TRICARE Nursing Home & Skilled Nursing Coverage Guide | TRICARE.com

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## Quick answer TRICARE does not pay for long-term "custodial care" in a nursing home, which includes assistance with daily living like eating, dressing, and bathing. However, TRICARE covers limited stays in a Skilled Nursing Facility (SNF) when you require professional medical care or rehabilitation following a hospital stay.

Details

TRICARE’s coverage of nursing facilities is strictly medical, not residential. Understanding the difference between "Skilled Nursing" and "Custodial Care" is essential for financial planning.

### Skilled Nursing Facility (SNF) Coverage TRICARE covers semi-private rooms and meals in a certified Skilled Nursing Facility if the following 2026 criteria are met: * **Medical Necessity:** You must require skilled nursing services or skilled rehabilitation services (like physical therapy) that can only be performed by clinical staff. * **Prior Hospitalization:** You must have been a hospital inpatient for at least three consecutive days (not including the discharge day) prior to the SNF admission. * **Timing:** You must be admitted to the SNF within 30 days of your hospital discharge. * **Pre-authorization:** TRICARE Prime beneficiaries require a referral and authorization from their Primary Care Manager (PCM). Select beneficiaries do not generally require authorization but the care must still be medically necessary.

### What is NOT Covered (Custodial Care) TRICARE is prohibited by law from paying for custodial care. This is defined as assistance with "activities of daily living" (ADLs), such as: * Bathing, dressing, and grooming. * Help with walking or getting in/out of bed. * Supervision for those with Alzheimer’s or dementia (unless there is a separate acute medical necessity). * Long-term residential placement.

### Costs and Plan Differences (2026) * **TRICARE For Life (TFL):** TFL acts as the secondary payer to Medicare. Medicare usually covers the first 20 days of SNF care at 100% and requires a co-insurance for days 21–100. TFL will typically cover that Medicare co-insurance. Beyond 100 days, Medicare coverage ends, and TRICARE generally does not step in to pay for continued stay. * **TRICARE Prime/Select:** Costs vary by beneficiary group (Group A vs. Group B). Retirees and their families typically pay a daily copayment for SNF care (check current 2026 rate schedules at TRICARE.mil/costs as these are adjusted annually). * **Active Duty Service Members (ADSM):** Coverage is 100% with no out-of-pocket costs, provided the care is coordinated through their military command and regional contractor (Humana Military in the East or TriWest in the West).

### Alternatives for Long-Term Care Since TRICARE does not cover long-term nursing home care, beneficiaries often look to: 1. **Medicaid:** A state-run program for those with limited income and assets. 2. **Federal Long Term Care Insurance Program (FLTCIP):** A separate insurance program available to federal employees and military members. 3. **VA Benefits:** Veterans may qualify for nursing home care through the VA if they meet specific service-connected disability ratings.

## Who this affects * **Retirees and their families:** Most likely to need SNF care; must navigate the 100-day Medicare limit. * **Active Duty Service Members:** Covered for recovery from injuries but not for terminal custodial care. * **Survivors:** Benefits mirror those of the retiree group. * **National Guard/Reserve:** Eligible for SNF care while on active duty orders or if enrolled in TRICARE Reserve Select (medical necessity rules apply).

## Sources * **TRICARE.mil:** Skilled Nursing Facility Care (https://www.tricare.mil/CoveredServices/IsItCovered/SkilledNursingFacilityCare) * **TRICARE.mil:** Custodial Care Policy (https://www.tricare.mil/CoveredServices/IsItCovered/CustodialCare) * **TriWest Healthcare Alliance (West Region):** (https://www.triwest.com) * **Humana Military (East Region):** (https://www.humanamilitary.com)