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    Does TRICARE cover scleral lenses?

    TRICARE generally excludes eyeglasses and contact lenses, but its policy makes exceptions for a short list of eye conditions, and scleral lenses appear in that list by name. Here is what the policy says, the one-set limit, and how to start.

    By the Scleral Lens Team · Last reviewed October 2, 2026 · 1 published source cited

    The short answer

    For certain conditions, yes. TRICARE's lens policy, as published by the West Region contractor, covers an initial set of corneal or scleral lenses for keratoconus, scleral lenses to retain moisture when normal tearing is absent or inadequate, and corneal or scleral lenses to reduce a corneal irregularity other than astigmatism. Benefits are limited to one set of lenses for the qualifying condition, with replacements only after a prescription change still related to it. Lost or worn-out lenses with an unchanged prescription aren't covered.

    Key points

    • Eyeglasses and contact lenses are excluded except for listed eye conditions.
    • Listed: corneal or scleral lenses for keratoconus.
    • Listed: scleral lenses to retain moisture when normal tearing is absent or inadequate.
    • Benefits are limited to one set of lenses for the qualifying condition.
    • Replacements require a prescription change related to that condition.

    The policy this page is based on

    TRICARE’s rules for lenses are in the TRICARE Policy Manual 6010.63-M, Chapter 7, Section 6.2, “Lenses (Intraocular or Contact) and Eyeglasses.” This page is based on the policy as published by TriWest Healthcare Alliance, the TRICARE West Region contractor, in its Ophthalmology Services Policy Key (original approval August 13, 2024; revised July 23, 2025). TriWest cites that manual section for every lens rule quoted below.[1]

    Before you rely on it, confirm the current rules with your own regional contractor or on tricare.mil.

    The general rule: lenses are excluded, with exceptions

    The policy lists eyeglasses and contact lenses as not covered, except as described in the lens section of the manual.[1] That lens section is where scleral lenses come in.

    The conditions that qualify

    The policy says the initial set of lenses may be approved for any of these conditions:[1]

    • Contact lenses for treatment of infantile glaucoma
    • Corneal or scleral lenses for treatment of keratoconus
    • Scleral lenses to retain moisture when normal tearing is not present or is inadequate
    • Corneal or scleral lenses prescribed to reduce corneal irregularity other than astigmatism
    • Intraocular lenses, contact lenses, or eyeglasses to do the job of the eye’s natural lens when it has been lost to surgery or injury, or is missing from birth

    That’s unusually direct. Several other insurers’ documents we read never use the word “scleral”; this list uses it three times.

    If you have keratoconus, severe dry eye, or an irregular cornea from scarring or a corneal transplant, ask your eye doctor which listed condition fits your diagnosis. Note that the third item says “other than astigmatism,” so ask how your plan would treat irregular astigmatism.

    The limits

    • One set. Benefits are limited to one set of lenses related to the qualifying eye condition. A set can include both lenses and glasses when the combination is necessary and related to the qualifying condition.[1]
    • FDA status. Lenses must be either approved for marketing by the FDA or used under an Investigational Device Exemption.[1]
    • Replacements. Replacement lenses or glasses may be approved when there has been a prescription change that is still related to the qualifying condition.[1]
    • What isn’t replaced. When the prescription is unchanged, replacing lenses that are lost, have deteriorated, or no longer fit because of growth is not covered.[1]

    The replacement rule matters for scleral lens wearers, because lenses can break or be lost. Ask your eye doctor about care and backup options, and ask your contractor exactly what counts as a qualifying prescription change.

    Where TRICARE and the VA differ

    TRICARE is a health plan for service members, retirees, and their families. VA health care is a separate system for eligible veterans, with its own rules for contact lenses. If you have both, see our page on whether the VA covers scleral lenses.

    What to ask

    Your regional contractor:

    1. Does my diagnosis qualify under the lens policy?
    2. Do I need a referral or prior authorization for the fitting and the lenses?
    3. Does the fitter I’m considering accept TRICARE, and are they in network for my plan?
    4. What counts as a prescription change that allows replacement lenses?

