Who and What is Not Covered by TRICARE (2026 Guide)
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## Quick answer TRICARE generally does not cover procedures that are considered medically unnecessary, unproven, or purely cosmetic. Specifically, TRICARE excludes services like LASIK, most dental care for retirees (unless purchased separately), gym memberships, and experimental treatments that have not been approved by the FDA or the Defense Health Agency.
In detail
TRICARE's coverage is governed by federal law and the "Reasonable and Necessary" standard. If a service is not scientifically proven to be effective for your specific condition, TRICARE will not pay for it.
Major Categories of Non-Covered Services
* **Cosmetic Surgery:** Procedures done solely to improve appearance, such as facelifts, elective breast enlargements, or tummy tucks, are not covered. However, reconstructive surgery for a physical functional impairment (e.g., following a mastectomy or a severe burn) is typically covered. * **Vision and Dental:** * **Vision:** Routine eye exams are limited based on your plan (Select vs. Prime) and beneficiary status. Surgery to correct refractive errors (LASIK/PRK) is almost never covered for dependents or retirees. * **Dental:** Most dental care for retirees and their families is excluded from the health plan. These beneficiaries can purchase dental coverage separately through the Federal Employees Dental and Vision Insurance Program (FEDVIP). * **Alternative and Experimental Medicine:** * Acupuncture (except for specific pain management cases in certain regions/pilot programs). * Chiropractic care (covered for active duty only; not covered for families or retirees). * Experimental treatments or drugs not yet FDA-approved for the specific diagnosis being treated. * **Lifestyle and Convenience:** * Gym memberships and personal trainers. * Weight loss programs (like WeightWatchers or Jenny Craig), though medically supervised obesity surgery (Bariatric) may be covered if strict criteria are met. * Over-the-counter (OTC) drugs and vitamins (unless they are part of the TRICARE pharmacy formulary and have a prescription, such as prenatal vitamins).
Excluded Items Comparison (2026 Status)
| Item/Service | Covered? | Caveat/Alternative | | :--- | :--- | :--- | | **LASIK Surgery** | No | Covered for some Active Duty to meet mission requirements. | | **Chiropractic** | No | Only available to Active Duty at specific MTFs. | | **Nursing Home Care** | No | TRICARE covers "Skilled Nursing," not "Custodial Care." | | **Hearing Aids** | Partial | Covered for Active Duty families; not covered for most retirees. | | **OTC Meds** | No | Requires a doctor’s prescription and must be on formulary. |
### The "Double Coverage" Rule TRICARE is the secondary payer to all other health insurance (OHI) except for Medicaid, TRICARE supplements, or the Indian Health Service. If your OHI denies a claim because it is a non-covered service, TRICARE will also likely deny it.
Who this applies to
* **Active Duty Service Members (ADSMs):** Have the fewest exclusions but still cannot get cosmetic surgery without command approval and medical necessity. * **Active Duty Family Members (ADFMs):** Are excluded from chiropractic care and most adult vision corrections. * **Retirees and Families:** Face the most exclusions, particularly regarding hearing aids and dental care, and must often pay 100% out-of-pocket for these items. * **TRICARE For Life (TFL) Users:** Must ensure services are covered by **both** Medicare and TRICARE. If Medicare excludes a service (like most dental), TRICARE will also exclude it unless specifically noted in policy.
Common scenarios
**Scenario 1: Refractive Surgery** An Army spouse on TRICARE Select (2026) wants LASIK to eliminate the need for glasses. Because LASIK is considered elective/cosmetic by the DHA, the spouse will pay **$3,500–$5,000 out-of-pocket**. TRICARE will pay $0.
**Scenario 2: Retiree Hearing Aids** A 68-year-old retired Navy Commander needs hearing aids. While Active Duty family members might get coverage, retirees do not have a hearing aid benefit under TRICARE. The retiree will pay roughly **$2,000–$4,000 per ear** out-of-pocket, though they may access the Retiree At-Home Hearing Aid Program for government-rate pricing.
**Scenario 3: Custodial Care** A retiree's parent (enrolled as a dependent) needs to move into an assisted living facility for help with "Activities of Daily Living" (bathing/dressing). TRICARE labels this "Custodial Care" and offers **$0 in coverage**. The family must pay the full monthly facility cost (often $5,000+).
Related terms
* **Medical Necessity:** The criteria used to determine if a service is required to diagnose or treat a condition. * **Exclusion:** A specific service or supply that a health plan explicitly states it will not pay for. * **Custodial Care:** Non-medical care that helps with daily living; a major TRICARE exclusion for the elderly. * **Formulary:** The list of brand-name and generic drugs covered by the Express Scripts pharmacy benefit. * **Point of Service (POS) Option:** A feature of TRICARE Prime that allows you to see non-network providers, but still does not cover "excluded" services.
Sources
* **TRICARE.mil - Covered Services:** https://www.tricare.mil/CoveredServices/IsItCovered * **TRICARE.mil - Exclusions:** https://www.tricare.mil/CoveredServices/IsItCovered/Exclusions * **Humana Military (East Region):** https://www.humanamilitary.com/beneficiary/plans-and-benefits/benefits-a-z/ * **TriWest Healthcare Alliance (West Region):** https://www.triwest.com/en/beneficiary/benefits-and-services/