What Eyecare (Including LASIK) Does TRICARE Vision Cover? – NVISION (2024)

A health care program for uniformed military service members, family members, and retirees, TRICARE provides health and vision coverage plans.

Your TRICARE vision coverage depends on who you are (active-duty military, a family member, or a retiree), your age, and your specific plan. Costs for TRICARE coverage also depend on your specific plan, coverage options, and service level.

If you are enrolled in a TRICARE health plan and meet eligibility requirements, you may also be able to enroll in the FEDVIP (Federal Employees Dental and Vision Insurance Program), which can cover routine eye exams and prescription eyewear.

TRICARE coverage can cover routine eye exams, glasses, contacts, and medically necessary eye surgery. Your plan may require prior authorization or a referral first.

LASIK surgery and eye surgery that is not deemed medically necessary are not covered by TRICARE vision plans.

TRICARE coverage is offered regionally through local providers in an extensive network of care.

TRICARE Vision Coverage

TRICARE is a health care program that offers coverage to:

• Uniformed active-duty military service members.
• Military spouses and children of active-duty military members
• Retirees.
• National guard members.
• Military reservists.

TRICARE vision plans can include coverage for eye glasses and contacts, routine eye exams, and medically necessary eye surgery. Plans differ depending on your level of service, age, and your sponsor (such as if you are active duty or retired, or your family member is active duty).

Insurance Costs

The cost for TRICARE vision coverage will depend on your specific plan and level of service.

Active-duty service members do not pay out-of-pocket fees. Family members of active-duty service members also do not have to pay out-of-pocket fees if services are in-network and a referral is used. Pharmacy services and TRICARE select plans can incur extra costs.

TRICARE plans use either a cost-sharing or copay system for out-of-pocket expenses. A copay is a set amount you will pay when you receive services, while a cost-share program involves a percentage of the total health care service. If you use a TRICARE network provider, your costs will be lower than if you use an out-of-network provider.

For vision services through many TRICARE plans, you will need a referral or prior authorization for services in order for them to be covered.

Federal Employees Dental & Vision Insurance Program (FEDVIP)

If you are enrolled in a TRICARE health plan and meet certain eligibility requirements, you may also be able to enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP). You must be either a:

• TRICARE for Life member.
• Retiree or retiree family member.
• Reservist or family member of a reservist.
• National Guard member or family member.
• Family member of an active-duty service member.

Vision coverage can include eye exams and prescription eyewear, dependent on your chosen plan and eligibility. Costs vary based on your coverage level and plan.

Coverage for Eye Exams

TRICARE vision coverage varies depending on your plan and military service level. Routine eye exams by an optometrist are generally covered through TRICARE in the following way:

• Active-duty service members: as needed at a military hospital or clinic or through a referral to a civilian in-network provider
• Family members of an active-duty member: once per year
• Retirees and family members of retirees: every two years
• Diabetic patients enrolled in TRICARE Prime: once per year

A routine eye exam is performed by an optometrist. When indicated and authorized, often requiring a referral, it can be performed by an ophthalmologist.

The routine eye exam includes vision and eye health screening as well as prescriptions for glasses when needed. If you need a prescription for contacts, this requires a separate appointment.

TRICARE Coverage for Glasses and Contacts

If you need prescription eyewear, your coverage through TRICARE vision will depend on who you are. 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.

If you are a retired service member, you will order your glasses from the Navy Ophthalmic Support Training Activity Command. If you are an active-duty service member and do not live near a military hospital or clinic, you can also order your glasses from there. Non-activated Reservists and National Guard members will have glasses ordered from the Navy Ophthalmic Support Training Activity Command through their unit.

Other beneficiaries of TRICARE are only covered for glasses and contacts in the following circ*mstances:

• Specialized lenses for the treatment of keratoconus (scleral or corneal lenses)
• Scleral lenses for dry eyes that do not produce enough tears
• Corneal or scleral lenses to correct corneal irregularities (not including astigmatism)
• Lenses for infantile glaucoma
• Specialized glasses, contact lenses, or intraocular lenses for the treatment of injury, defect, or surgical trauma

Glasses repair, cleaning, and adjustments are not covered services through TRICARE vision.

Does TRICARE Cover Eye Surgery or LASIK?

Eye surgery that is considered to be medically necessary due to injury, illness, surgical trauma, or disease can be covered through TRICARE vision. Coverage amounts and costs are dependent on your plan.

If the condition can be treated through medications, this treatment path is typically considered first before surgery is authorized.

Surgical eye procedures, such as corrective refractive surgery like LASIK, are not covered through TRICARE vision. LASIK is considered to be an elective surgery and therefore not covered through most insurance plans.

TRICARE Providers & Regional Coverage

TRICARE providers include military clinics and hospitals as well as in-network civilian providers. TRICARE has an extensive network of contracted providers that you can choose from.

There are TRICARE-authorized providers through regional contractors, either through East Region Network Providers or West Region Network Providers. Your regional contractor depends on where you live.

Through your regional contractor, you will find a comprehensive network of providers. For vision services, depending on your plan, you can typically use either the optometry clinic at a military hospital or clinic, or an in-network and contracted civilian optometrist.

Your plan will dictate if you need a referral or prior authorization for vision services and treatment. Treatment often starts with your primary care manager.

Talk to your primary care provider to discuss your TRICARE health and vision coverage, and how your specific plan works. You can also contact a TRICARE representative directly for more information on plans, coverage options, payment information, and what services you can receive.

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