What Does TRICARE Cover? 2026 Benefits Guide | TRICARE.com

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## Quick answer TRICARE covers services that are "medically necessary and appropriate," including doctor visits, hospitalization, preventive care, and prescription drugs. While it covers most standard medical treatments, it generally excludes cosmetic surgery, experimental treatments, and non-prescription vitamins.

Details

TRICARE coverage is standardized across major plans like Prime and Select, but out-of-pocket costs vary based on your status (Active Duty vs. Retiree) and your assigned group (Group A vs. Group B).

### Covered Medical Services * **Preventive Care:** Includes annual wellness exams, immunizations, cancer screenings (mammograms, colonoscopies), and well-child care. For most beneficiaries, these have a $0 copay. * **Outpatient Care:** Routine office visits to primary care managers (PCMs) or specialists. Under TRICARE Prime, active duty family members typically pay $0 for clinical visits. * **Inpatient Care:** Hospital stays, surgeries, and labor and delivery. * **Mental Health:** Inpatient and outpatient mental health services, รวมถึง substance use disorder treatment, are covered. No referrals are required for many outpatient mental health visits for non-active duty beneficiaries. * **Prescriptions:** Managed by Express Scripts. Coverage is divided into Generic, Brand Name (Formulary), and Non-Formulary tiers.

### 2026 Cost Examples (Group B) As of 2026, costs depend on your plan type. For TRICARE Select (Retirees): * **Primary Care Visit:** Approximately $38 - $40 per visit. * **Specialty Care Visit:** Approximately $52 - $55 per visit. * **Emergency Room:** Approximately $145 - $150 per visit. *(Note: Active Duty Service Members have $0 out-of-pocket costs for all covered services).*

### Ancillary and Durable Medical Equipment (DME) TRICARE covers items like wheelchairs, hospital beds, and oxygen equipment if prescribed by a physician. It also covers "ancillary" services like laboratory tests and X-rays required for diagnosis.

### What is NOT Covered * **Cosmetic Surgery:** Unless required due to a congenital anomaly, accidental injury, or mastectomy. * **Experimental Treatments:** Procedures or drugs not yet proven safe and effective by the FDA or medical consensus. * **LASIK/Refractive Surgery:** Generally not covered for family members or retirees, though available to active duty members through military treatment facilities (MTFs). * **Custodial Care:** Long-term care for activities of daily living (bathing, dressing) is not a TRICARE benefit.

## Who this affects * **Active Duty Service Members (ADSMs):** Full coverage with zero out-of-pocket costs. * **Active Duty Family Members (ADFMs):** Comprehensive coverage; costs vary by Prime vs. Select. * **Retirees and their Families:** Coverage continues, but enrollment fees and higher copays apply. * **National Guard and Reserve:** Covered via TRICARE Reserve Select (TRS) while in a qualified status. * **Survivors:** Benefits continue for spouses and children of deceased service members.

## Sources 1. **TRICARE.mil:** Is It Covered? [https://www.tricare.mil/coveredservices](https://www.tricare.mil/coveredservices) 2. **Defense Health Agency (DHA):** TRICARE Plans Overview [https://health.mil/](https://health.mil/) 3. **Express Scripts:** TRICARE Pharmacy Home [https://www.express-scripts.com/tricare](https://www.express-scripts.com/tricare) 4. **TriWest Healthcare Alliance:** West Region Portal [https://www.triwest.com](https://www.triwest.com)