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Learn About TRICARE Vision Coverage

Tricare vision is a form of health insurance specifically tailored to the needs of insureds who require care for their eyes and vision. Much like its dental counterpart, Tricare vision insurance is made available to those serving in the United States Armed Forces as well as their families. Also eligible to enroll in Tricare eye care health insurance plans are those who may be members of the United States National Guard, U.S. Reserve members, as well as veterans of the U.S. military and their spouses.

Tricare vision programs can include a host of services that they cover and a variety of different types of eye doctors and specialists. Tricare insurance also include a host of services and durable medical good as well including testing and diagnostics, preventative and clinical care, and a variety of lenses. Download our free, comprehensive guide on Tricare to learn more.

Who qualifies for TRICARE Vision Insurance?

Those who qualify for Tricare’s other coverage plans may wonder what coverage for eye care is available to them. Luckily, Tricare vision care extends itself to the same sorts of clientele that other modes of Tricare benefits do. Tricare vision providers extend eligibility to the following categories of individuals for coverage:

  • Service members – Active duty servicemen and women who are uniformed members of the United States Armed Forces are all eligible to participate in Tricare programs. This includes their families comprised of spouses and dependent children.
  • National Guard/Reserves – Members of the United States National Guard and/or the Reserves are also eligible for Tricare vision as are their family members.
  • Survivors – This group is comprised of those individuals who are survivors of the primary Tricare member, such as an active duty serviceman or woman, who passed away.
  • Former Spouses – Former spouses of eligible Tricare participants may be eligible to continue with Tricare eye care even though they are no longer married to their former spouses.
  • Medal of Honor – Those receiving the United States’ highest military award, the Congressional Medal of Honor, are eligible for Tricare coverages, as are their immediate family members.
  • DEERS – Any other people who are registered in the Defense Enrollment Eligibility Reporting System are also eligible to participate in Tricare health care insurance coverage plans.

Tricare vision plans will typically group their beneficiaries into one of two specific groupings. The two categories for the vision care plans are:

  • Sponsors – Sponsors are the active duty, Reserve, National Guard, or retired members of these groups who have the root eligibility for coverage.
  • Family members – Family members are the children and spouses of the sponsors who are registered in DEERS.

The particular benefits covered by any Tricare vision insurance coverage plan can vary. This is often associated with a type of beneficiary category assigned to those covered under such plans. These categories are typically broken down into the following groups:

  • Active duty service members and families
  • National Guard/Reserve members and families
  • Retired service members and families
  • Retired Reserve members and families
  • Beneficiaries eligible for TRICARE and Medicare
  • Survivors
  • Children
  • Former spouses
  • Medal of Honor recipients and their families
  • Dependent parents and parents-in-law
  • Foreign Force members and families

What does TRICARE Vision cover?

“Does Tricare cover eye exams?” is just one of many questions those seeking coverage may ask. The answer depends largely on the level of service to which you may or may not be entitled as well as the sort of plan you purchase. Basic vision benefits for active duty members and their families typically include a Tricare eye exam once per year. This is a comprehensive ophthalmological eye exam. The eye doctors that accept Tricare are authorized and include optometrists as well as ophthalmologists.

The next level of service provided to Tricare members is called the Prime level of coverage. Prime level coverage provides a Tricare prime eye exam to any service members or their family members who are enrolled and over the age of three years. Any enrollees may receive services from any Tricare vision providers without a prior referral or authorization from a primary health care provider or from the health care plan manager or any other authority overseeing the health care services or plans for the service member or their families.

Retirees and their families who are enrolled in Tricare vision under the Prime level are entitled to one authorized eye care exam every 24 months. Any services rendered by an out-of-network provider or made without prior authorization or a referral may require payment under the Tricare Prime point of service option. Pediatric vision screening is available at birth and then again at approximately six months of age. Tricare vision patients who are diabetic at any age are entitled to annual, comprehensive eye exams. Tricare vision insurance also provides select clinical and preventative services.

Get Information About Contact Lenses and Eye Glasses

Tricare optical coverages provide for corrective lenses of various sorts when they meet certain eligibility requirements. Active duty members who are enrolled in Tricare plans are covered for their lenses and/or eye glasses. However, for any other enrollees on a Tricare vision plan, the cost of any sort of corrective lenses or eye glasses are provided only on a cost share basis. These include corrective lenses which may be proscribed to treat any of the following conditions:

  • Infantile glaucoma
  • Keratoconus
  • Dry eyes
  • Irregularities in the shape of the eyes
  • A loss of functionality in the lenses of the eyes as a result of surgery or congenital condition

Tricare vision benefits provide for only one set of lenses which may be implanted to restore eyesight. This set can include both implantable lenses as well as regular eye glasses when the combination is deemed necessary to restore a person’s vision. Any change in the prescription for the corrective lenses is permissible as a cost share. Not covered by Tricare vision are any lost or damaged corrective lenses or those that have worn with use over time. Any adjustments, cleanings, or repairs needed for corrective lenses are also not covered. You can find out more about the corrective lenses and options available to you by downloading our comprehensive guide.