Clearing Up the Confusion: What Military Families Need to Know About Your Vision Healthcare Coverage - Blue Star Families (2024)

FAQs

Why doesn't TRICARE cover vision? ›

Doesn't TRICARE cover my vision care? Kind of. Here's the deal; your basic TRICARE Health Plan only pays for vision exams. If you need contacts or glasses, you'll foot the bill unless you have supplemental insurance through a vision plan like BCBS FEP Vision.

You may be eligible for an eye exam, depending on who you are and why you need the exam. Active duty service members can get eye exams as needed to maintain fitness for duty. >> Learn more. TRICARE covers annual routine eye exams for active duty family members, regardless of plan. >>

TRICARE only covers glasses or contact lenses to treat certain conditions, like infantile glaucoma, for family members. However, if you're an ADSM, a member of the National Guard or Reserve, or a retiree, TRICARE will cover the cost of glasses or sunglasses needed for vision correction.

TRICARE Prime covers the cost for prescription glasses, sunglasses, or contacts for ADSMs and activated members of the National Guard and Reserve. For members of the National Guard, Reserve, and their families, eye care services depend on the sponsor's status and TRICARE health plan.

“There have been reports of a dearth of Prime providers, especially specialists,” said Hickey. The problem stems from the fact that most Tricare managed care support contractors have negotiated physician reimbursem*nt rates that are even lower than those paid by Medicare.

Some common reasons for prescription denials are: You aren't TRICARE-eligible. You exceeded the retail refill limit for your maintenance drug.

Can my spouse get glasses at the VA? Yes, family members may purchase glasses with a valid written prescription.

Family members of active duty uniformed service members who are enrolled in a TRICARE health plan are eligible for FEDVIP vision coverage.

In general, TRICARE covers routine eye exams: As needed for active duty service members to maintain fitness for duty. Once a year for active duty family members. Every two years for all other TRICARE Prime beneficiaries (e.g. retired service members, their families, etc.)

TRICARE only covers glasses and contacts to treat certain conditions. This includes: Infantile glaucoma. Corneal or scleral lenses for treatment of keratoconus.

Can military spouses get free LASIK? ›

TRICARE doesn't cover lasik surgery.

TRICARE Coverage for Glasses and Contacts

For example, active-duty members and activated National Guard or Reservists can receive one standard issue pair of glasses, one standard issue pair of sunglasses, and one pair of glasses of your choice from the optometric clinic at your military clinic or hospital.

Non-covered drugs. TRICARE doesn't cover these. They may be drugs used to treat a non-covered condition, drugs used for cosmetic purposes, multivitamins, or other products the Food and Drug Administration doesn't consider to be clinically effective.

When you see a TRICARE-authorized network provider, you'll pay a copayment. If you see a TRICARE-authorized non-network provider, you'll pay a cost-share after you meet your annual deductible.

– Do you need to fill or refill a prescription? You have four pharmacy options for filling your prescription: military pharmacies, TRICARE Pharmacy Home Delivery, TRICARE retail network pharmacies, and non-network pharmacies.

TRICARE doesn't cover vision therapy. See Orthoptics.

Exceptions and Special Circ*mstances

While the standard policy is that LASIK is not covered because it's elective, there are exceptions within the military for specific circ*mstances where refractive surgeries, including LASIK, may be deemed necessary for operational effectiveness.

You can get routine eye exams from any TRICARE-authorized optometrist or ophthalmologist. You don't need a referral or authorization.