What Services Does Military Healthcare Cover?
*TRICARE.com is an independent reference site and is not affiliated with the Department of Defense. For official policy, please visit TRICARE.mil.*
## Quick answer TRICARE covers most healthcare services that are considered "medically necessary" and "proven" by the Defense Health Agency. This includes preventative screenings, outpatient doctor visits, hospital stays, prescriptions, and behavioral health, though coverage limits and out-of-pocket costs vary based on your specific plan and your status as an active-duty or retired service member.
In detail
TRICARE focuses on evidence-based medicine. If a treatment is experimental or cosmetic, it is generally not covered. Below are the primary categories of covered services as of 2026.
### 1. Preventive and Clinical Services TRICARE emphasizes prevention to maintain force readiness. Most preventive services have **$0 out-of-pocket costs** for all beneficiaries, provided they are received from a network provider. * **Preventive Care:** Annual physicals, immunizations (flu shots, HPV, etc.), and cancer screenings (mammograms, colonoscopies). * **Outpatient Care:** Visits to primary care managers (PCMs) or specialists. * **Hospitalization:** Semi-private rooms, surgery, and nursing care.
### 2. Pharmacy and Medications Managed by **Express Scripts**, the pharmacy benefit depends on the "tier" of the drug (Generic, Brand, or Non-formulary). * **Military Pharmacies:** $0 copay for a 90-day supply. * **Mail Order (Home Delivery):** Typically the most cost-effective option for maintenance meds. * **Retail Network:** Available for short-term needs (e.g., antibiotics).
### 3. Mental Health and Substance Abuse Coverage includes both inpatient and outpatient services: * Psychotherapy (individual, family, and group). * Medication management. * Residential Treatment Centers (RTC) for children and adolescents. * Opioid Treatment Programs.
### 4. Special Programs and Equipment * **Durable Medical Equipment (DME):** Wheelchairs, oxygen tanks, and CPAP machines are covered if prescribed by a doctor. * **Maternity Care:** Comprehensive coverage from prenatal to delivery and postpartum care. * **Hospice Care:** End-of-life care is fully covered for those with a terminal prognosis.
### 5. Cost-Sharing Examples (2026 Rates) Costs vary by "Group" (based on when you or your sponsor joined the military) and Plan. Below are typical 2026 rates for Group A Retirees:
| Service Type | TRICARE Prime | TRICARE Select (Network) | | :--- | :--- | :--- | | **Preventive Care** | $0 | $0 | | **Primary Care Visit** | ~$25 | ~$35 | | **Specialist Visit** | ~$38 | ~$50 | | **ER Visit** | ~$75 | ~$100+ |
*Note: Active Duty Service Members (ADSMs) have $0 out-of-pocket costs for all covered medically necessary care.*
## Who this applies to * **Active Duty Service Members (ADSMs):** Must use TRICARE Prime; 100% of medically necessary care is covered with no out-of-pocket costs. * **Active Duty Family Members (ADFMs):** Can choose Prime (no cost unless using Point of Service) or Select (deductibles and copays apply). * **Retirees & Families:** Generally pay annual enrollment fees and higher cost-shares for services. * **Guard/Reserve:** Eligible for TRICARE Reserve Select (TRS) while in a qualified status, which functions similarly to TRICARE Select.
## Common scenarios 1. **The New Parent:** An ADFM on TRICARE Select gives birth in a civilian network hospital in 2026. While prenatal visits are covered at $0, the hospital stay may incur a small per-day charge or a flat fee (e.g., ~$25–$60 total depending on Group status). 2. **The Maintenance Med:** A retiree needs daily blood pressure medication. They fill a 90-day generic prescription through Express Scripts home delivery for a 2026 copay of approximately $16, vs. $0 at a Military Treatment Facility. 3. **The Emergency:** An ADSM breaks a leg while hiking and visits a civilian ER. Because it is an emergency, TRICARE covers 100% of the cost, provided the member notifies their PCM or regional contractor (Humana Military or TriWest) within 24 hours.
## Related terms * **Medically Necessary:** Care that is appropriate, reasonable, and required to treat a specific illness or injury. * **Proven:** A treatment that has been scientifically validated; TRICARE does not cover "experimental" procedures. * **Cost-Share:** The percentage of the total cost you pay for a service (common in TRICARE Select). * **Catastrophic Cap:** The maximum amount you will pay out-of-pocket for covered services each calendar year. * **Point of Service (POS) Option:** An added cost incurred when Prime members see a specialist without a referral.
## Sources * **TRICARE covered services:** [https://www.tricare.mil/coveredservices](https://www.tricare.mil/coveredservices) * **Humana Military (East Region):** [https://www.humanamilitary.com/](https://www.humanamilitary.com/) * **TriWest Healthcare Alliance (West Region):** [https://www.triwest.com/](https://www.triwest.com/) * **Express Scripts Pharmacy:** [https://militaryrx.express-scripts.com/](https://militaryrx.express-scripts.com/)