How TRICARE Covers Vaccines

How TRICARE Covers Vaccines
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Vaccine coverage under TRICARE can be somewhat confusing; MOAA members frequently reach out because they have been charged a fee for getting what they thought was a routine immunization. That’s because TRICARE covers vaccines differently when they are given at a TRICARE network pharmacy or given at your doctor’s office.


Vaccine coverage also depends on whether you are a member of an active duty military family, on TRICARE Prime or Select, or are on Medicare and TRICARE For Life (TFL).


Regardless of your plan or type of coverage, the least expensive and most convenient option is typically to receive covered vaccines at a TRICARE network pharmacy. Here’s a breakdown of how vaccines are covered so you can avoid receiving a surprise bill.


What TRICARE Covers

TRICARE covers age-appropriate doses of vaccines as recommended by the Centers for Disease Control and Prevention (CDC). You can find a list of covered vaccines at this link. TRICARE adds coverage for new vaccines based on CDC recommendations.


TRICARE only covers vaccines needed for travel outside the U.S. for active duty family members who are traveling with their sponsor on permanent change-of-station orders or other official travel.




Where You Can Get Vaccines

Your beneficiary status helps determine the most cost-efficient place for you to get vaccinated. TRICARE beneficiaries may be able to get vaccines at a military hospital or clinic, but active duty servicemembers and those enrolled in TRICARE Prime or TRICARE Plus have priority. Contact your local military treatment facility (MTF) for vaccine availability.


Prime beneficiaries who are enrolled in the U.S. Family Health Plan (USFHP) are not eligible to use military treatment facilities and must see a USFHP network provider.


Getting Vaccines at Your Provider

You also can get TRICARE-covered vaccines from any TRICARE-authorized provider. It’s important to note the vaccine itself is covered at no cost, but you may have to pay a copayment or cost share for the office visit or other services received depending on your plan:

  • If you are using TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas, USFHP, or TRICARE Young Adult Prime, you can get a vaccine from your primary care manager (PCM) or any network provider without a referral or authorization.

  • If you are using TRICARE Select, TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult Select, or TRICARE Select Overseas, you can get vaccines from any TRICARE-authorized provider, whether they are in or out of network.

  • If you are using TFL, you also can get a vaccine from any TRICARE-authorized provider, whether in or out of network. However, you will be liable for TRICARE’s deductible and cost share because Medicare does not cover vaccines under Parts A or B. Vaccines fall under Part D, which most military retirees do not have because they use their TRICARE pharmacy benefit instead.

That means retirees on TFL who get their vaccinations at a doctor’s office will have to pay the $150 TRICARE deductible ($300 for families) plus a cost share for the office visit. You can read more about copayments and cost shares at this link.


[RELATED: The Shingles Vaccine and Your TRICARE Coverage]


Getting Vaccines at Network Pharmacies

You can get covered vaccines for free at participating network pharmacies. You can find a network pharmacy at this link.


It’s always a good idea to check with the pharmacy and make sure the vaccine you need is in stock, whether there are any restrictions on the vaccine, and whether you need to make an appointment.


[TAKE ACTION: Help MOAA Fight Cuts to the TRICARE Pharmacy Network]


You will also want to verify that it is the pharmacist who is giving the vaccine. If a provider gives it, you may face out-of-pocket costs.



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About the Author

Lila Quintiliani, ChFC®, AFC®
Lila Quintiliani, ChFC®, AFC®

Quintiliani is MOAA's Program Director, Financial and Benefits Education/Counseling. She is a former Army Military Intelligence Officer as well as the spouse of an active-duty servicemember, and worked for over a decade at military installations as a personal financial counselor.