TRICARE Vision Programs

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TRICARE offers limited vision benefits depending on your beneficiary status and what type of TRICARE coverage you have. Medically necessary vision benefits are available under all TRICARE plans.

Basic Vision Benefit for Active Duty Family Members:

Active duty family members are eligible for one comprehensive ophthalmological eye examination per calendar year.

The services are provided by TRICARE-authorized optometrists or ophthalmologists, and the deductibles and cost shares/copayments are based on whether the beneficiary is enrolled in TRICARE Prime or opts to use TRICARE Extra or TRICARE Standard.

TRICARE Prime Clinical Preventive Services:

TRICARE Prime enrollees age three and older are authorized comprehensive eye examinations once every year. TRICARE Prime enrollees may receive the services from any TRICARE network provider without a referral or authorization from the primary care manager (PCM), health care finder (HCF) or any other authority. If the eye examination is not available from a network provider, enrollees may receive services from a non-network provider if they have a referral from the PCM and authorization from the HCF.

Retirees and their families enrolled in TRICARE Prime are authorized one routine eye exam ever 24 months.

If services are received from a non-network provider without the proper referral and authorization, payment is made under the TRICARE Prime point-of-service option.

  • Pediatric vision screening is available at birth and approximately six months of age.
  • Diabetic patients, at any age, are allowed annual comprehensive eye examinations.

TRICARE Extra and Standard Clinical Preventive Services:

Vision screening is excluded from the TRICARE Extra and TRICARE Standard plans except for one comprehensive ophthalmological routine eye examination per calendar year for active duty family members and vision screening under the well-child benefit. The well-child benefit is available from birth to age six and includes eye and vision screening by a PCM during a routine examination at birth and at approximately six months of age. Comprehensive eye examinations are authorized once every two years between ages three and six.

Retirees and their family members who use TRICARE Standard, TRICARE Extra and TRICARE For Life are not eligible for routine eye examinations.

TRICARE Routine Eye-Examination Coverage (for Beneficiaries over Age 6)
Beneficiary Type TRICARE Program Options Routine Eye Examination Coverage Provider Type
Active Duty Service Members TRICARE Prime As needed to maintain fitness-for-duty status Military hospital or clinic, unless specifically referred to a civilian provider
TRICARE Prime Remote As needed to maintain fitness-for-duty status Network optometrist or opthamologist
Active Duty Family Members or TRICARE Reserve Select Members TRICARE Prime or TRICARE Prime Remote One routine eye examination per calendar year Network optometrist or opthamologist
TRICARE Standard and Extra, TRICARE Reserve Select One routine eye examination per calendar year Any TRICARE authorized optometrist or opthamologist (network or non-network)
Retirees, Their Families, and Others TRICARE Prime One routine eye examination every two years Network optometrist or opthamologist
TRICARE Standard and Extra, TRICARE Retired Reserve None N/A

 

TRICARE Routine Eye-Examination Coverage under the Well-Child Benefit (for Beneficiaries under age 6)
Beneficiary Type TRICARE Program Options Routine Eye Examination Coverage Provider Type
Infants (up to age 3) All programs One routine eye and vision screening at birth and at 6 months Primary care manager or physician
Active Duty Family Members or TRICARE Reserve Select Members Children (ages 3 - 6) TRICARE Prime or TRICARE Prime Remote One routine eye examination per calendar year Network optometrist or opthamologist
TRICARE Standard and Extra, TRICARE Reserve Select One routine eye examination per calendar year Any TRICARE authorized optometrist or opthamologist (network or non-network)
Non Active Duty Family Children (ages 3 - 6) TRICARE Prime One routine eye examination every two years Network optometrist or opthamologist
TRICARE Standard and Extra, TRICARE Retired Reserve One routine eye examination every two years Any TRICARE authorized optometrist or opthamologist (network or non-network)

Lenses (lenses implanted within the eye or contacts) and Eye Glasses:

Except for active duty members, lenses or eye glasses are only cost shared for treatment of the following conditions:

  • Infantile glaucoma
  • Keratoconus
  • Dry Eyes
  • Irregularities in the shape of the eye
  • Loss of human lens function resulting from eye surgery or congenital absence.

Benefits are limited to only one set of implantable lenses required to restore vision. A set may include a combination of both implantable lenses and eyeglasses when the combination is necessary to restore vision. If there is a prescription change related to the qualifying eye condition, a new set may be cost shared.

Replacement lenses for those that are lost, have deteriorated, or have become unusable due to physical growth are not covered. Adjustments, cleaning and repairs of eyeglasses are also not covered.

TRICARE VisionMore

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TRICARE vision benefits vary depending on beneficiary status and type of TRICARE coverage you have.

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