TRICARE: A Comprehensive Guide

TRICARE

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

 

 

TRICARE for Active Duty Service Members

TRICARE is the United States military healthcare program for active duty military members and their families. When you start your career in the Armed Forces, you are covered by TRICARE from the moment you ship out to boot camp, and you will later formally enroll in TRICARE on behalf of yourself and your family.

Military members have basic coverage options, but family members have expanded options and may, depending on the plan, have the option to apply for TRICARE coverage to supplement the options they have with civilian or federal employers.

The programs below are all approved for active duty troops. This article does not cover the TRICARE options for those retiring or separating from the military; these are options for those who are currently serving on active duty status. Terms and conditions for Guard and Reserve troops who are activated may be similar, but conditions may apply.

TRICARE for Active Duty Service Members and Families

Active duty service members and eligible family members registered in DEERS have options for TRICARE including the following:

  • TRICARE Prime is a managed care health insurance plan all active duty military members use when assigned to a stateside base.
  • TRICARE Prime Remote is for servicemembers and their families stationed in remote locations in the United States.
  • TRICARE Prime Overseas is similar to Prime but is a “managed care” plan for those assigned to overseas areas near military hospitals and clinics.
  • TRICARE Prime Remote Overseas is also a managed care option but this is for those stationed overseas in remote locations.

TRICARE Prime

TRICARE Prime is offered to those assigned stateside, located in “Prime Service Areas”. This plan is offered to active duty service members and their families, who will use a Primary Care Manager or PCM who is either a military care provider or an in-network provider. You get referrals for services your PCM cannot offer and you make your copays to the PCM. Active duty troops pay no fees out of pocket, and family members likewise unless they select a “point-of-service” option. Point-of-service plans cost more but allow the following:

  • Care available from any TRICARE-authorized provider
  • Options for routine care
  • No referrals required

Active duty troops are covered by Prime when they ship out to basic training. Enrollment is required but it typically does not happen immediately in spite of being covered. TRICARE Prime is the only option you can have as an active duty service member–you cannot carry other health insurance when stationed in the United States. Family members are not restricted in this way (see below).

TRICARE Prime Remote

TRICARE Prime Remote is a managed care plan similar to Prime but offered only in remote areas in the United States. According to the TRICARE official site, you may only enroll in Prime Remote when the service member’s home and work addresses are more than 50 miles (or one hour’s drive time) from a military hospital or clinic. Enrollment is required but there are no fees for active duty troops.

“Most care” comes from a primary care manager (PCM) or a network PCM where applicable. The PCM will offer referrals for services they cannot provide and you may be offered help finding specialists and filing claims. Prime Remote is not offered overseas as there is a different plan for those assignments.

TRICARE Prime Overseas

Like its stateside equivalent, TRICARE Prime Overseas is a managed care option for those assigned to bases outside the United States. Enrollment is required, there are no enrollment fees, and TRICARE Prime is available to both the service member and “command sponsored: dependents.

“Command sponsored” means the family members are listed on the service member’s orders and are approved to accompany the service member to the overseas location. Those who are not command sponsored may not be eligible for care under TRICARE Prime Overseas. Likewise for spouses and/or dependents who were originally command sponsored but lost that command sponsorship for some reason.

Like TRICARE Prime for stateside assignments, most care is offered via a PCM. For Prime Overseas your care is likely to start at a military clinic or hospital. The PCM offers referrals when specialist care is needed. There are no copays as long as your care comes from the PCM or via a referral.

TRICARE Prime Remote Overseas

Prime Remote Overseas is for those who are stationed at remote assignments. This plan is offered to both service members and families, but in many cases a soldier, sailor, airman, Marine, or Guardian may be sent to such an assignment without dependents. In order for dependents and spouses to qualify for Prime Remote Overseas, they must be command sponsored.

There are three coverage areas for Prime Remote:

  • Eurasia-Africa
  • Latin America and Canada
  • Pacific

Most healthcare under Prime Remote comes via an assigned primary care manager who will refer you to specialists for care the PCM cannot offer. There are no enrollment fees, and no copays as long as your care is from the PCM or by referral.

