TRICARE and You – What is covered

This blog is the most recent in a series helping members of the Coast Guard family understand how to use their TRICARE benefits. The blog series will continue every Monday, right here on Coast Guard All Hands.

Written by Cmdr. Paul Fawcett

The TRICARE medical insurance program is designed to assist you and your eligible family members with maintaining your health, and providing you with care when you are sick or injured. While TRICARE coverage is comprehensive, covering a wide range of services, products and programs, it doesn’t cover everything. It’s important that you know what TRICARE does and doesn’t cover so that you can take best advantage of your benefit, and don’t incur any unnecessary costs.

What TRICARE does cover

TRICARE will pay for all emergency care, including true emergencies seen in the Emergency Room, in emergencies, seek care immediately. Coverage for acute care visits such as strep throat, sprains and strains, ear infections and the like is also assured. You can elect to go to your primary care manager or can use the urgent care demonstration for dependents to be seen at the Urgent Care twice per year without a referral. TRICARE benefits also include hospitalization for medical and surgical care. Mental and behavioral health care are also covered. For a comprehensive listing you can visit the TRICARE website and utilize the search function.

What TRICARE doesn’t cover

While TRICARE is a great plan providing excellent services, it doesn’t cover everything. The TRICARE exclusion directory lists those products and services that aren’t covered. Among services that aren’t covered are acupuncture, experimental medical procedures, massage therapy, medical care received from a family member, exercise programs, gym memberships and hair removal, among others.

How do I know if the procedure I’m undergoing is covered?

If you received a referral letter for care with a TRICARE authorization number, then your care is approved. You normally only receive this for specialty care. If you are seeking care for preservation of life, limb or eyesight, your care is always approved. Acute care for illness and injury is generally approved. If you undergo cosmetic or elective surgery, in most cases it s not covered. Some exceptions would be for reconstructive surgery such as a result of an accident, birth defect or medically necessary procedure. If you request a referral from TRICARE for a procedure and it is denied, you will receive a denial letter.

How does a benefit become covered?

The standard that TRICARE uses to accept a procedure as a covered benefit is that it is medically necessary and considered proven. Some procedures are specifically prohibited by law and TRICARE can’t pay for them. An official change to TRICARE policy has to be in place before a benefit is covered. For more information about how a benefit becomes covered visit the TRICARE page about becoming a TRICARE benefit.

If you have questions about if a procedure r drug is covered you can contact your regional TRICARE contractor at :

  • TRICARE North
    • Health Net Federal Services 1-877-TRICARE
  • TRICARE South
    • Humana Military 1-800-444-5445
  • TRICARE West
    • United Health Care 1-877-988-WEST

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