TRICARE Coverage for Medical Feeds & Nutrition

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

## Quick answer In the TRICARE system, "feed" typically refers to the specialized medical nutrition (tube feeding or enteral nutrition) provided to beneficiaries who cannot consume food normally due to illness or injury. TRICARE covers enteral nutrition—including the formula and supplies—when it is deemed medically necessary and serves as the primary source of nutrition.

In detail

Medical nutrition, often referred to by patients as "tube feeds" or "nutritional feeds," falls under the category of **Enteral Nutrition** or **Parenteral Nutrition** (IV feeding). TRICARE coverage is specific and depends on whether the nutrition is being used as a supplement or as a primary life-sustaining source.

### What is Covered? TRICARE covers enteral nutrition when it is the primary source of nutrition for a patient who cannot swallow or digest food due to a covered medical condition (e.g., esophageal cancer, severe Crohn’s disease, or metabolic disorders). Covered items include: * **Enteral Formula:** Specialized liquid nutrition. * **Equipment:** Gravity sets, infusion pumps, and poles. * **Supplies:** Feeding tubes, syringes, and bags.

### Key Coverage Rules 1. **Medical Necessity:** A physician must prescribe the feed and document that the patient has a functioning gastrointestinal tract but cannot maintain weight and strength with regular food. 2. **The "Food" Exclusion:** TRICARE does not cover regular food, baby food, or "thickening agents" used for convenience. It also generally excludes nutritional supplements (like Ensure or Boost) if the patient can still consume regular solid food. 3. **Special Formulas:** Metabolic or "orphan" formulas for conditions like PKU (phenylketonuria) are covered even if they aren't the sole source of nutrition.

### Cost-Shares and Contractors (2026 Rates) Costs depend on your plan and sponsor status (Group A vs. Group B). Effective January 1, 2025, **TriWest Healthcare Alliance** manages the West Region, while **Humana Military** continues in the East.

*Note: Medical nutrition is typically processed as Durable Medical Equipment (DME) or medical supplies through your regional contractor rather than the pharmacy benefit.*

## Who this applies to * **Active Duty Service Members (ADSMs):** Fully covered with 100% coverage for all medically necessary feeding supplies and formula. * **Active Duty Family Members (ADFMs):** Covered under Prime or Select; requires prior authorization to ensure the formula is not considered a "supplement." * **Retirees and their Families:** Covered, but subject to annual deductibles and cost-shares for DME. * **Pediatric Beneficiaries:** Children with congenital defects or metabolic disorders often rely on these "feeds" as their primary nutrition.

Common scenarios

**Scenario 1: Pediatric Tube Feeding (East Region)** An ADFM child in Georgia (East Region) requires a G-tube and specialized formula due to a swallow disorder. The family uses **Humana Military**. Because they are on TRICARE Prime, and the formula is the child's primary nutrition, the family pays **$0** for the pump rental and monthly formula shipments, provided they use an in-network DME provider.

**Scenario 2: Retiree Enteral Nutrition (West Region)** A retired Navy veteran in California (West Region) needs enteral feeding following throat surgery. Under the T-5 contract, their care is managed by **TriWest**. As a TRICARE Select Group A beneficiary, the veteran must first meet their **$150 deductible** (2026 rate). Afterward, they pay a **20% cost-share** of the negotiated rate for the formula and feeding bags.

## Related terms * **Enteral Nutrition:** Feeding through a tube placed in the stomach or small intestine. * **Parenteral Nutrition (TPN):** Nutrients delivered intravenously, bypassing the digestive system entirely. * **Durable Medical Equipment (DME):** The category under which feeding pumps and hardware are usually billed. * **Certificate of Medical Necessity (CMN):** The documentation a doctor must provide to justify the "feed" to TRICARE. * **Metabolic Mineral Formulas:** Specialized products for genetic disorders like PKU, covered differently than standard feeds.

## Sources 1. **TRICARE.mil - Medical Nutrition:** https://www.tricare.mil/CoveredServices/IsItCovered/MedicalNutrition 2. **Humana Military (East Contractor):** https://www.humanamilitary.com/ 3. **TriWest Healthcare Alliance (West Contractor):** https://www.triwest.com/ 4. **TRICARE Policy Manual - Enteral Nutrition:** https://manuals.health.mil/