Tricare covers some nursing home costs, but not all of them, and the amount depends on which Tricare plan you have and whether you need skilled nursing care or custodial care
Tricare is the health insurance program for active-duty service members, retirees, and their families. If you are covered by Tricare and need a nursing home, Tricare will pay for skilled nursing facility (SNF) care — the kind where nurses and therapists provide medical treatment — but typically only for a limited time after a hospital stay. Tricare does not cover custodial care, which is help with daily activities like bathing, dressing, and eating when no medical treatment is needed. Many nursing homes provide both types of care, so you may pay Tricare's share for the skilled part and your own money for the custodial part.
The amount Tricare pays depends on your specific plan and whether you meet the requirements for coverage. Most importantly, Tricare will only pay if your nursing home stay follows a hospital stay of at least three days and if the facility is authorized by Tricare. Understanding these limits before you need a nursing home helps you plan for costs that Tricare will not cover.
Key Takeaways
- Tricare covers skilled nursing care for up to 100 days per benefit period if you were hospitalized first, but you pay a daily copay after day 20.
- Tricare does not cover custodial care or long-term residential nursing home stays once skilled care ends.
- You must use a Tricare-authorized nursing home and get pre-authorization before admission, or Tricare may deny the claim.
- Medicare, Medicaid, long-term care insurance, or your own savings typically cover the costs Tricare does not.
- Your Tricare plan type (Prime, Select, or Standard) affects how much you pay and which facilities you can use.
How Tricare Pays for Skilled Nursing Care
Tricare covers skilled nursing facility care only when it follows a hospital stay of at least three days. The facility must be licensed as a skilled nursing facility and must be authorized by Tricare. You do not pay anything for the first 20 days; starting on day 21, you pay a daily copay (the amount varies by Tricare plan and changes yearly). Tricare covers up to 100 days per benefit period, which runs October 1 to September 30 each year.
The key word is skilled. This means a doctor has ordered medical treatment — wound care, intravenous therapy, physical therapy after surgery, or monitoring of a new condition — that requires a nurse or therapist to deliver. If you need a nursing home only because you cannot bathe or dress yourself, Tricare will not pay, even if a nurse works at the facility.
You must obtain pre-authorization from Tricare before you enter the nursing home. Your hospital discharge planner or the nursing home's admissions staff can request this, but you should confirm it happened before you sign admission papers. If you do not get pre-authorization and Tricare later decides the stay was not medically necessary, you will owe the full bill.
What Tricare Does Not Cover
Tricare does not cover custodial care, which is the largest part of most nursing home bills. Custodial care includes bathing, dressing, toileting, eating, and supervision — the daily help that allows someone to live safely in a facility. Even if a registered nurse is on staff, if your primary need is custodial care, Tricare will not pay.
Tricare also does not cover nursing home care that is not preceded by a hospital stay. If your doctor recommends a nursing home directly from home or from an outpatient visit, Tricare will not cover it. Additionally, once your skilled care needs end — for example, after your wound heals or your therapy is complete — Tricare stops paying, even if you remain in the facility. You then become responsible for the full daily rate.
Tricare does not cover assisted living facilities, memory care units, or residential care homes. These are not licensed as skilled nursing facilities and fall outside Tricare's coverage rules entirely. If you need one of these settings, you will need to pay out of pocket or use another source of coverage.
How Your Tricare Plan Type Affects Coverage
Tricare Prime, Tricare Select, and Tricare Standard have different rules for nursing home coverage. With Tricare Prime, you must use a Tricare-authorized facility and obtain pre-authorization; if you do not, you may owe the full cost. Tricare Select and Standard allow you to use any Tricare-authorized facility, but you still need pre-authorization for coverage to explore.
The daily copay amount differs by plan. Tricare Prime typically has the lowest copay for skilled nursing care, while Tricare Select and Standard copays are higher. You can find the current copay amounts on the official Tricare website or by calling your regional Tricare contractor — the phone number is on your Tricare card.
If you are a retiree or family member over 65, you may also be covered by Medicare. Medicare has its own skilled nursing facility benefit that sometimes pays before or alongside Tricare. Coordinating between the two programs can be complex, so ask the nursing home's billing department to verify coverage before admission.
Finding a Tricare-Authorized Nursing Home
Not every nursing home accepts Tricare. You can search for authorized facilities using the Tricare provider search tool on the Tricare website, or you can call your regional Tricare contractor to ask which facilities near you are in-network. The nursing home's admissions staff can also tell you whether they accept Tricare and what the daily rate is for patients with Tricare coverage.
When you call or visit, ask specifically whether the facility is authorized for skilled nursing care under your Tricare plan. Some facilities may accept Tricare for some services but not others. Get the answer in writing if possible, because verbal assurances do not protect you if a bill arrives later.
What to Do When Tricare Coverage Ends
Tricare's 100-day skilled nursing benefit runs out, or your skilled care needs end before day 100. At that point, you have several options. If you are also covered by Medicare, Medicare may continue to cover skilled care under its own rules (which are similar to Tricare's but have different limits). If you have long-term care insurance, that policy may cover custodial care or extended stays. Medicaid covers nursing home care for people who meet income and asset limits, though the process process takes time.
If none of these options explore, you will need to pay out of pocket or move to a less expensive setting, such as assisted living or home care. Some nursing homes offer a lower daily rate for private-pay residents once insurance coverage ends. Discuss this with the facility's business office before you need it, so you understand what your costs will be.
Steps to Take Before Admission
Before entering a nursing home, contact your Tricare regional contractor to confirm that the facility is authorized and to understand your copay obligation. Ask the nursing home to submit a pre-authorization request on your behalf; do not assume they will do this automatically. Request a written estimate of what you will owe out of pocket, including any charges Tricare does not cover.
Bring your Tricare card and any other insurance cards (Medicare, Medicaid, supplemental insurance) to the admissions appointment. Ask the admissions staff to verify your coverage in writing before you sign any financial responsibility forms. If the facility cannot or will not do this, consider choosing a different facility.
Frequently Asked Questions
Will Tricare pay for my nursing home stay if I was not hospitalized first?
No. Tricare covers skilled nursing facility care only when it follows a hospital stay of at least three days. If your doctor recommends a nursing home directly from home or an outpatient clinic, Tricare will not pay. You would need to use Medicare, Medicaid, long-term care insurance, or your own money.
What happens after my 100 days of Tricare coverage run out?
Tricare stops paying after 100 days per benefit period. If you still need skilled care, Medicare may cover it under its own rules. If you need only custodial care, you must pay out of pocket, use Medicaid if you may have access to, or use long-term care insurance. Talk to the nursing home's business office about payment options before your Tricare days end.
Do I have to use a Tricare-authorized nursing home?
Yes, if you want Tricare to pay. If you use a facility that is not authorized, Tricare will not cover the cost, and you will owe the full bill. You can search for authorized facilities on the Tricare website or call your regional Tricare contractor for a list.
Does Tricare cover assisted living or memory care?
No. Tricare covers only skilled nursing facilities. Assisted living, memory care, and residential care homes are not covered, even if they employ nurses. If you need one of these settings, you must pay out of pocket or use Medicaid if you may have access to.
What should I ask the nursing home before I admit?
Ask whether the facility is Tricare-authorized, what your daily copay will be, whether they will submit pre-authorization to Tricare, and what charges Tricare does not cover. Request a written estimate of your out-of-pocket costs. Ask how long they expect your skilled care to last and what happens when Tricare coverage ends.