TRICARE Not Covered: Exclusions & Non-Covered Services | TRICARE.com

*TRICARE.com is an independent reference site and is not a government agency. For official policy and enrollment, visit TRICARE.mil.*

## Quick answer TRICARE does not cover services that are not medically necessary, are considered "investigational," or are not proven safe and effective by the FDA. Major exclusions include most cosmetic surgeries, unproven holistic treatments, and nursing home care (long-term custodial care).

Details

TRICARE follows strict federal law (Title 10, U.S. Code) which mandates that coverage only extends to services and supplies that are "medically or psychologically necessary." If a procedure is deemed elective or experimental, it will likely be denied.

### Major Exclusions (Not Covered) * **Custodial Care:** This is the most common point of confusion. TRICARE does not pay for long-term care or nursing home stays where the primary goal is assistance with "activities of daily living" (bathing, dressing, eating). * **Cosmetic Surgery:** Procedures intended solely to improve appearance (e.g., elective facelifts, breast augmentations, or liposuction) are not covered unless they are reconstructive for a congenital anomaly or following a mastectomy/trauma. * **Experimental/Investigational Treatments:** TRICARE will not pay for drugs, devices, or medical treatments that have not been fully approved by the FDA or lack clinical evidence of efficacy. * **Holistic and Alternative Medicine:** Services like acupuncture (except under specific pain management pilots), dry needling, massage therapy, and herbal supplements are generally excluded. * **LASIK and PRK:** While available to active duty members through military treatment facilities (MTFs) on a space-available basis, these "vision correction" surgeries are generally not covered for dependents or retirees under TRICARE Prime or Select. * **Gym Memberships:** TRICARE does not pay for fitness club memberships or personal trainers.

### Exclusions with Exceptions * **Weight Loss Services:** TRICARE does not cover "weight loss programs" like Weight Watchers or Jenny Craig. However, it *does* cover medically supervised bariatric surgery if specific BMI and health criteria are met (2026 guidelines). * **Dental Care:** Routine dental care is not part of the standard TRICARE medical benefit. It requires a separate premium-based plan: the **TRICARE Dental Program** (for active duty families/reservists) or the **FEDVIP** program (for retirees).

### Costs of Non-Covered Services If you receive a service that is not covered, you are responsible for **100% of the cost**. Providers are required to inform you if a service isn't covered via a "Notice of Non-Coverage." If you sign this notice and proceed, you cannot appeal the bill to TRICARE.

## Who this affects * **Active Duty Service Members (ADSMs):** Generally have the fewest exclusions but still require referrals for all non-emergency care. * **Active Duty Family Members (ADFMs):** Affected most by exclusions on elective procedures and alternative therapies. * **Retirees and Families:** Heavily impacted by the exclusion of long-term custodial care. * **National Guard and Reserve:** Affected by the same medical necessity standards as active duty families when on TRICARE Reserve Select.

## Sources * **TRICARE.mil:** [Exclusions - What's Not Covered](https://www.tricare.mil/CoveredServices/IsItCovered/Exclusions) * **Humana Military (East):** [Medical Necessity and Coverage](https://www.humanamilitary.com/provider/education-and-resources/quick-access/policy-and-benefits) * **TriWest Healthcare Alliance (West):** [Provider Specifics and Exclusions](https://www.triwest.com) * **Defense Health Agency (DHA):** [Bariatric Surgery Policy](https://health.mil)