TRICARE Glaucoma Coverage: Screenings & Treatment Guide

*Note: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense or the official TRICARE program. For official policy, visit TRICARE.mil.*

## Quick answer TRICARE covers the diagnosis and treatment of glaucoma, including routine screenings for high-risk individuals, prescription eye drops, laser therapy, and surgical procedures. Coverage generally falls under your medical benefit rather than the vision benefit, meaning you don't necessarily need a separate vision plan to receive treatment for this medical condition.

## In detail Glaucoma is considered a medical condition of the eye, not a routine vision issue like nearsightedness. Because of this, TRICARE covers its management under its standard medical benefits (like TRICARE Prime or Select).

### 1. Coverage for Glaucoma Screenings TRICARE covers annual glaucoma screenings for beneficiaries who are at high risk. You are considered high risk if you meet any of the following criteria: * You have a family history of glaucoma. * You have diabetes mellitus. * You are African American and age 40 or older. * You are age 60 or older.

### 2. Diagnostic Testing If a screening indicates potential issues, TRICARE covers diagnostic procedures including: * **Tonometry:** Measuring internal eye pressure. * **Ophthalmoscopy:** Examining the optic nerve. * **Visual Field Testing:** Checking for peripheral vision loss. * **Pachymetry:** Measuring corneal thickness.

### 3. Treatment Options (2026 Coverage) * **Prescription Eye Drops:** Classified as "Maintenance Medications," these are managed by **Express Scripts**. In 2026, most beneficiaries pay $16 for a 90-day supply of generics via home delivery. * **Laser Therapy:** Procedures such as Selective Laser Trabeculoplasty (SLT) are covered when medically necessary. * **Surgery:** Traditional surgeries (like trabeculectomy) or Micro-Invasive Glaucoma Surgery (MIGS) are covered. * **Specialty Referrals:** * **TRICARE Prime:** Requires a referral from your Primary Care Manager (PCM) to see an ophthalmologist. * **TRICARE Select:** No referral is needed; you can visit any TRICARE-authorized provider, though costs are lower with network providers.

### 4. Regional Administration As of 2026, claims and authorizations are handled by: * **East Region:** Humana Military. * **West Region:** TriWest Healthcare Alliance. * **Overseas:** International SOS.

## Who this applies to * **Active Duty Service Members (ADSMs):** Fully covered; must coordinate through military hospitals or via TriWest/Humana with a referral. * **Active Duty Family Members (ADFMs):** Covered under Prime or Select. Preventive screenings are typically $0 out-of-pocket. * **Retirees and their Families:** Covered, though subject to annual deductibles and cost-shares (Group A or Group B depending on enlistment date). * **TRICARE For Life (TFL) Beneficiaries:** Medicare acts as the primary payer for glaucoma treatment, and TRICARE acts as the secondary payer.

Common scenarios

**Scenario 1: Senior Retiree in the West Region (2026)** An 65-year-old retiree using TRICARE Select in California (West Region managed by TriWest) goes for an annual glaucoma screening. Because they are over 60, the screening is a covered preventive service with a **$0 copay**. If diagnosed, their subsequent specialist visits to an ophthalmologist would cost approximately **$38 per visit** (2026 network rate).

**Scenario 2: Active Duty Spouse in the East Region** A 42-year-old African American spouse on TRICARE Prime in Virginia (East Region managed by Humana Military) notices vision changes. She gets a referral from her PCM to a network ophthalmologist. Her exam, diagnostic imaging, and subsequent prescription for Timolol (generic) via Express Scripts home delivery costs her **$0 for the exam** and **$16 for the 90-day medication supply**.

## Related terms * **Ophthalmologist:** A medical doctor specializing in eye disease and surgery (covered for medical issues). * **Optometrist:** A healthcare professional who provides primary vision care; they can often diagnose glaucoma and manage it depending on state law and TRICARE authorization. * **Intraocular Pressure (IOP):** The fluid pressure inside the eye; the primary metric used to monitor glaucoma. * **Medical Necessity:** The standard used by TriWest or Humana to decide if a specific surgical procedure or branded medication is covered. * **Express Scripts:** The pharmacy benefit manager that handles all TRICARE prescription eye drops.

## Sources * TRICARE.mil Vision Coverage: https://www.tricare.mil/CoveredServices/IsItCovered/VisionCare * Humana Military (East): https://www.humanamilitary.com/ * TriWest Healthcare Alliance (West): https://www.triwest.com/ * Express Scripts TRICARE Pharmacy: https://militaryrx.express-scripts.com/