Home Health Care | TRICARE Glossary & Coverage Rules | TRICARE.com

TRICARE.com is an independent reference site and is not the official TRICARE program; for official policy and current rates, please visit TRICARE.mil.

## Definition Home health care is a benefit that provides medically necessary skilled nursing, therapy services, or home health aide assistance to homebound beneficiaries in their own residence.

## What it means in practice For TRICARE beneficiaries, home health care is designed to help patients recover from an acute illness or injury, or to manage a chronic condition, without requiring long-term hospitalization or a stay in a skilled nursing facility. To qualify, a patient must be considered "homebound," meaning it is very difficult or physically taxing for them to leave their home, and the care must be ordered by a doctor as part of a formal plan of care.

Under the TRICARE benefit, services typically include skilled nursing care (such as wound care or catheter changes), physical therapy, occupational therapy, and speech-language pathology. If a patient is receiving one of these skilled services, TRICARE may also cover a home health aide to assist with "activities of daily living" like bathing or dressing. However, TRICARE does not cover "custodial care" (long-term help with daily tasks) if that is the *only* care required.

As of 2026, TRICARE uses a Prospective Payment System (PPS) similar to Medicare. For most active duty service members and their families, there is a $0 copayment for authorized home health care services. For retirees and others, cost-shares are typically $0 for the services themselves, though durable medical equipment (DME) used in the home may require a separate 20% cost-share depending on the plan.

All home care requires prior authorization from your regional contractor (Humana Military in the East or TriWest Healthcare Alliance in the West). The provider must be a TRICARE-authorized, Medicare-certified Home Health Agency (HHA).

## Related terms * **Homebound:** A status where a patient’s condition makes leaving the home difficult, requiring a taxing effort or the assistance of another person or device. * **Custodial Care:** Non-skilled personal care (bathing, eating, dressing) that is not covered by TRICARE if it is the only type of care needed. * **Prior Authorization:** A mandatory requirement to get approval from Humana Military or TriWest before receiving home health services. * **Skilled Nursing:** Medical care provided by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) that requires professional training to perform safely. * **Durable Medical Equipment (DME):** Medical tools like wheelchairs, oxygen tanks, or hospital beds used in the home to facilitate recovery.

## Sources * TRICARE.mil - Home Health Care: https://www.tricare.mil/CoveredServices/IsItCovered/HomeHealthCare * TRICARE Policy Manual: https://manuals.health.mil/ * TriWest Healthcare Alliance (West Region): https://www.triwest.com/