What is Not Covered by TRICARE For Life Military?
As a retired or disabled veteran, having TRICARE For Life (TFL) as your health coverage can provide a sense of security and peace of mind. TFL is a premium-free coverage option offered by the Department of Veterans Affairs (VA) that provides comprehensive medical coverage, including prescriptions and hospitalizations. However, like all insurance plans, TFL has its limitations and does not cover certain services. In this article, we will delve into the details of what is not covered by TRICARE For Life military.
Prescription Medicine**
**Over-the-Counter (OTC) Medications**: TFL does not cover OTC medications, such as pain relievers, antacids, and cold remedies. Patients are responsible for paying the full cost of these medications.
**Certain Prescription Drugs**: TFL may not cover certain prescription drugs that are considered investigational or experimental. Patients should review their medication list with their healthcare provider to determine what is covered.
**Cost-Sharing**: Patients enrolled in TFL are required to pay a copayment for prescription medications. However, this cost-sharing arrangement does not apply to retirees with a disability rating of 100%.
Chiropractic and Alternative Medicine**
**Routine Chiropractic Care**: TFL does not cover routine chiropractic care for conditions such as back pain or headaches. Patients who require chiropractic care should consult with their primary care physician to determine if alternative treatments are available.
**Acupuncture and Massage**: TFL does not cover acupuncture or massage therapy.
**Other Alternative Therapies**: TFL also does not cover other alternative therapies, such as homeopathic remedies, naturopathy, and reflexology.
Dental Care**
**Routine Dentistry**: TFL does not cover routine dental cleanings, fillings, or extractions. For retirees, a dental health maintenance organization (DHMO) plan is available at a premium rate.
**Orthodontics and Sedation Dentistry**: TFL does not cover orthodontics, sedation dentistry, or crowns.
**Dentures and Partial Dentures**: TFL covers prosthetic dentures, including partial dentures, if deemed medically necessary.
**Emergency Dental Services**: TRICARE Prime and Extra cover emergency dental services for conditions such as a traumatic injury or dental infection. However, TFL recipients are responsible for paying up to $1,400 per year.
Vision Care**
**Routine Eye Exams and Glasses**: TFL does not cover routine eye exams or glasses for conditions such as nearsightedness or farsightedness.
**Cataract Surgery and Vision Therapy**: TFL covers cataract surgery, but beneficiaries are responsible for paying an annual maximum of $4,000. Vision therapy is not covered.
Mental Health**
**Outpatient Mental Health Services**: TFL does not cover outpatient mental health services, including therapy and counseling, unless the beneficiary has a TRICARE-managed care contract.
**Inpatient Mental Health Services**: TFL covers inpatient mental health services in a psychiatric hospital or hospice care, but copays apply.
Other Services**
**Wellness Programs**: TFL does not cover spa services, weight loss programs, or fitness classes under the umbrella of wellness programs.
**Lifestyle Procedures**: TFL does not cover lifestyle procedures, including elective plastic surgery, fertility treatments, or gender confirmations.
**Cosmetic Procedures**: TFL also does not cover cosmetic procedures, including facial rejuvenation, hair transplantation, and tattoo removal.
**Routine Physicals and Wellness Checks**: TFL does not cover routine physicals, wellness checks, or blood work unless deemed medically necessary.
**Summary Table of What is Not Covered**
| Service | Coverage Level |
| — | — |
| Over-the-counter medications | Not covered |
| Investigational prescription drugs | Not covered |
| Routine chiropractic care | Not covered |
| Alternative therapies | Not covered |
| Routine dentistry | Not covered |
| Orthodontics and sedation dentistry | Not covered |
| Routine eye exams and glasses | Not covered |
| Cataract surgery | Covered (limited copay) |
| Outpatient mental health services | Not covered |
| Inpatient mental health services | Covered (copays apply) |
| Wellness programs | Not covered |
| Lifestyle procedures | Not covered |
| Cosmetic procedures | Not covered |
| Routine physicals and wellness checks | Not covered |
Conclusion:
TRICARE For Life military offers comprehensive healthcare coverage, but it does have its limitations. Reviewing what is not covered by TFL is essential for retirees and disabled veterans to understand their coverage options. By understanding what services are not covered, beneficiaries can plan ahead, make informed decisions, and seek care from qualified healthcare providers to ensure they receive the care they need.
