Benefits A-Z

Observation Services

Outpatient observation stays are a covered benefit when a hospital places a patient under observation, but has not admitted him or her as an inpatient. These services generally occur after an emergency room visit or after an outpatient surgical procedure (ambulatory surgery). While outpatient observation stays generally should not exceed 23 hours, up to 48 hours are covered when medically necessary.

The costs for these services are based on the related services: emergency room costs or ambulatory surgery costs. If an observation stay is for more then 48 hours, the costs for inpatient hospitalization or inpatient hospitalization for mental health will apply.

Occupational Therapy

Occupational therapy is covered to improve, sustain, or restore functions which have been lost or reduced as a result of injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, or developmental, learning or physical disability(ies), to the highest possible level for independent functioning. More >>

Office Visits

Office visits, also known as individual provider services, are covered. The following services may be included in an office visit:

  • outpatient office-based medical and surgical care
  • diagnosis and treatment by a specialist
  • second opinion
  • allergy tests and treatment
  • osteopathic manipulation
  • rehabilitation services, for example, physical therapy, speech pathology services and occupational therapy
  • medical supplies used within the office, including casts, dressings and splints

Cost Information

Opioid Replacement Therapy (ORT)

Opioid replacement therapy (ORT) is a covered outpatient benefit for the treatment of substance use disorders. Examples of ORT include methadone or suboxone maintenance treatment. Opioid replacement treatment requires prior authorization for all beneficiaries. If ORT is used in an inpatient or partial hospitalization program setting, it does not require a separate authorization and is considered included in that episode of care.

Orthodontia

Orthodontia, such as braces or retainers, is not a covered benefit except when related to the surgical correction of a congenital abnormality such as a cleft palate. Note dental benefits are available under the separate TRICARE dental programs. Also see adjunctive dental.

Orthoptics

Orthoptics is not a covered benefit. Examples of orthoptics include vision therapy, eye exercises or visual training. See alternative resources.

Orthotics

Orthotic devices are a covered benefit. However, benefits for foot orthotics and cranial orthotics are very limited. More >>

Outpatient Behavioral Health

See psychotherapy

Over-the-counter drugs

Any drug not requiring a physician’s prescription, even if a physician writes a prescription for such drugs, is not a covered benefit.