TRICARE Coverage for Diabetes
Overview
Diabetes affects an estimated 1 in 4 military beneficiaries over age 45. TRICARE provides comprehensive coverage for diabetes management including routine monitoring, medications, supplies, specialist visits, and diabetes self-management education programs.
Treatment Options Covered by TRICARE
- Insulin and oral diabetes medications
- Continuous glucose monitors (CGMs) and blood glucose meters
- Insulin pumps and supplies
- Hemoglobin A1C testing (quarterly)
- Diabetic eye exams (annually)
- Diabetic foot care
- Diabetes Self-Management Education (DSME)
- Nutritional counseling
- Endocrinologist consultations
How TRICARE Covers Diabetes
TRICARE covers all medically necessary diabetes care. This includes insulin, oral medications, testing supplies, continuous glucose monitors (when medically necessary), insulin pumps, specialist visits, and preventive screenings. The TRICARE Diabetes Care Program provides additional resources including education and nutrition counseling at no extra cost.
Coverage by Plan
TRICARE Prime
Full coverage with $0 copay for most services when using PCM. Referral needed for endocrinologist. Insulin available at $0 from military pharmacy.
TRICARE Select
Covered with standard cost shares. $28 copay for specialist visits (network). Insulin $34 max at retail pharmacy, $0 at military pharmacy.
TRICARE For Life
Medicare pays first, then TFL covers remaining costs. Most diabetes care at $0 out of pocket after Medicare.
Estimated Costs
| Scenario | Estimated Cost |
|---|---|
| Monthly insulin (military pharmacy) | $0 |
| Monthly insulin (retail pharmacy, Select) | $14–$34 |
| Continuous glucose monitor (with authorization) | $0 (Prime) / cost share (Select) |
| Quarterly A1C blood test | $0 (Prime) / $0 network preventive (Select) |
| Annual diabetic eye exam | $0 (Prime) / $28 copay (Select) |
Authorization Requirements
Prior authorization may be required for insulin pumps, continuous glucose monitors, and some specialty medications. Routine diabetes management (office visits, standard insulin, testing supplies) typically does not require authorization.
Network & Provider Notes
Endocrinologists and diabetes educators are available in the TRICARE network. For Prime members, a referral from your PCM is required. Select members can self-refer to any TRICARE-authorized endocrinologist.