TRICARE: A Comprehensive Guide

When you join the United States military, you become eligible for healthcare coverage under the military’s health insurance program, TRICARE. For those who serve this is not optional, but for dependents and spouses, there are ways to use TRICARE as their main coverage or as a supplement to health insurance they get elsewhere through an employer or by other means.

The TRICARE official site describes itself as the health care program for members of the uniformed services and qualifying family members for all of the above. TRICARE works by offering health care options through a network of on and off-base providers.

All active duty service members are automatically covered by TRICARE when they begin their military career by going to basic training. Enrollment is required, and each branch of military service determines your eligibility for TRICARE.

Who Qualifies for TRICARE?

There is an extensive list of people who qualify for healthcare coverage through TRICARE, and they are not necessarily all active duty, Guard or Reserve members. Some foreign troops may qualify, some former spouses and even some in-laws may qualify.

TRICARE basically subdivides its members into two basic groups. Military members are referred to as “Sponsors” with DEERS-registered spouses and children being “Family Members”. But among these groups, there are those who qualify for TRICARE based on their status as any of the below:

  • Active duty service members
  • Active duty immediate family members
  • National Guard/Reserve members and families
  • Retired service members and families
  • Beneficiaries eligible for both TRICARE and Medicare
  • Survivors
  • Children
  • Certain qualifying former spouses
  • Medal of Honor recipients and families
  • Dependent parents
  • Parents-in-law
  • Foreign Force members and families

To qualify for TRICARE coverage you and your spouse/dependents must be registered in the DEERS system. Those who ship out to basic training aren’t technically enrolled in TRICARE yet, but they are covered by it. A formal enrollment process is required in spite of the initial coverage, which is effective for up to 180 days until you are placed on active duty. Family members may also be covered.

Read More: TRICARE Basics

TRICARE Coverage Plans

The plans listed below are offered based on where you will perform your military duty. For example, for those who are active duty and stationed stateside, TRICARE Prime or TRICARE Prime Remote is typical, depending on location. The TRICARE plan active duty service members use when assigned to an overseas base is typically either TRICARE Prime Overseas or TRICARE Remote Overseas.

  • TRICARE Plus
  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Select
  • TRICARE Select Overseas
  • TRICARE For Life
  • TRICARE Reserve Select
  • TRICARE Retired Reserve
  • TRICARE Young Adult
  • US Family Health Plan

Of the options listed above, active duty troops are automatically enrolled in TRICARE Prime when shipping out to basic training. Spouses and dependents may have other options to consider when the time is right–knowing what those options are is crucial to making the most informed decisions about your health insurance.

Read More: TRICARE Prime vs. Select: How to Decide

TRICARE Costs

Costs vary depending on your plan. For example, an active duty service member who is enrolled today in TRICARE Prime will pay zero dollars in premiums and there is no deductible. Compare that to TRICARE Reserve Select, which features the following costs from 2022:

  • Service Member only: $46.70/month
  • Service Member and Family: $229.99/month

Much depends on whether you are getting a premium-based plan or not. Some TRICARE plans such as Prime Overseas costs may depend on whether you have selected a “point of service” plan or not. In many cases when serving overseas you will get your primary care on-base or on-post, with referrals to off-base providers in the network possible depending on the need and other factors. Active duty service members don’t have the point-of-service option but their family members may.

Getting Medical Care Under TRICARE

You will typically use a care provider within your network, which may be an on-base clinic or hospital but may also include off-base non-military options. You may also qualify for TRICARE coverage with authorized non-network providers, depending on the circumstances.

Options vary between plans, you will need to review the specific policies of the TRICARE plan you qualify for to learn what is possible under that plan.

An authorized TRICARE provider is described on the official site as, “any individual, institution/organization, or supplier that is licensed by a state, accredited by a national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE.”

Read More: What TRICARE Covers

Carrying Other Health Insurance Besides TRICARE

The TRICARE official site notes that active duty service members cannot carry other health insurance besides TRICARE. That rule does not apply to dependents and spouses. Under federal law, TRICARE pays after all other health insurance, except for:

  • Medicaid
  • TRICARE supplements
  • State Victims of Crime Compensation Programs
  • Other Federal Government Programs

Spouses and dependents who carry other health insurance such as that through an employer will have that insurance pay first. Once that payment is made your care provider can submit a claim for any qualifying remainder via TRICARE.

Spouses and dependents with other health insurance are advised to follow the rules of your main insurer for care and claims, and if your main insurance denies a claim because you did not follow their rules TRICARE may likewise deny the claim. It’s best not to treat TRICARE as a “second chance” option if you fail to meet the requirements of your primary insurer.

Read More: Using Other Health Insurance Besides TRICARE

Getting Other Medical Treatment and Care

Military spouses, dependents, veterans, and military retirees may have additional health care treatment options from the Department of Veterans Affairs. Most currently serving military members know they may qualify for VA medical care depending on their circumstances, but did you know that certain qualifying spouses and dependents may also be eligible for VA care? When exploring your TRICARE options, it’s important to also use any other medical benefits offered to you as a dependent or spouse.

Read More: VA Health Benefits For Military Spouses And Dependents

Enrolling In TRICARE

Knowing the type of TRICARE plan you need is key, but timing also counts. Your prior health coverage may have had similar features to plans offered by TRICARE in that you can enroll in or change during an open season period, or after a Qualifying Life Event (QLE). If you are selecting a premium-based plan such as the Continued Health Care Benefit Program you can enroll at any time.

