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Who and What is Not Covered ?

Who and What is Not Covered ?

This section states which health care facilities or equipment are not covered and Who and What is Not Covered by TRICARE. Furthermore, you can also find out whether you are eligible for TRICARE health care plans or not.

Who is Not Covered ?

The previous section discusses exactly who is covered by TRICARE plans. By default, this means that anyone who falls outside of those categories is not covered by TRICARE plans. For example, since an ex-spouse who has not remarried still remains eligible, this implies that if a person’s former spouse has remarried, then he or she is no longer eligible to receive TRICARE benefits. In addition to this, the parents-in-law and parents of an individual who is still in service or who has retired are not considered to be eligible for having access to the benefits provided by the TRICARE program. Furthermore, any individual who can be considered to be eligible to receive health benefits under the system of CHAMPVA, which is the Civilian Health and Medical Program of the Department of Veteran Affairs, is not considered to be eligible for TRICARE.

Which Treatments and Supplies Are Not Covered?

TRICARE will cover the cost of any treatment or supply that is considered to be essential for the medical needs or psychological needs of an individual. However, if a certain supply or procedure is not considered to be fundamental for the betterment of an individual (physically or mentally), then it is possible that that particular treatment or supply is not covered by the individual’s TRICARE plans. Therefore, this means that if, for example, a certain procedure is not considered to be absolutely necessary to diagnose a certain illness or to treat a certain illness or injury (which is otherwise covered by TRICARE); then chances are that an individual’s TRICARE plan will not cover this treatment.

In addition to this, TRICARE will not cover the cost of any medical treatments, procedures or supplies that are used for the treatment of a medical condition or an injury that is otherwise not covered by TRICARE plans.

There are certain services that are not covered by TRICARE plans at all. This includes acupuncture, alterations to living space and any alternative treatments. TRICARE does not cover the costs incurred if an individual chooses to go for assisted living facilities, or for various other assistance or care facilities, such as custodial care, long term care services, domiciliary care, residence and everyday living expenses incurred at nursing homes, or lodging and board at nursing homes.

The TRICARE health care program does not cover the cost of various medical devices, such as devices to monitor an individual’s blood pressure, any elective supplies, equipment for exercise or the installation of chair lifts and elevators for individuals who have trouble moving around easily. There are certain drugs that are not covered by the TRICARE health care system; these include drugs or products that are used in weight loss programs, any megavitamins or multivitamins that a person may wish to take, herbal concoctions or homeopathic drugs, fluoride preparations or drugs that are used for cosmetic purposes. In fact, the TRICARE health care system does not provide coverage for any procedure, treatment or drug that is meant for cosmetic purposes (such as reshaping the nose). For example, the TRICARE health care program will not cover treatments such as augmentation mammoplasty, laser hair removal or LASIK surgery. The only exception to this case is cosmetic treatment that has to take place to correct any disfigurement that may be caused in an individual due to an accident (such as a fire).

In addition to this, although the TRICARE health care program does provide coverage for certain treatments, therapies or diagnostic procedures for mental health disorders that are considered to be absolutely necessary for the individual, some services do not fall within the umbrella of the TRICARE health care plans that are available to people. At present, the mental health care facilities and benefits that individuals with TRICARE plans have access to are such that they do not cater to learning disorders.

In addition, individuals do not have access to any sort of mental health counseling or therapy services in case they wish to be treated for any sexual inadequacies or malfunctions that they may be facing. Other psychological treatment options that are not included in the TRICARE health care plans currently include mind expansion psychotherapy, treatment for dyslexia and elective psychotherapy.

Aversion therapy is also not covered by TRICARE. The treatments that are, in general, covered for by the TRICARE health care system also involve certain rules and regulations. For example, the TRICARE system may only cover therapy for up to a certain number of days. After that, only if it is considered absolutely necessary for the patient will the TRICARE system agree to cover any additional therapy or counseling expenses, otherwise the individual will have to compensate for any additional charges that may be incurred.

There are several other treatments and services that are not covered by the TRICARE health care program, such as the cost of carrying out a full autopsy on bodies, chiropractic care, and dynamic posturography, computerized dynamic posturography (which is simply referred to as CDP), magnetic resonance neurography, psychogenic surgery and treatment of temporomandibular joint syndrome.

In addition, the TRICARE health care plans do not cover for other random costs that may be incurred, such as receiving massages or having a family member treat you or cost of gym membership. Any other procedure or treatment process that is not necessary, such as inpatient stays that are not needed or irrelevant diagnostic tests, are not covered. The TRICARE health system will also not provide coverage for individuals who miss their scheduled appointments or for individuals who are opting for any unproven or experimental treatment or procedure.

A good idea would be to visit the See What’s Covered page and plug in the treatment or procedure that you wish to enquire about. It will provide you with all relevant information that you wish to know about a certain treatment, such as whether or not it is covered and any rules and regulations that may apply to it. You can also consult a member of the TRICARE health care program if you wish to know further details.

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17 comments

  1. Could you please let me know if I’m still covered with Tri Care when I turn 65? I thought I had to have more coverage after I turn 65 but still have Tri Care. I lost my husband Jan7th 2014 he was a Vietnam Vet. Thank you so much for your time Gloria J. Crocker

  2. My question is not answered. Does Tri Care for life cover shingle Immunization shots?
    I understand these are very expensive and may or may not be covered by Tricare for retired vets.
    How can I find the information ? Thank You.

  3. Please explain if I am calling from a physicians office how am I to determine if a procedure is covered when there is no way to reach a live person. This system is completely unusable.

  4. I am a Retiree that has Tricare Prime, is my wife and I covered for eye exams under Tricare Prime.

  5. I am wanting additional information on who is covered to recieve Tricare benefits. Please give me a contact phone number I can speak with. Thank you

    • The U.S. regional contractors provide customer service for all plans except TRICARE For Life and the US Family Health Plan.

      North Region – Connecticut, Delaware, the District of Columbia, Illinois, Indiana, Iowa (Rock Island area), Kentucky (except Fort Campbell), Maine, Maryland, Massachusetts, Michigan, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, and Wisconsin.

      Regional Contractor: Health Net Federal Services, LLC

      http://www.hnfs.com
      1-877-TRICARE (1-877-874-2273)

      South Region – Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee, Texas (excluding El Paso area), and Fort Campbell, Kentucky

      Regional Contractor: Humana Military, a division of Humana Government Business

      http://www.HumanaMilitary.com
      1-800-444-5445

      West Region – Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excludes Rock Island arsenal area), Kansas, Minnesota, Missouri (except St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (southwestern corner including El Paso), Utah, Washington and Wyoming.

      Regional Contractor: UnitedHealthcare Military & Veterans

      http://www.uhcmilitarywest.com
      1-877-988-WEST (1-877-988-9378)

    • You can also find more information here: http://www.tricare.mil/ContactUs/CallUs

  6. Currently my primary insurer is Anthem.
    My question is does Tricare cover any portion of my schedule physical theraphy?
    Kindy quide me as to where I can read the rules regarding my physical theraphy coverage.
    Thank You for your prompt attention to this matter

  7. My wife had stint surgery while in the hospital. Now two weeks later she’s been referred to a clinic that specializes in the removal of this type of stint. She called the clinic and was informed that her co-pay would be $700.00 up front! I have never paid a $700. co-pay up front.
    The clinic is Encino Plaza Surgical Center, California. This Urology Dr. has the uncaring bed side manners that relate to a disgruntled badger.
    Can she just schedule to have the procedure performed at the hospital?

  8. Is the generic testing to see if prescriptions are not compatible with our DNA covered. One company is Fastet Labs

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