TRICARE DME: Durable Medical Equipment Coverage & Costs | TRICARE.com

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## Definition Durable Medical Equipment (DME) refers to medical devices and tools that can withstand repeated use, serve a medical purpose, and are generally not useful to a person in the absence of illness or injury.

## What it means in practice For TRICARE beneficiaries, DME coverage is essential for managing chronic conditions, recovering from surgery, or maintaining mobility. To qualify for coverage, the equipment must be ordered by a TRICARE-authorized provider and meet three high-level criteria: it must be primarily used for a medical purpose, it must be able to withstand repeated use, and it must be medically necessary. Common examples include wheelchairs, hospital beds, oxygen concentrators, and CPAP machines.

Navigating the costs of DME depends on your plan and sponsor status. For **TRICARE Prime** retirees and their families, there is typically a 20% cost-share for DME (2026 rates). Active duty service members (ADSMs) generally have $0 out-of-pocket costs for DME, provided they have a referral and authorization. For **TRICARE Select** beneficiaries in Group A, the cost-share is often 20% of the allowed amount after the annual deductible is met. It is important to note that TRICARE will only pay for the "basic" model that meets the patient's needs; if you want a "deluxe" version with extra features, you may be responsible for the price difference.

As of 2026, the region you live in dictates which contractor manages your DME authorizations. In the **East Region**, Humana Military provides these services. In the **West Region**, TriWest Healthcare Alliance manages authorizations and the provider network. Because DME often requires "prior authorization," you should ensure your doctor submits the necessary paperwork to the regional contractor before you purchase or rent the equipment. Choosing a network provider is critical; if you go out-of-network, your costs could be significantly higher or the claim could be denied entirely.

## Related terms * **Medical Necessity:** The standard used to determine if a service or piece of equipment is required to diagnose or treat a condition according to accepted medical practice. * **Prior Authorization:** A requirement to get approval from your TRICARE regional contractor (Humana or TriWest) before receiving certain services or equipment. * **Cost-Share:** The percentage of the TRICARE-allowed amount you pay out-of-pocket after meeting your deductible. * **TRICARE-Authorized Provider:** A healthcare provider or medical supply company that has met TRICARE's licensing and certification requirements. * **Prosthetic:** A specialized category of medical equipment designed to replace a missing body part, such as an artificial limb.

## Sources * TRICARE.mil - Durable Medical Equipment: https://www.tricare.mil/CoveredServices/IsItCovered/DME * Humana Military (TRICARE East): https://www.humanamilitary.com/ * TriWest Healthcare Alliance (TRICARE West): https://www.triwest.com//