TRICARE Coverage for Skilled Nursing: 2026 Rules & Costs | TRICARE.com

*Notice: TRICARE.com is an independent reference site and is not the official TRICARE program or affiliated with the Department of Defense. For official policy, visit TRICARE.mil.*

## Quick answer Yes, TRICARE covers skilled nursing facility (SNF) care when it is medically necessary and follows a hospital stay of at least three consecutive days. This coverage includes a room, meals, nursing care, and rehabilitation services, provided the facility is TRICARE-certified.

Details

TRICARE’s coverage for Skilled Nursing Facilities (SNF) mimics the Medicare benefit structure but includes specific requirements for eligibility and duration.

### Requirements for Coverage To qualify for SNF coverage in 2026, the following criteria must be met: * **Three-Day Prior Stay:** The patient must have been admitted to a hospital as an inpatient for at least three consecutive days (not counting the day of discharge). * **Medical Necessity:** A physician must certify that the patient requires daily "skilled" nursing or specialized rehabilitative services (like physical or occupational therapy) that can only be provided in a SNF. * **Timeliness:** Entry into the SNF must generally occur within 30 days of discharge from the hospital. * **Certified Facility:** The facility must be TRICARE-authorized.

### How Long Coverage Lasts TRICARE generally covers up to **100 days** of skilled nursing care per "spell of illness." * **Days 1–20:** TRICARE typically pays 100% of the allowed amount (subject to plan-specific enrollment if applicable). * **Days 21–100:** Beneficiaries may be responsible for a daily copayment. * **Beyond 100 Days:** TRICARE typically stops paying for SNF care after day 100. At this point, the care is often classified as "custodial care" (assistance with daily living like bathing or dressing), which TRICARE does not cover.

### 2026 Costs and Copays Costs vary based on the beneficiary’s plan and sponsor status. Under the 2026 fee schedule: * **Active Duty Service Members (ADSM):** $0 out-of-pocket, but require a referral and authorization. * **TRICARE Prime (Retirees/Families):** Generally $0 for the first 20 days; for days 21–100, retirees may pay a daily copay (approximately $210–$215 per day in 2026, though exact rates vary by Group A vs. Group B status—check your specific Humana Military or TriWest portal for the exact 2026 cent-rate). * **TRICARE Select:** Beneficiaries pay a daily copay or a percentage of the allowed amount after the annual deductible is met.

### The "Custodial Care" Exclusion The most common reason for a claim denial is the transition from "skilled" care to "custodial" care. If a patient is no longer showing progress in therapy or no longer requires a licensed nurse for daily treatments, TRICARE will deem the stay custodial. TRICARE **does not cover** long-term nursing home stays for custodial purposes.

## Who this affects * **Active Duty Service Members:** Full coverage, but requires coordination through Primary Care Manager (PCM). * **Active Duty Family Members:** Covered under Prime or Select. * **Retirees and their Families:** Covered, but subject to daily copays after day 20. * **TRICARE For Life (TFL) Users:** TFL acts as secondary payer to Medicare for SNF care. * **National Guard/Reserve:** Covered if on active duty orders or enrolled in TRICARE Reserve Select.

## Sources 1. TRICARE.mil: Skilled Nursing Facility Care (https://www.tricare.mil/CoveredServices/IsItCovered/SkilledNursingFacilityCare) 2. Humana Military (East Region): SNF Authorization Requirements (https://www.humanamilitary.com) 3. TriWest Healthcare Alliance (West Region): Provider Guide for SNF (https://www.triwest.com) 4. Defense Health Agency (DHA): TRICARE Policy Manual 6010.60-M (https://manuals.health.mil)