TRICARE for Spouses and Dependents
TRICARE is the military health insurance plan for service members and their families. TRICARE automatically covers new troops when they ship out to basic training, but they must enroll themselves and their family members later. Servicemembers are automatically covered by TRICARE Prime during basic training and technical training and are required to enroll in Prime or other options depending on where their first duty station might be (stateside or in the United States).
Family members are typically enrolled in Prime or Prime Overseas but have other options–including those not offered to active duty service members.
TRICARE Options for Spouses and Dependents
Spouses and dependents of active duty service members have the following options under TRICARE:
- TRICARE Select: a preferred provider organization plan, also known as a PPO, which offered to those in the United States
- TRICARE Select Overseas: This plan provides comprehensive coverage for family members living at overseas duty locations.
- US Family Health Plan: the TRICARE official site as “an additional TRICARE Prime option available through networks of community-based, not-for-profit health care systems”. This plan is not offered nationwide, but only in “designated US Family Health Plan” areas.
- TRICARE For Life: The TRICARE official site describes this as Medicare-wraparound coverage for TRICARE-eligible beneficiaries. To qualify you must have Medicare Part A and B.
Who Is TRICARE Select for?
TRICARE Select is offered to the immediate families (spouses, children) of active duty service members, military retirees and family, spouses and children of qualifying Guard/Reserve members, survivors, and several others. You must enroll in this program and you must be registered in DEERS before doing so.
Using TRICARE Select
When you use TRICARE Select, you may make medical appointments with any TRICARE-authorized care provider. You have options to use in-network and out-of-network providers and referrals are not required for “most primary and specialty appointments.”
The TRICARE official site advises that you may need “pre-authorization from your regional contractor for some services”. TRICARE Select does not require you to carry a TRICARE insurance card. You use your military-issued ID as proof of your insurance coverage.
Paying For TRICARE Select
This health insurance features costs that may vary depending on the status of the service member. In general, you’ll pay an annual outpatient deductible, plus cost sharing for any TRICARE-covered services. There are enrollment fees for TRICARE Group A retirees, a practice that started in 2021.
Who Is TRICARE Select Good For?
TRICARE Select is not available to service members on active duty. That includes members of the National Guard and the Reserve. Spouses and family members may choose Select in cases where they live somewhere TRICARE Prime is not offered or available, or if you have other health insurance coverage. Select is also good when using a healthcare provider that is not in the TRICARE network and you do not want to change your provider.
What Is TRICARE Select Overseas?
TRICARE Select Overseas is a plan offered to spouses and dependents. Select Overseas offers “comprehensive coverage in all overseas areas” according to the TRICARE official site. You must enroll in TRICARE Select Overseas, and you are required to be registered in DEERS (and your record must show you as eligible to enroll in TRICARE) before you do so.
Who Is TRICARE Select Overseas for?
After active duty family members, other groups may be eligible for TRICARE Select Overseas. These include, but may not be limited to:
- Retired service members and their families
- Family members of those ordered to active duty service for more than 30 days in a row.
- Guard/Reserve members
- Qualifying non-activated Guard/Reserve members and their families under the Transitional Assistance Management Program
- Retired Guard/Reserve members (who are 60 or older) and their families*
Using TRICARE Select Overseas
You don’t need a referral to an overseas provider, and you can schedule an appointment with “any” overseas care provider as long as they are listed in the authorized directory. Pre-authorization may be required for some care or services. You do not need a TRICARE card, your military-issued ID card acts as your proof of insurance.
Paying for TRICARE Select Overseas
Overall costs may depend on the status of the service member, but in general expect to pay an annual outpatient deductible, cost sharing for services, plus any required enrollment fees. With TRICARE Select Overseas, you should expect to pay for your care upfront and out of pocket. You will file a claim to be reimbursed for your health care.
Who Is Right for TRICARE Select Overseas?
You are not required to use TRICARE Select Overseas; you can be enrolled in the service members’ TRICARE Prime Overseas instead. If you don’t want either option you may need to purchase other health insurance.
What Is the TRICARE US Family Health Plan?
This option is offered as “an additional TRICARE Prime option” offered via community-based, not-for-profit health care systems. There are six care centers in the United States offering care under this option. Those care centers are:
- Johns Hopkins Medicine
- Martin’s Point Health Care
- Brighton Marine Health Center
- St. Vincent Catholic Medical Centers
- CHRISTUS Health
- Pacific Medical Centers
Not all regions have US Family Health Plan options. You may be eligible for the TRICARE US Family Health Plan if you live in one of the following areas:
- New Hampshire
- Upstate and Western New York
- Northern Tier of Pennsylvania
- Washington D.C.
- Parts of Pennsylvania, Virginia, Delaware, New York City
- Long Island
- Southern Connecticut
- New Jersey
- Philadelphia and area suburbs
- Southeast Texas
- Southwest Louisiana
- West Virginia
- Rhode Island
- Northern Connecticut
- Western Washington state
- Parts of eastern Washington state
- Northern Idaho
- Western Oregon
Who Qualifies for the TRICARE US Family Health Plan?
This TRICARE option is offered to active duty family members, military retirees, and their families, family members of Guard/Reserve members who are called to active duty for more than 30 days, plus the following:
- Qualifying non-activated National Guard/Reserve members and their families under the Transitional Assistance Management Program
- Retired National Guard/Reserve members (age 60 or older) and their families
- Medal of Honor recipients and their families
- Qualified former spouses
Using the TRICARE US Family Health Plan
All care under this plan is provided by an approved provider you pick from a list of private doctors affiliated with an approved not-for-profit health care option. If you need specialized care, the primary care provider is expected to help you get appointments for these services. No care at military hospitals or TRICARE providers in the area is possible with the TRICARE US Family Health Plan.
Paying for the US Family Health Plan
There are no enrollment fees for active duty family members. There are no out-of-pocket costs for care IF you are getting that care from your approved provider. All other care requires annual enrollment fees and copays.
Who Is Right for the TRICARE US Family Health Plan?
Those who live in one of the designated areas for this program should consider the option, even if they choose not to enroll. Making a fully informed choice about your healthcare–even TRICARE options–is crucial if you want to get the most out of your coverage.
What Is TRICARE For Life?
TRICARE For Life is offered to those who are eligible for TRICARE and who also carry Medicare Part A and B. Enrollment is NOT required, this coverage is automatic if you have Part A and B. You must pay Medicare Part B premiums, and in the United States, TRICARE is NOT the primary payer. TRICARE pays AFTER Medicare in the USA and U.S. territories. In overseas areas, TRICARE is the first payer.
Who Is Eligible for TRICARE For Life?
The eligibility requirements for this option are likely the most simple of all those listed here. To qualify you must simply be TRICARE-eligible AND carry Medicare Part A and Part B.
How TRICARE For Life Works
TRICARE For Life is available to use with any care provider who accepts Medicare. You WILL need a Medicare card, but you won’t need a TRICARE insurance card since your military-issued ID card serves as your proof of insurance. Treatment MAY be available at military hospitals or other facilities but this is provided on a space-available basis only.
Paying for TRICARE For Life
There are no enrollment fees for this TRICARE option but you are required to pay premiums for Medicare Part B. Those fees are established based on the applicant’s income. If you need to know which options are covered under this TRICARE program you can use a search tool provided on the official site to look up specific types.
Using TRICARE For Life
This program is offered worldwide; the TRICARE official site says you may use “any provider you want” but warns that higher costs may be possible when you “get care from Veteran’s Administration providers or providers who opt-out of Medicare because they’re not allowed to bill Medicare”.