Tricare Help

Can I still get eye exams covered under Tricare for Life?

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I am a military retiree who lives near an Air Force base. I have been using Tricare Prime, but next month I’m eligible for Medicare and Tricare for Life. I’ve been getting bi-annual eye exams and free glasses on base, and I’ve been using them for mammograms and other diagnostic services as well, with no out-of-pocket costs to me. Will I still be able to do that once I have TFL?

Unfortunately, one of the quirks of Tricare for Life is that neither Medicare (the primary payer) nor Tricare Standard (the secondary payer) covers the costs of routine vision and hearing exams or eyeglasses and hearing aids — the very services that Medicare-eligible seniors are most likely to need. However, Medicare does cover a number of other diagnostic services, including mammograms.

The lack of vision and hearing coverage under TFL is the main reason beneficiaries seek out Tricare supplemental policies offered by most of the major military associations. Almost all of these supplemental policies offer vision and hearing coverage, because they know full well that TFL does not. However, before you consider a Tricare supplemental policy, make sure you examine its coverage conditions very carefully to determine whether the premiums would be less than what you’d pay out of pocket for your vision and hearing needs.

Does Tricare for Life cover hearing aids?

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Does Tricare for Life cover hearing aid testing and hearing aids if needed?

Neither Medicare nor Tricare Standard, the two components of Tricare for Life, cover routine hearing tests or hearing aids. Similarly, neither Medicare nor Tricare Standard will pay for routine eye exams or eyeglasses.

In the case of Medicare, some diagnostic hearing exams are covered by Medicare Part B, but only when they are ordered by a doctor. Also, if a hearing problem is due to a specific injury or disease — such as removal of a brain tumor or a head injury — Medicare may cover the charges in those cases.

In the case of Tricare, hearing aids are covered only for active-duty family members who suffer “profound” hearing loss based on specific criteria.

Many Medicare Part C (“Medigap”) insurance policies and Tricare “supplemental” policies specifically cover hearing and eye exams, and hearing aids and eyeglasses, precisely because Medicare and Tricare do not. But before you consider buying such a backup plan, it’s very important to read all the fine print and do some basic math to make sure that the supplemental plan’s monthly premiums and cost shares won’t end up costing you more money than if you simply paid the costs out of your own pocket.

Will Tricare pay for lens replacement surgery to fix cataracts?

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I am scheduled for an intraocular implant lens replacement due to cataracts in my eye. I do not see this procedure listed as a covered in the Tricare for Life web pages for eye surgery. Does TFL cover the balance due after my Medicare Part B pays their approved share?

When medically necessary and appropriate for the particular Tricare beneficiary, the costs of surgery to remove and replace the eye’s natural lens is covered by Tricare, as is one pair of spectacles following the surgery if medically necessary in the particular case.

Note that Tricare may cover the procedure only when performed by a Tricare-authorized provider. An authorized provider is one that is registered with Tricare and is approved to be paid by Tricare for covered medical services provided to Tricare beneficiaries. Tricare may not pay for any health-related services received from an unauthorized provider.

Contact your Tricare regional contractor for more information.

Will Tricare cover glasses for macular degeneration?

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I am writing for my father, a retired World War II vet. He wants to know whether Tricare for Life will pay for glasses since he has macular degeneration. Would he be covered?

I wish I had better news for you. Tricare’s benefits are determined by federal law, which specifically excludes eyeglasses and contact lenses from its benefit, with one exception. One pair of spectacles will be covered following cataract surgery to remove the eye’s natural lens and the placement of an approved artificial lens.

Glasses are covered only in rare cases

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Q. I’m a 61-year-old retired reservist who needs new glasses. What kind of vision coverage does Tricare provide?

For retirees, Tricare cannot cover refractions — that is, measurements of your eyes for glasses. Near- or farsightedness are not considered to be eye diseases and generally are not covered.

Neither does Tricare have a benefit for eyeglasses or contact lenses for any beneficiary, except in the case of a few specific but uncommon eye conditions, and for one pair of spectacles or contact lenses following an intraocular lens implant.

Although Tricare cannot cover the kind of vision care you ask about, it does provide coverage for the medical and surgical treatment of diseases of, or injuries to, the eye, including the replacement of the eye’s natural lens lost for any reason.