TRICARE Skilled Nursing Facility Coverage & Costs (2026) | TRICARE.com

*Note: TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy and the most current individual data, visit [TRICARE.mil](https://www.tricare.mil).*

## Quick answer TRICARE covers skilled nursing care in a specialized facility (SNF) when a doctor determines you require 24-hour medical supervision and daily skilled nursing or rehabilitation services. Coverage is generally limited to 100 days per "spell of illness" and requires prior authorization for most beneficiaries.

Details

### Coverage Requirements TRICARE will only pay for a Skilled Nursing Facility (SNF) if the stay meets specific criteria. It is not a benefit for "custodial care" (help with bathing, dressing, or eating). To qualify: * You must be under the care of a physician who has prescribed a plan of care. * You must require "skilled" services (e.g., intravenous injections, physical therapy, or complex wound care) that can only be performed by licensed nurses or therapists. * For TRICARE For Life (TFL) users, you must typically have a qualifying 3-day inpatient hospital stay prior to admission.

### The 100-Day Rule TRICARE generally follows Medicare guidelines regarding the length of stay. Coverage is limited to **100 days** per "spell of illness." A spell of illness usually ends when you have not received skilled care in a hospital or SNF for 60 consecutive days.

### Costs and Copays (2026 Rates) Costs vary significantly based on your plan and beneficiary status: * **Active Duty Service Members (ADSMs):** $0 out-of-pocket, but require a referral and authorization from their primary care manager (PCM). * **TRICARE Prime (Retirees/Families):** Usually $0 copayment for the covered 100 days, provided the facility is in-network and authorized. * **TRICARE Select (Group A):** For 2026, retirees may pay a per-diem rate (varies by year, typically around $25–$60 per day) or a flat specialty copay depending on the specific service provided. * **TRICARE For Life (TFL):** Medicare is the primary payer. TRICARE acts as the secondary payer. For days 1–20, Medicare usually pays 100%. For days 21–100, TRICARE typically covers the Medicare daily co-insurance.

### Regional Management Authorization for SNF stays is managed by the regional contractors: * **East Region:** Humana Military. * **West Region:** TriWest Healthcare Alliance (as of the T-5 contract start). * **Overseas:** International SOS.

### What is NOT Covered TRICARE does not cover: * **Custodial Care:** Long-term care for the elderly who simply need help with activities of daily living (ADLs) and do not require medical "skills." * **Private Rooms:** Unless medically necessary (e.g., for contagion control). * **Long-term residential nursing home stays:** Once the 100 days are exhausted or the patient no longer requires "skilled" rehabilitative care, TRICARE coverage ends.

## Who this affects * **Active Duty Service Members:** Covered with full authorization. * **Active Duty Family Members (ADFMs):** Covered under Prime and Select. * **Retirees and their families:** Covered, subject to plan-specific cost-shares. * **TRICARE For Life (TFL) beneficiaries:** Supplementing Medicare coverage for the first 100 days. * **National Guard and Reserve:** Covered if on active duty orders or enrolled in TRICARE Reserve Select (TRS).

## Sources 1. TRICARE.mil: [Skilled Nursing Facility Care Overview](https://www.tricare.mil/CoveredServices/IsItCovered/SkilledNursingFacilityCare) 2. Humana Military (East): [SNF Authorizations](https://www.humanamilitary.com/provider/authorizations/snf) 3. TriWest Healthcare Alliance (West): [West Region Provider Handbook](https://www.triwest.com) 4. TRICARE.mil: [Costs and Fees](https://www.tricare.mil/Costs)