A QLE can be a marriage, the birth of a child, or retirement from active duty. QLEs offer you a three-month (90 days) opportunity to change your TRICARE enrollment. If you aren’t sure about your options or your eligibility for a specific TRICARE plan, review your eligibility online or call 1-800-538-9552 to get assistance.

Depending on the QLE you may gain or lose certain health care coverage options. If you have a QLE you may be able to change your current TRICARE plan or enroll in a new one.

Read More: TRICARE Qualifying Life Events And Your Health Insurance

TRICARE Coverage Exclusions

There is a list of “covered services” on the TRICARE official site, which is too extensive to publish here, but includes services deemed medically or psychologically necessary. There is also a list of specific issues that are NOT covered by TRICARE under any circumstances. Those include, but are not limited to:

  • Alternative Treatments
  • Assisted Living Facility Care
  • Augmentation Mammoplasty
  • Aversion Therapy
  • Blood Pressure Monitoring Devices
  • Elective Psychotherapy and Mind Expansion Psychotherapy
  • Elective Services or Supplies
  • Exercise Programs
  • Experimental Procedures
  • Fluoride Preparations
  • Gym Membership
  • Hospitalization for Medical or Surgical Error
  • LASIK Surgery
  • Massage
  • Medical Care from a Family Member
  • Therapeutic Absences from Inpatient Facility
  • Uncovered Services and Supplies
  • Unnecessary Diagnostic Tests or unnecessary Inpatient Stays
  • Unproven Procedures
  • Vestibular Rehabilitation
  • Vision Therapy

There is no value judgment inferred from inclusion in the list above. As you can see, it’s a mixed bag of legitimate services that simply aren’t covered by TRICARE and services which may yet be unproven or not considered medically necessary. Such lists are subject to change, it’s best to speak with a TRICARE rep before you assume certain types of care may or may not qualify for coverage.

Use the TRICARE Covered Services tool at the TRICARE official site to see what may be currently approved under TRICARE. You can search via the link above using relevant keywords or categories.

Read More: TRICARE and Non-Covered Services

Is TRICARE Available Worldwide?

The United States has two TRICARE regions.

  • TRICARE East
  • TRICARE West

Overseas, TRICARE features a single region divided into three separate areas:

  • TRICARE Eurasia-Africa
  • TRICARE Latin America and Canada
  • TRICARE Pacific

What to Know About TRICARE Coverage

No two TRICARE options are exactly the same. Here’s what you need to know about some of the basic differences between these plans.

TRICARE for Active Duty

Active duty service members are covered in TRICARE from the moment they begin their military service, but they must enroll in the program when the opportunity is available. Initial coverage lasts six months before going on active duty after initial training and technical training.

There are a variety of active duty TRICARE options including:

  • TRICARE Prime
  • TRICARE Select
  • TRICARE Prime Overseas
  • TRICARE Select Overseas

Active duty troops, as mentioned above, cannot use any other health insurance program other than TRICARE. The same is NOT true for spouses and dependents as we will examine below.

Read More: TRICARE for Active Duty Service Members 

TRICARE for Spouses and Dependents

Spouses and dependents of active duty service members have options under TRICARE including but not necessarily limited to:

  • TRICARE Select: a preferred provider organization plan (PPO) offered to those in the United States.
  • US Family Health Plan: this is a TRICARE Prime option available through networks of community-based health care systems. This plan is not offered to all and is not nationwide. It is available only in “designated US Family Health Plan” areas.
  • TRICARE Select Overseas: This plan provides comprehensive coverage for family members living at overseas duty locations.

Read More: TRICARE for Spouses and Dependents

TRICARE For Reserve And National Guard Members

TRICARE benefits will vary based on the service member’s status. One of the most important initial benefits is something called Line of Duty Care which applies to members of the Guard and Reserve who are injured or get sick in the line of duty up to and including weekend drills, ADT, IDT, or other official training. TRICARE coverage is provided for travel to and from official duty as well.

Line Of Duty coverage is designed to address issues that may require an emergency room visit during Guard/Reserve training that is not considered being ordered to active duty, federal service, etc.

Line Of Duty care is separate from other TRICARE coverage such as TRICARE Reserve Select, pre-activation benefits you may be entitled to when called to federal service, and benefits provided under military transition assistance programs.

Read More: TRICARE Benefits For Guard and Reserve Members.

TRICARE Options for Retirees

It should be noted that when we discuss “retirees” in this context we are referring specifically to military members who are eligible to draw military retirement pay. We are not referring generically to all who are retired from work in general, just those who retired from military service.

Retired military members may be eligible for a variety of TRICARE options including:

  • TRICARE Prime
  • TRICARE Select
  • US Family Health Plan
  • TRICARE For Life
  • TRICARE Select Overseas

These healthcare options are offered based on location (stateside or overseas) and in some cases by age (TRICARE For Life is one example). Co-pays and enrollment fees may apply depending on age, status (Guard/Reserve versus active duty), and eligibility for Medicare Part A and B.

TRICARE Prime is the stateside option for those who have retired from the military and have not reached the age for Medicare eligibility. Once you have reached the age of eligibility for Medicare, you are no longer approved for TRICARE Prime as a retiree and must choose one of the other options open to those who can also use Medicare.

TRICARE requirements for members of the National Guard and the Reserve are different from those who retired from active duty service, and you may need to contact a TRICARE rep to discuss your specific circumstances if you have both active service and Guard/Reserve service in your military career history.

Read More: TRICARE For Active Duty Retirees

 

 

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