE generally does **not** cover: * Prosthetics used solely for exercise or specialized sports (though exceptions sometimes exist for Active Duty members through specialized programs). * Purely cosmetic devices that do not improve function. * Duplicate "backup" prosthetics for the same body part (unless medically justified).

### Authorization Requirements In the **East Region (Humana Military)** and the **West Region (TriWest Healthcare Alliance)**, high-cost prosthetic items usually require **prior authorization**. Your provider must submit clinical documentation to the regional contractor proving that the specific device is necessary for activities of daily living.

## Who this affects * **Active Duty Service Members:** Comprehensive coverage with no out-of-pocket costs. * **Retirees and Family Members:** Covered, but subject to plan-specific cost-shares and deductibles. * **National Guard and Reserve:** Covered under TRICARE Reserve Select (TRS) or TAMP, typically following TRICARE Select cost-sharing rules. * **Survivors:** Benefits remain available based on the status of the sponsor at the time of death.

## Sources * **TRICARE.mil:** [Prosthetics Coverage Overview](https://tricARE.mil/CoveredServices/IsItCovered/Prosthetics) * **Humana Military (East):** [Durable Medical Equipment and Prosthetics](https://www.humanamilitary.com/provider/education-and-resources/quick-reference/medical-necessity) * **TriWest Healthcare Alliance (West):** [Provider Resources and Authorizations](https://www.triwest.com) * **Defense Health Agency (DHA):** [TRICARE Policy Manual 6010.60-M](https://manuals.health.mil)