    The practice:

    1. Do you accept TRICARE for my plan?
    2. Will you submit any authorization request with my records?
    3. How many lenses do you expect to order during the fitting, and how does that fit the one-set limit?

    If a request is denied, our appeals guide explains the general steps. For costs TRICARE won’t cover, see HSA, FSA, and other ways to pay.

    Common questions

    Does TRICARE cover scleral lenses for keratoconus?

    Yes, the policy lists corneal or scleral lenses for treatment of keratoconus as a qualifying condition for the initial set of lenses. Benefits are limited to one set of lenses related to the qualifying condition, and the lenses must be FDA approved for marketing or under an Investigational Device Exemption.

    Does TRICARE cover scleral lenses for dry eye?

    The policy lists scleral lenses to retain moisture when normal tearing is not present or is inadequate. Your eye doctor's records need to show that your tearing is absent or inadequate. Ask your regional contractor what documentation it needs.

    Will TRICARE replace my scleral lenses?

    Only in limited cases. The policy allows replacement lenses when there has been a prescription change that is still related to the qualifying eye condition. It does not cover replacing lenses that are lost, have deteriorated, or no longer fit because of growth when the prescription hasn't changed.

    Do I need a referral or prior authorization?

    That depends on your TRICARE plan and region, and rules change. Check with your regional contractor before the fitting, and ask your fitter's office to submit any request with your records.

    Keep reading

    Does the VA cover scleral lenses?

    For eligible veterans with a qualifying eye condition, often yes. VA provides eyeglasses and contact lenses only to veterans who are receiving VA care and fall into an eligible group under federal regulation, such as those with a compensable service-connected disability. VHA Directive 1034 then lists conditions for contact lenses, including keratoconus, significant corneal pathology, corneal transplant, irregular astigmatism, and specialty lenses for conditions like severe dry eye. A VA eye care provider decides. Ask your VA eye clinic or prosthetics representative.

    Prior authorization for scleral lenses

    Prior authorization is your plan agreeing in advance that a service or item is medically necessary. Many plans require it for medically necessary contact lenses; your fitter's office usually submits it with your records. Approval isn't a promise to pay: the claim can still be limited by your benefits, deductible, and network. Ask both your plan and the practice whether it's needed before any lenses are ordered.

    What counts as medically necessary contact lenses?

    It means lenses needed to treat or see with a qualifying eye condition, where glasses don't do the job. Plans that publish criteria commonly list keratoconus and other irregular corneas, very high prescriptions, a large difference between the eyes, missing natural lens or iris, and severe ocular surface disease. Each plan sets its own conditions, measurements, and paperwork, and meeting the criteria doesn't guarantee approval. Ask your plan for its written criteria.

    How to appeal a denied scleral lens claim

    Start by finding out exactly why the claim or prior authorization was denied. For most private health plans you can then file an internal appeal within 180 days of the denial notice, with a letter from your fitter and the records that answer the reason given. If the plan still says no, you can usually ask for an independent external review. Medicare and some other plan types have their own processes, so check your denial letter.

    Paying for scleral lenses with an HSA or FSA, and other options

    Usually yes. IRS Publication 502 says you can include contact lenses needed for medical reasons as a medical expense, along with the supplies needed to use them, such as saline. That generally makes them eligible for HSA and FSA funds. Keep itemized receipts, check your account administrator's documentation rules, and be careful with deferred-interest medical credit cards.

    Sources

    1. TriWest Healthcare Alliance, TRICARE West Region. Policy Key: Ophthalmology Services. Original approval August 13, 2024; revised July 23, 2025. Citing TRICARE Policy Manual 6010.63-M, Chapter 7, Section 6.2, Lenses (Intraocular or Contact) and Eyeglasses. triwest.com

    Last updated October 2, 2026. Found an error or a newer study? Let us know and we'll correct the page.