TRICARE for Active Duty Family Members

Active duty family members can enroll in the Prime plans above along with the service member but they are not restricted from seeking other TRICARE options which may include:

TRICARE Select is a plan described as a preferred provider organization plan (PPO) offered to those in the United States. This option is described as a self-managed, preferred provider organization (PPO) plan available, and is offered to those living in the United States. Family members who are registered in DEERS may apply for this option.

TRICARE Select Overseas provides comprehensive coverage for family members living at overseas duty locations. This is offered for command-sponsored family members only and works in a similar fashion to TRICARE Select.

US Family Health Plan is a TRICARE Prime option available through networks of community-based health care systems. This plan is not offered to all and is available only in “designated US Family Health Plan” areas. It’s an “additional TRICARE Prime option” offered to those living in qualifying regions. Care is offered via networks of community-based healthcare providers in six regions in the USA.

TRICARE For Life is for family members who are TRICARE-eligible and have Medicare Part A and B. Enrollment for this program is automatic if you meet the requirements. Under this program, you can use any care provider who accepts Medicare, which is the “first payer” with TRICARE For Life paying the remainder for approved services.

TRICARE Young Adult is for qualifying adult children after their eligibility for “regular” TRICARE coverage ends at age 21 (or 23 if enrolled in college according to the official site). This option is for those who are unmarried adult children of an eligible TRICARE sponsor or active duty service member.

You must be between 21 and 26 years old. In cases where you are enrolled full-time at “an approved institution of higher learning” and the service member is responsible for at least half of your financial support eligibility may not begin “until age 23 or upon graduation, whichever comes first” according to the TRICARE official site.

What to Know About TRICARE Options

It is a very good idea to compare TRICARE plans to see which options are best for your family. Active duty troops don’t have a choice, they must enroll in TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, or TRICARE Prime Remote Overseas, depending on where they have been assigned.

Comparing these plans with other family options under TRICARE can help you select the most appropriate coverage depending on duty station, your next scheduled permanent change of station move, or other career changes.

Not all plans are appropriate for all family members; some may be offered health insurance through an employer and coverage options should be selected carefully on that basis. An active duty military member should expect to have to change TRICARE plans every few years or so depending on where they are reassigned–stateside or overseas.

Compare plans at the TRICARE official site using the TRICARE comparison tool.

 

TRICARE Basics

The Basics of TRICARE: An Overview

TRICARE is a health care program offered to military members, veterans, and their families.  TRICARE offers a blend of coverage and treatment opportunities shared between civilian providers and the military healthcare system. TRICARE is offered worldwide, and there are specific coverage options for remote assignments, those who are military retirees, and military family members.

The TRICARE official site reminds applicants that each branch of service determines who in its ranks is eligible for TRICARE. At press time that includes but may not be limited to:

To see if you are eligible for TRICARE, check your records in DEERS to make sure your information there is fully up to date. Then review your eligibility for TRICARE by logging into MilConnect.

Where You Get Healthcare Under TRICARE

Depending on your location, you may have the option to get on-base care at a military clinic or hospital, you may be able to choose a civilian provider in your network, or you may need to select an authorized-but-non-network option.

If you choose care on-post, know that you will be given priority based on your TRICARE healthcare plan. TRICARE Prime and TRICARE Plus patients have priority on base, so if your plan is on a lower priority you may wish to select a different option. But how do you know which plan you are on?

TRICARE Coverage Plans

There are many options, but what you qualify for from the list below depends on where you are stationed if you are still serving, whether you are a retiree or not, and whether you are on active duty or not. Your TRICARE options include:

  • 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. All others have the choice to use Prime or TRICARE Select which is a preferred provider organization plan also known as a PPO.

TRICARE Prime and TRICARE Select are offered as stateside options and overseas options. When you are assigned to a base overseas after having served stateside, you will enroll in the Overseas version of Prime or Select. That enrollment is not necessarily automatic–expect to file paperwork and update your insurance coverage.

