TRICARE Expands Care With New Policy Changes

12/5/2019

TRICARE recently expanded coverage for beneficiaries who meet certain criteria. Coverage now includes: concurrent pediatric hospice and curative care, portable continuous positive airway pressure (CPAP) machine, and platelet rich plasma injections.

“TRICARE is always working to improve the benefit,” said Elan Green, chief of the Medical Benefits and Reimbursement Section for the TRICARE Health Plan at the Defense Health Agency. “We want to advance health care for our beneficiaries, and we hope these changes improve treatment options for you and your family.”

Concurrent Pediatric Hospice and Curative Care

Hospice patients under 21 years old may now be eligible for curative care for the same illness. The patient must have a diagnosis of a terminal illness with a life expectancy of six months or less.

The curative concurrent care must be:

  • Medically necessaryClick to closeTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. for the terminal illness for which the child is receiving hospice services
  • Treatment covered by TRICARE

TRICARE covers curative care provided by health care professionals, as well as institutional providers. A shared care plan must be created to ensure a smooth partnership between hospice and other doctors. Your provider must refer you to hospice care. Also, the concurrent care must be pre-authorized.

Once the patient turns 21 years old, he or she is no longer eligible for concurrent care.

Portable CPAP Machine

Active duty service members who travel at least three days per month or deploy may qualify for a portable CPAP machine. You must have a referral from your provider to get a portable CPAP machine.

That referral must include that you:

  1. Have a diagnosis of obstructive sleep apnea.
  2. Travel on official business at least three days per month, or have orders to deploy.
  3. Aren’t retiring or separating from the military within the year.

The device must also be able to work as a humidifier and use batteries.

If you have a standard CPAP machine, you can get a portable machine as long as you qualify with the terms above. However, TRICARE won’t cover a standard CPAP machine if you already used your coverage for a portable one.

Platelet Rich Plasma (PRP) Injections

TRICARE may cover PRP injections if you’re diagnosed with:

  • Mild to moderate chronic osteoarthritis of the knee.
  • Lateral epicondylitis, also known as “tennis elbow.”

Under the provisional coverage program, PRP injections are approved for up to a five-year period. This period is Oct. 1, 2019 to Sept. 30, 2024. You must meet certain criteria for coverage.

“If these policy updates apply to you or your family member, we hope that you will take steps to learn more and take advantage of your health benefits,” said Green.

There are many changes to the TRICARE program every year. To stay current on updates to the TRICARE benefit, sign up for email updates. You can also visit Covered Services to see what’s covered. If you have questions about your coverage, you can call your regional contractor.

Last Updated 12/20/2019