TRICARE Health Care Program Covered Items & Services 2026

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## Quick answer TRICARE covers services that are medically necessary and proven to be safe and effective. This includes everything from routine doctor visits and hospitalizations to prescription drugs, mental health care, and specialized maternity services. Coverage is generally consistent across all plans, though your out-of-pocket costs and how you access care (referrals vs. self-referral) will change depending on which specific plan you use.

In detail

TRICARE coverage is broadly divided into several categories. To be covered, an item or service must be **medically necessary** and **proven** (not experimental).

### 1. Outpatient and Inpatient Medical Care This is the "standard" medical care most people think of. Under the current T-5 contract (managed by **Humana Military** in the East and **TriWest** in the West), TRICARE covers: * **Preventive Care:** Annual physicals, cancer screenings (mammograms, colonoscopies), and immunizations. Most preventive services have a $0 copay for all beneficiaries. * **Emergency Care:** Visits to an ER for life-threatening or serious conditions. * **Urgent Care:** Care for non-emergencies. TRICARE Prime beneficiaries usually need a referral for urgent care unless using a TRICARE-authorized urgent care center. * **Hospitalization:** Semi-private rooms, surgical supplies, and nursing care.

### 2. Pharmacy Benefits Managed by **Express Scripts**, the pharmacy benefit is uniform across almost all plans (Prime, Select, and Reserve Select). * **Military Pharmacies:** $0 for a 90-day supply. * **Home Delivery:** Preferred brand-name drugs generally cost $38 for a 90-day supply (2026 rates). * **Retail Pharmacies:** Preferred brand-name drugs generally cost $48 for a 30-day supply (2026 rates).

### 3. Mental Health and Substance Use TRICARE provides robust coverage for mental health: * Inpatient psychiatric care. * Outpatient psychotherapy (individual, family, group). * Residential Treatment Centers (RTC) for children and adolescents. * Opioid Treatment Programs (OTP).

### 4. Maternity and Newborn Care Coverage includes prenatal care, delivery, and postnatal care. * **Breast Pumps:** TRICARE covers one manual or electric breast pump per birth event, including replacement parts. * **Newborn Screenings:** Standard screenings and hearing tests are covered.

### 5. Durable Medical Equipment (DME) TRICARE covers equipment that can withstand repeated use and is primarily used for a medical purpose. * Wheelchairs and walkers. * CPAP machines for sleep apnea. * Oxygen concentrators. * Note: "Convenience" items (like specialized beds that are not medically required) are typically excluded.

### 6. Specialized Items * **Hospice Care:** Comprehensive end-of-life care. * **Skilled Nursing:** Limited to patients who require 24-hour medical supervision. * **Transplants:** Most standard organ transplants (heart, lung, liver, kidney) are covered at specialized Centers of Excellence.

Coverage Comparison Table (2026 Sample Costs)

## Who this applies to * **Active Duty Service Members (ADSMs):** Receive 100% coverage with $0 out-of-pocket costs for all authorized care; must use TRICARE Prime. * **Active Duty Family Members (ADFMs):** Have the choice between Prime (lower cost, less flexibility) and Select (higher cost, more flexibility). * **Retirees and Families:** Generally pay annual enrollment fees and higher cost-shares for the same covered items. * **National Guard/Reserve:** Eligible for TRICARE Reserve Select (TRS), which covers the same medical items but requires a monthly premium.

Common scenarios

**Scenario 1: New Parents** An Active Duty spouse on TRICARE Select gives birth in a civilian hospital in 2026. TRICARE covers the hospital stay, the OB/GYN fees, and the pediatrician's initial exam. The spouse also receives a hospital-grade electric breast pump at no cost by requesting a prescription from their doctor and ordering through an authorized DME provider.

**Scenario 2: Chronic Condition Management** A retired Navy Commander in the West Region (managed by TriWest) is diagnosed with Type II diabetes. TRICARE covers his insulin through Express Scripts Home Delivery ($38 for 90 days), his quarterly blood work, and his visits to an endocrinologist. Because he is on TRICARE Select, he does not need a referral to see the specialist, but he pays a cost-share for each visit.

**Scenario 3: Mental Health Support** An Army Reservist on TRICARE Reserve Select (TRS) seeks counseling for PTSD. TRICARE covers his weekly sessions with a TRICARE-authorized civilian life coach or therapist. He pays a 15% - 20% cost-share after meeting his annual deductible.

## Related terms * **Medically Necessary:** Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. * **Cost-Share:** The percentage of the total cost of a covered health care service that you pay (after you’ve paid your deductible). * **Catastrophic Cap:** The maximum amount you will pay out-of-pocket for covered services each calendar year. * **Prior Authorization:** A requirement that your provider gets approval from the regional contractor (Humana or TriWest) before certain services are performed. * **Allowable Charge:** The maximum amount TRICARE will pay for a covered service.

## Sources * **TRICARE Covered Services:** https://www.tricare.mil/coveredservices * **TRICARE Pharmacy Benefits (Express Scripts):** https://militaryrx.express-scripts.com/ * **Humana Military (East):** https://www.humanamilitary.com/ * **TriWest Healthcare Alliance (West):** https://www.triwest.com/