RELATED: TRICARE Prime vs Select: How To Decide

Enrolling In TRICARE Prime When Entering Active Duty

When you ship out to your basic training, the TRICARE official site says you are “automatically covered” by TRICARE Prime but enrollment is still required. New troops typically sign up for TRICARE at their first duty assignment.

You’ll enroll any qualifying immediate family members at that time, but those family members must be registered in DEERS.

Those wondering about dental coverage should know that in most cases active duty members get dental care at an on-base clinic but there are civilian options available via the Active Duty Dental program operated by United Concordia.

Active duty troops should know that TRICARE is the only health benefit you may use. There are no out-of-pocket expenses under TRICARE Prime; those who must pay for coverage are reimbursed by TRICARE.

TRICARE For National Guard/Reserve Members and Families

Members of the Guard/Reserve and their family members may be eligible for TRICARE. You’ll need to log into the Defense Manpower Data Center or MilConnect to verify eligibility for Line of Duty Care, Active and Inactive care, and options for those who are retiring. In general, the TRICARE official site says members of the Individual Ready Reserve (IRR) may have the option to purchase dental coverage but typically do not qualify for other TRICARE benefits unless on active duty orders OR recently deactivated.

TRICARE Enrollment Seasons

Like many insurance programs, once enrolled in Prime or Select you may only make changes to your enrollment during the Open Season or after a Qualifying Life event such as a marriage, leaving active duty, or the birth of a child. Changes must typically be applied for within 90 days of the event. For some TRICARE plans (premium-based plans) you can enroll at any time.

What If I Have Other Health Insurance?

The TRICARE official site states that those with other coverage in addition to TRICARE (think Medicare or coverage offered by an employer, TRICARE supplements do not qualify as “other health insurance” and the Prime option may not be the best choice in such cases.

How Much Does TRICARE cost?

Each TRICARE plan has its own unique features, and your costs may vary depending on the nature of your plan, how many (if any) dependents you want to list in your plan, where you are assigned (stateside or overseas), and other variables. The TRICARE Compare Cost tool can help you get an idea of what to expect from your own coverage.

TRICARE Coverage for Survivors

Surviving family members may still be covered by TRICARE after the service member dies. This will depend on the military status of the service member at the time of death and the relationship of the survivor to the servicemember (a spouse or child).

In the event of the service member’s death, the survivor is not required to update DEERS but the death must be reported to the TRICARE pharmacy contractor in order to update those specific records.

However, some information may be slow to update in certain military records systems; the TRICARE officials site advises that it may be helpful to inform the Defense Manpower Data Center by:

  • Visiting a local ID card office with a copy of the death certificate;
  • Faxing a copy of the death certificate to 1-800-336-4416 or;
  • Mailing a copy of the death certificate to:

Defense Manpower Data Center Support Office
400 Gigling Road
Seaside, CA 93955-6771

TRICARE When Separating from Military Service

Some want to know if they are still eligible for TRICARE coverage when separating (not retiring) from active duty. TRICARE literature states, “You and your family may qualify for temporary health care coverage when you separate from the service”.

In order to know what you may qualify for, you will need to schedule a physical exam and a “separation history” between 90 and 180 days before your official date of separation. This process is designed to help review your “complete medical history”.

Your family members, age 18 and older, may be able to access their medical information on MilConnect up to six months after you separate, but a DS Logon is required.

There are two programs for temporary TRICARE coverage while you are separating. You may qualify for one of the following:

  • Transitional Assistance Management Program
  • Continued Health Care Benefit Program

The Transitional Assistance Management Program provides up to 180 days of premium-free health care benefits after regular TRICARE benefits end. These benefits help with your transition to civilian life.

The Continued Health Care Benefit Program (CHCBP) is a premium-based plan offering up to 36 months of temporary healthcare coverage when you lose your current eligibility. It is intended as a “bridge” between TRICARE and a replacement health care plan.

 

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