TRICARE Home Health Care: 2026 Coverage & Costs
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## Quick answer TRICARE provides comprehensive coverage for medical services delivered in your home when you are homebound and require skilled nursing care or therapy. This coverage, known as the Home Health Care (HHC) benefit, includes part-time skilled nursing, physical therapy, and speech-language pathology services, provided they are ordered by a physician and delivered by a TRICARE-authorized Home Health Agency (HHA).
## In detail TRICARE’s home health benefit is designed to help beneficiaries recover from an illness or injury in their residence rather than a hospital or skilled nursing facility. To qualify, a patient must be "homebound," meaning it is very difficult to leave the home due to illness or injury, and absences are infrequent and of short duration.
### Covered Services in the Home If you meet the eligibility criteria, TRICARE covers: * **Skilled Nursing Care:** Part-time or intermittent care provided by a Registered Nurse (RN) or Licensed Practical Nurse (LPN). * **Therapy Services:** Physical therapy, occupational therapy, and speech-language pathology. * **Home Health Aides:** Assistance with personal care (bathing, dressing) if the patient is also receiving skilled nursing or therapy. * **Medical Social Services:** Counseling and assistance with social and emotional factors related to the illness. * **Medical Supplies:** Routine supplies provided by the HHA as part of the plan of care.
### The Home Health Perspective Payment System (HHPPS) TRICARE generally follows Medicare’s HHPPS model. For 2026, HHAs are paid a fixed rate for each 30-day period of care. This rate covers all services, supplies, and equipment used during that window, excluding Durable Medical Equipment (DME).
### Regional Contractors (2026) Access to home health services depends on your region's contractor for prior authorization: * **TRICARE East:** Managed by Humana Military. * **TRICARE West:** Managed by TriWest Healthcare Alliance (effective Jan 1, 2025).
### What is NOT Covered * **24-hour nursing care** at home. * **Custodial care** (assistance with activities of daily living only, without a medical need). * **Meals** delivered to the house. * **Homemaker services** (cleaning, laundry).
## Who this applies to * **Active Duty Service Members (ADSMs):** Requires a referral and prior authorization; $0 out-of-pocket for authorized home health care. * **TRICARE Prime Retirees:** Requires a referral from the Primary Care Manager (PCM). In 2026, there are generally $0 copayments for home health services from network providers. * **TRICARE Select Beneficiaries:** No referral required, but services must be medically necessary. Cost-shares may apply for the initial assessment and certain supplies depending on the beneficiary's Group (A or B). * **TRICARE For Life (TFL) Users:** TFL acts as secondary payer to Medicare. If Medicare covers the home health visit, TFL pays the remaining out-of-pocket costs.
Common scenarios
**Scenario 1: Post-Surgery Recovery (TRICARE Prime)** An active duty spouse in the East Region (Humana Military) has knee surgery and is temporarily homebound. Their doctor prescribes physical therapy twice a week for four weeks. Since they are using a network HHA and have a referral, their out-of-pocket cost for these 2026 home visits is **$0**.
**Scenario 2: Chronic Management (TRICARE For Life)** A 70-year-old retiree in the West Region (TriWest) requires skilled nursing for wound care twice a week. Medicare is the primary payer and covers 100% of the approved home health rate. TRICARE For Life acts as a supplement, ensuring the patient pays **$0** for the authorized 30-day care episode.
**Scenario 3: Non-Covered Custodial Care** An elderly beneficiary requires help with cooking and bathing but does not require skilled nursing or therapy. Because this is classified as **Custodial Care** rather than Home Health Care, TRICARE will cover **$0**, and the family must pay for these services out-of-pocket.
## Related terms * **Homebound:** A status where a patient cannot leave home without a supportive device or the assistance of another person. * **Home Health Agency (HHA):** A public or private organization that specializes in providing skilled nursing and other therapeutic services in the home. * **Prior Authorization:** A requirement to get plan approval before receiving certain home health services to ensure coverage. * **Custodial Care:** Non-medical care that helps with activities of daily living; generally not covered by TRICARE. * **Durable Medical Equipment (DME):** Items like wheelchairs or hospital beds which are billed separately from the Home Health 30-day episode.
## Sources * TRICARE.mil Home Health Care: https://www.tricare.mil/CoveredServices/IsItCovered/HomeHealthCare * Humana Military (East Region): https://www.humanamilitary.com/ * TriWest Healthcare Alliance (West Region): https://www.triwest.com/ * TRICARE Manuals (Defense Health Agency): https://manuals.health.mil/