Does TRICARE pay for everything?

No, TRICARE does not cover everything. It covers services that are considered medically necessary and proven safe and effective, but it has several notable exclusions and limits.

What TRICARE Excludes

• Routine Dental and Vision: Most standard plans do not cover routine adult dental care (cleanings and fillings) or routine eye exams, glasses, and contact lenses for dependents. (Separate vision and dental plans can be purchased through FEDVIP).
• Cosmetic and Elective Procedures: Surgeries done purely to change your appearance—such as standard liposuction, cosmetic rhinoplasty, or hair restoration—are not covered.
• Alternative Therapies: Most alternative treatments like acupuncture, massage therapy, and naturopathy are largely excluded.
• Custodial Care: Long-term nursing home or assisted living care focused on assistance with daily living activities rather than skilled medical nursing is not covered.
• Certain Weight Loss or Fertility Services: Weight loss programs and bariatric surgery require strict criteria to be met, and other categories like routine fertility treatments are generally restricted.

How to Check Coverage

You can verify if a specific doctor, treatment, or prescription drug is included by using official tools:

• Search for specific procedures using the Covered Services Tool.
• Look up medications using the TRICARE Formulary Search Tool.

No, not everything is free with TRICARE. While TRICARE offers excellent coverage and many preventative services cost nothing out of pocket, your actual costs depend on your military status, the specific plan you choose, and where you receive care.

Active-duty service members pay nothing for their healthcare, but family members, retirees, and reserve components often have various out-of-pocket costs.

Summary of Costs by Plan Category

What is Usually Free?

• Preventative Care: Routine immunizations, cancer screenings, and annual well-child exams generally have $0 copays for all plans when seeing a network provider.
• Active Duty Healthcare: Active duty service members (ADSMs) have full coverage with zero out-of-pocket costs for all medically necessary care.

What Usually Costs Money?

• Prescriptions: While medications filled at military pharmacies are free, you will pay a copay if you use the TRICARE Home Delivery mail-order program or a retail network pharmacy.
• Non-Covered Services: TRICARE does not pay for services that are not medically necessary. This includes cosmetic surgery, laser eye surgery (for dependents/retirees), and most holistic or alternative therapies.
• Dental and Vision: Routine dental and vision care are handled under separate premium-based dental programs (like FEDVIP) for family members and retirees, meaning they are not automatically free.
• Retiree Healthcare: Once a service member retires, they and their families transition to retiree status, which introduces higher enrollment fees, deductibles, and copays.

TRICARE does not pay for services, drugs, or treatments that are not considered medically necessary, as well as specific categories of routine and elective care.

Common TRICARE Exclusions

• Cosmetic and Elective Procedures: Surgery or treatments done purely to change appearance (such as routine rhinoplasty, liposuction, or hair restoration) are excluded.
• Routine Dental Care: Standard dental cleanings, fillings, and orthodontics for dependents are not covered under standard health plans and require a separate plan like the TRICARE Dental Program.
• Routine Vision Care: Routine eye exams, eyeglasses, frames, and contact lenses are generally not covered for retirees or dependents.
• Weight Loss and Fertility Drugs: Medications or programs for weight loss and fertility treatments are largely excluded, with narrow exceptions.
• Alternative Therapies: Treatments like acupuncture (with rare exceptions), naturopathy, homeopathy, and most massage or chiropractic therapies are excluded.
• Custodial Care: Long-term personal care or assistance with daily living activities in a nursing home or assisted living facility (when skilled nursing is not required) is not covered.
• Experimental Treatments: Any medical procedure, device, or cancer treatment not proven effective or not approved by the FDA is excluded.

TRICARE covers 100% of medically necessary care for active-duty service members, while coverage for family members, retirees, and reservists depends on the specific plan chosen. TRICARE generally pays for doctor visits, hospitalizations, surgeries, vaccinations, and prescription medications, but your actual out-of-pocket costs will vary.

TRICARE splits beneficiaries into Group A (joined before Jan 1, 2018) and Group B (joined on or after Jan 1, 2018).

Quick Comparison of Out-of-Pocket Costs

The exact amount TRICARE covers depends heavily on whether you choose a managed care plan (Prime) or a fee-for-service plan (Select). Below are the standard network costs for retirees and their families:

The "Catastrophic Cap" Safety Net

TRICARE features a powerful safety limit called the Catastrophic Cap. Once your out-of-pocket spending on deductibles and copays reaches this threshold in a single calendar year, TRICARE covers 100% of all allowable costs for the remainder of that year.

• Active-Duty Families: The maximum cap is much lower, ranging from $1,000 to $1,324 per year.
• Retirees: The maximum cap ranges from $3,000 to $4,635 per year depending on the specific plan and Group designation.

Pharmacy and Prescription Coverage

TRICARE covers prescription medications through the TRICARE Pharmacy Program:

• Military Pharmacies: 100% covered ($0 copay) for all beneficiary types.
• Home Delivery & Retail Network: Active-duty members pay $0. All other beneficiaries pay small fixed copays based on whether the drug is generic, brand-name, or non-formulary.

To look up exact details for your specific category and tier, you can use the official TRICARE Compare Costs Tool.

TRICARE is widely considered exceptionally worth it due to its significantly lower premiums, deductibles, and out-of-pocket costs compared to civilian health insurance.

Financial Value

• Active-Duty Coverage: TRICARE Prime for active-duty members and their families features $0 enrollment fees, $0 premiums, and $0 deductibles for care at military treatment facilities.
• Civilian Equivalents: Comparable civilian family health coverage often runs $600 to $2,000 per month in premiums, plus thousands more in annual deductibles, translating to an estimated $15,000 to $25,000 per year in equivalent savings.
• Reserve and Retiree Options: Programs like TRICARE Reserve Select offer affordable monthly premiums that heavily undercut private market alternatives, while TRICARE For Life provides robust secondary coverage alongside Medicare. As outlined in TRICARE Costs vs. Civilian Health, factoring in $0 or low-cost TRICARE often completely shifts the financial value of military service compared to civilian compensation. Additional details on historical savings can be explored in TRICARE: Another Reason to Stay.

Pros and Cons by Plan

• TRICARE Prime: Offers low or no out-of-pocket costs and coordinated care through a Primary Care Manager (PCM), but requires strict referrals for specialty care and limits provider choice.
• TRICARE Select: Features greater freedom to see any authorized provider without a referral, but introduces annual deductibles and standard cost-shares or copayments.