TRICARE Home Health Care: Coverage, Costs, and Rules | TRICARE.com

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## Quick answer TRICARE covers home health care services when a doctor prescribes them for patients who are homebound due to illness or injury. These services include part-time or intermittent skilled nursing care, physical therapy, and home health aide services, usually provided by a Medicare-certified Home Health Agency (HHA).

Details

TRICARE uses a **Prospective Payment System (PPS)** to cover home health services, which pays a fixed amount for each 30-day "episode" of care. To qualify, the care must be medically necessary, and the patient must be unable to leave their home without a "taxing effort."

### Covered Home Health Services If you meet the criteria for being homebound, TRICARE typically covers: * **Skilled Nursing Care:** Part-time or intermittent care provided by a Registered Nurse (RN) or Licensed Practical Nurse (LPN). * **Therapy Services:** Physical, occupational, and speech-language pathology services. * **Home Health Aides:** Assistance with "activities of daily living" (ADLs) like bathing or dressing, but only if the patient is also receiving skilled nursing or therapy services. * **Medical Social Services:** Counseling and social work related to the patient’s medical condition. * **Medical Supplies:** Basic supplies like wound dressings related to the home health treatment.

### Costs and Plan Variations (2026 Rates) Costs depend on your beneficiary status and the TRICARE plan you are enrolled in:

* **Active Duty Service Members (ADSMs):** $0 out-of-pocket for all authorized home health care. ADSMs must have a referral and prior authorization. * **TRICARE Prime (All Categories):** Generally $0 out-of-pocket for authorized home health services from network providers. * **TRICARE Select (Group A & B):** Retirees and family members may be responsible for cost-shares or a percentage of the allowed amount once the annual deductible is met. For 2026, many retirees pay a 20-25% cost-share for "Other Professional Services," though specific home health episodes are often bundled. * **TRICARE For Life (TFL):** Because Home Health is a Medicare-covered benefit, Medicare acts as the primary payer. TRICARE acts as the secondary payer, often resulting in $0 out-of-pocket for the beneficiary, provided the HHA is Medicare-certified.

### The Home Health Agency (HHA) Requirement To be covered, the provider must be a **Medicare-certified Home Health Agency**. Under the T-5 regional contracts (effective 2025/2026), your regional contractor—**Humana Military** in the East or **TriWest Healthcare Alliance** in the West—must authorize the care before it begins.

### What is NOT Covered TRICARE does not cover: * Full-time nursing care (24/7). * "Custodial care" (assistance with daily living) when it is the *only* care needed. * Meals delivered to the home ("Meals on Wheels"). * Homemaker services like shopping, cleaning, or laundry.

## Who this affects * **Active Duty Service Members (ADSMs):** Always requires prior authorization. * **Active Duty Family Members (ADFMs):** Covered under Prime and Select. * **Retirees and their Families:** Includes those on TRICARE Select and TRICARE For Life. * **National Guard/Reserve:** Members on active duty or enrolled in TRICARE Reserve Select (TRS). * **Survivors:** Eligible family members of deceased service members.

## Sources * **TRICARE.mil:** [Home Health Care Overview](https://tricARE.mil/CoveredServices/IsItCovered/HomeHealthCare) * **Humana Military (TRICARE East):** [Provider Requirements for Home Health](https://www.humanamilitary.com) * **TriWest Healthcare Alliance (TRICARE West):** [Authorization and Referrals](https://www.triwest.com) * **Medicare.gov:** [Home Health Services Basics](https://www.medicare.gov)