TRICARE covers a broad range of medical services, from routine checkups and preventive screenings to emergency care, surgery, prescription drugs, and durable medical equipment. The specifics of what you pay and how you access care depend on which of the 11 TRICARE plan options you’re enrolled in, your military status, and where you live.
How TRICARE Plans Work
TRICARE isn’t a single insurance plan. It’s a family of health plans, each designed for a different group of beneficiaries. The most common are TRICARE Prime, which works like an HMO with assigned primary care managers and referrals for specialists; TRICARE Select, which operates more like a PPO with freedom to see any TRICARE-authorized provider; and TRICARE For Life, which serves as supplemental coverage alongside Medicare for retirees aged 65 and older.
Beyond those three, there are plans tailored to specific situations: TRICARE Prime Remote for service members stationed far from military treatment facilities, TRICARE Reserve Select for drilling Guard and Reserve members, TRICARE Retired Reserve for “gray area” retirees not yet receiving retired pay, and TRICARE Young Adult for dependent children up to age 26. Overseas versions of Prime and Select exist for families stationed abroad. Plan availability depends on who you are and where you live.
Preventive Care and Screenings
Preventive services are covered at no cost across all TRICARE plans. The list is extensive and includes annual physicals, well-child care, well-woman exams, immunizations, and a wide range of cancer screenings. Specific covered screenings include mammograms, colonoscopies, HPV testing and vaccination, cholesterol panels, cardiovascular screening, hepatitis B and C screening, tuberculosis screening, blood pressure checks, hearing exams, eye exams, and pediatric lead level screening.
TRICARE also covers tobacco cessation services, breast MRI when clinically indicated, abdominal aortic aneurysm screening, and echocardiograms as preventive measures. One caveat worth noting: for colorectal cancer screening, TRICARE does not cover blood-based or stool-based RNA testing, so check that your specific screening method is covered before scheduling.
Maternity and Breastfeeding Support
Prenatal care, labor and delivery, and postpartum visits are all covered services. TRICARE also covers breastfeeding counseling at no cost in several settings: during an inpatient maternity stay, at follow-up outpatient visits, and during well-child care appointments. On top of that, you can receive up to six separate outpatient breastfeeding counseling sessions when the counseling is billed as a preventive service and provided by a TRICARE-authorized provider. Covered counselors include board-certified lactation consultants, certified lactation counselors, and authorized doctors, nurse practitioners, nurse midwives, physician assistants, or registered nurses.
Prescription Drug Coverage
TRICARE’s pharmacy benefit uses a three-tier system: generic formulary drugs, brand-name formulary drugs, and non-formulary drugs. Your costs vary significantly depending on where you fill your prescription.
For most beneficiaries in 2026 and 2027, home delivery (up to a 90-day supply) costs $13 for generics, $38 for brand-name formulary drugs, and $76 for non-formulary drugs. Filling the same prescriptions at a retail network pharmacy for a 30-day supply runs $16, $43, and $76 respectively. Using a non-network pharmacy means paying full price upfront and filing a claim for reimbursement.
Medically retired service members, their families, and survivors of active duty members get significantly lower pharmacy costs, frozen at 2017 rates by law. Their home delivery copays are $0 for generics, $20 for brand-name formulary, and $49 for non-formulary. Retail network costs for this group are $10, $24, and $50.
Durable Medical Equipment
TRICARE covers durable medical equipment (things like wheelchairs, CPAP machines, hospital beds, and prosthetics) when prescribed by a physician. To qualify, the equipment must withstand repeated use, serve a primarily medical purpose, and not be useful to someone without an injury or illness. The equipment must improve, restore, or maintain function of a diseased or injured body part, or prevent deterioration of your condition.
Your regional contractor decides whether the equipment is rented or purchased based on what’s more economical. TRICARE also covers medically necessary customizations, accessories, and attachments to make the equipment work for your specific disability. Repairs to equipment you own are covered when needed, and replacement is covered when your physical condition changes, the equipment is accidentally damaged, it can’t be repaired, or the FDA has declared it unsafe.
Emergency and Urgent Care
Emergency room visits never require a referral, regardless of your plan. If you believe you’re having an emergency, go to the nearest ER or call 911. If you’re enrolled in TRICARE Prime, you do need to notify your primary care manager within 24 hours or the next business day after receiving emergency care.
Urgent care rules are slightly different depending on your status. Active duty service members on TRICARE Prime need a referral for urgent care. Family members of active duty members, retirees, and retiree family members do not need a referral, as long as they visit a TRICARE-authorized urgent care center or network provider. TRICARE Select beneficiaries can visit any TRICARE-authorized provider for urgent care without a referral.
Dental and Vision Coverage
TRICARE’s medical plans do not include routine dental or vision benefits for most beneficiaries. Active duty service members receive dental care through military treatment facilities, but their family members and retirees get dental coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP), a separate enrollment. Retired members of the uniformed services, National Guard, and Reserve components (including “gray area” retirees under 60) and their families are eligible for FEDVIP dental. FEDVIP vision coverage is available to active duty family members and retirees enrolled in a TRICARE health plan.
Annual Costs and Spending Caps
Active duty family members pay no annual deductible on either TRICARE Prime or Select. Their catastrophic cap, the maximum they’ll spend out of pocket in a year, is $1,000 for Group A beneficiaries and $1,288 for Group B (the group designation depends on when the sponsor first entered service).
Retirees and their families face higher but still manageable costs. On TRICARE Prime, there’s no deductible, but the catastrophic cap is $3,000 (Group A) or $4,509 (Group B). On TRICARE Select, retirees pay annual deductibles: $150 per individual or $300 per family for Group A, and $193/$386 (network) for Group B. The catastrophic cap on Select ranges from $4,261 to $4,509 depending on your group. Survivors of active duty deceased sponsors and medically retired members on TRICARE Select Group A have a reduced catastrophic cap of $3,000.
What TRICARE Does Not Cover
TRICARE excludes any service that isn’t medically or psychologically necessary for diagnosing or treating a covered condition, injury, pregnancy, or well-child care. Services from unauthorized providers are also excluded regardless of medical necessity.
The list of specific exclusions is long. Notable items include LASIK surgery, acupuncture, massage therapy, dry needling, cosmetic procedures (including breast augmentation), homeopathic and herbal drugs, naturopathic care, and experimental procedures. TRICARE won’t cover gym memberships, exercise equipment or programs, multivitamins, assisted living facility care, long-term care, or home modifications like elevators and chair lifts. Treatment for learning disorders and dyslexia is excluded, as is elective psychotherapy focused on personal growth rather than treating a diagnosed condition. Even charges for missed appointments and medical care provided by a family member fall outside coverage.
If a service is connected to a non-covered condition, all related costs are excluded as well, including any inpatient hospital stays tied to that treatment.