TRICARE Durable Medical Equipment (DME) Coverage & Costs | TRICARE.com

*Note: TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy and coverage determinations, visit TRICARE.mil.*

## Quick answer TRICARE covers Durable Medical Equipment (DME) when it is medically necessary, prescribed by a provider, and used to improve a specific medical condition. This includes items like wheelchairs, CPAP machines, and hospital beds, though most expensive equipment requires prior authorization and must be obtained from a TRICARE-authorized provider.

Details

### What Qualifies as DME? To be covered by TRICARE, the equipment must meet several strict criteria. It must be able to withstand repeated use, serve a medical purpose, and generally not be useful to someone who isn't sick or injured.

Commonly covered items include: * **Mobility Aids:** Wheelchairs, walkers, and crutches. * **Respiratory Equipment:** CPAP/BiPAP machines, oxygen concentrators, and nebulizers. * **Home Items:** Hospital beds, patient lifts, and bedside commodes. * **Monitoring Gear:** Blood glucose monitors (for diabetics) and heart monitors.

### The Prior Authorization Requirement For most beneficiaries—especially those in TRICARE Prime—any DME item costing more than a specific threshold (often $2,000 or more) or requiring custom fitting (like power wheelchairs) requires **prior authorization**. Your regional contractor (Humana Military in the East; TriWest Healthcare Alliance in the West) must approve the medical necessity before you purchase or rent the item.

### Renting vs. Buying TRICARE generally follows Medicare guidelines regarding "rent-to-own" equipment. For many items, TRICARE will pay a monthly rental fee. Once the total rental payments reach the purchase price of the equipment, the equipment is considered "bought" and belongs to the beneficiary.

### 2026 Costs and Copayments Your out-of-pocket costs for DME depend on your plan and beneficiary status. While Active Duty Service Members (ADSMs) pay $0 for DME, others generally have a cost-share:

* **TRICARE Prime (Retirees/Family):** Typically a 20% cost-share of the TRICARE-allowed amount (2026 rates). * **TRICARE Select (Group A):** 20% cost-share after the deductible is met (2026 rates). * **TRICARE Select (Group B):** 20% cost-share after the deductible is met (2026 rates). * **TRICARE For Life:** TRICARE pays second to Medicare. If Medicare covers the DME, TRICARE typically covers the remaining 20% coinsurance.

### Exclusions (What is NOT covered) TRICARE will not pay for: * **Luxury or Convenience Items:** Electric scooters used solely for long distances, or deluxe versions of equipment when a standard version meets medical needs. * **Home Modifications:** Ramps, widened doors, or elevators. * **Exercise Equipment:** Treadmills or stationary bikes, even if recommended by a doctor.

## Who this affects * **Active Duty Service Members:** 100% coverage with no out-of-pocket costs; requires PCM referral. * **Active Duty Family Members (ADFMs):** Covered under Prime or Select; authorization is key to minimizing costs. * **Retirees and their Families:** Subject to cost-shares and deductibles based on their specific plan. * **National Guard and Reserve:** Covered via TRICARE Reserve Select (TRS) or TRICARE Retired Reserve (TRR) with standard cost-shares. * **TRICARE For Life (TFL) Beneficiaries:** Coverage follows Medicare’s lead for DME.

## Sources * **TRICARE.mil:** [Durable Medical Equipment Overview](https://www.tricare.mil/CoveredServices/IsItCovered/DME) * **Humana Military (East):** [DME Authorizations and Costs](https://www.humanamilitary.com/provider/education-and-resources/quick-reference-guides/dme) * **TriWest Healthcare Alliance (West):** [Provider DME Guidelines](https://www.triwest.com/en/provider/medical-management/prior-authorizations/) * **Defense Health Agency (DHA):** [TRICARE Policy Manual Chapter 8](https://manuals.health.mil/)