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TRICARE Coverage for Medically Necessary Nutritional Needs

3/27/2018

March is National Nutrition Month. It’s a smart time to focus on choosing healthier foods to fuel your body. But complete nutrition is complex and depends on your individual needs. People with certain diseases or conditions may require special foods and vitamins beyond the normal healthy diet. Recent changes to the TRICARE benefit include updating the coverage for medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. foods and vitamins, and helping people with obesity get care to help manage their weight.

Medically necessary specialized formulas are covered by TRICARE for oral nutritional therapy, or therapy requiring a feeding tube or intravenous tube. This coverage extends to nutrition therapy for malnutrition as a result of end-stage renal disease.

Medically necessary food (including some vitamins and minerals), medical equipment, supplies and services may be cost-shared when used as a treatment for the following covered medical conditions:

  • Inborn errors of metabolism

  • Medical conditions of malabsorption

  • Pathologies of the alimentary or digestive tract

  • A neurological or physiological condition

Prenatal vitamins that require a prescription may also be cost-shared, but are covered for prenatal care only. Ketogenic diets for the treatment of seizures that are resistant to standard anti-seizure medication are covered, including medical services and supplies provided in inpatient or outpatient settings.

Adults with a body mass index (BMI) of 30 kg/m2 or higher and children/adolescents with a BMI value greater than the 95th percentile may also receive care under TRICARE. Intensive behavioral interventions from a TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. to encourage sustained weight loss (12-26 sessions in a year) are covered. These interventions include, but aren’t limited to:

  • Setting weight loss goals

  • Diet and physical activity guidance

  • Addressing barriers to change

  • Active self-monitoring

  • Strategies to maintain lifestyle changes

For many people, complete nutrition means more than simply eating right. TRICARE supports medically necessary nutritional needs and ensures you and your family get the care you deserve. Learn more about your TRICARE coverage.

Last Updated 7/31/2018