Understanding your TRICARE coverage for eye exams is essential for maintaining your vision health. The scope of your benefits depends on several factors, including who you are, your specific TRICARE plan, and your age. In some instances, you might need a referral or pre-authorization before scheduling an eye exam. For detailed information, you can always >>Learn more about referrals and pre-authorizations.
For comprehensive details on your eye exam coverage, continue reading.
Routine Eye Exams Under TRICARE
TRICARE allows you to visit an optometrist for routine eye exams, which are crucial for assessing your vision and overall eye health. During these exams, you’ll receive a glasses prescription if needed. It’s important to note that a separate exam is required for a contact lens prescription. A routine eye exam goes beyond basic vision screenings conducted by primary care physicians using standard eye charts.
Generally, TRICARE covers routine eye exams under the following conditions:
- Active duty service members can get eye exams as needed to maintain their fitness for duty.
- Active duty family members are entitled to routine eye exams once per year.
- All other TRICARE Prime beneficiaries, such as retired service members and their families, are covered for routine eye exams every two years.
If you have diabetes, TRICARE provides coverage for medically necessary eye exams in addition to your routine eye exam benefits. Medically necessary eye exams are deemed appropriate, reasonable, and adequate for your specific condition.
Note: Costs for eye exams can vary depending on your TRICARE plan.
Well-Child Eye Exams: Ensuring Early Vision Health
Through TRICARE’s Well-child Care benefit, children between the ages of three and six are eligible for routine eye exams every two years. These well-child eye exams include screening for amblyopia (lazy eye) and strabismus (crossed eyes) and are conducted by either an optometrist or ophthalmologist.
TRICARE coverage for well-child eye exams includes:
- Exams every two years
- For children aged three to six
- Screening for amblyopia and strabismus
- No cost, regardless of your TRICARE plan
Specialized Ophthalmic Services
Beyond routine and well-child exams, TRICARE covers eye exams and specialized services necessary for diagnosing and treating various eye conditions. This ensures beneficiaries have access to comprehensive eye care when needed.
Exploring FEDVIP Vision Coverage
You might also qualify for vision coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP). Eligibility for FEDVIP vision plans is available to many, and enrollment can be done during a Qualifying Life Event (QLE) or the Federal Benefits Open Season, which occurs every fall. To discover more about FEDVIP and its vision plans, visit >>BENEFEDS.com.
Last Updated 11/21/2024
