A Primer on TRICARE

TRICARE is a Department of Defense health care program that provides services to the military community, including active duty servicemembers and their families, National Guard and reserve servicemembers, retirees and their family members, and survivors of eligible deceased servicemembers. TRICARE is a complicated program, consisting of several sub-plans that are available depending on the service history and family status of an individual. All provide health care coverage tailored to an individual’s service and location and their preferences for receiving care.

Note that while retirees may be eligible for TRICARE benefits, separated servicemembers and their families are not able to access TRICARE programs.

Who does TRICARE cover?

TRICARE breaks eligibility into two categories: sponsors and family members.

Sponsors include active duty, retired, National Guard, and reserve servicemembers.

Family members include spouses and children who are registered in the Defense Enrollment Eligibility Reporting System (DEERS). In some cases, dependent parents may be eligible for limited coverage.

Different programs within TRICARE are available to sponsors and family members depending on the sponsor’s service status and location. While there are no enrollment fees for active duty service members and their families, retirees must pay an annual enrollment fee for TRICARE coverage.

TRICARE Prime

Active duty servicemembers are automatically enrolled in TRICARE Prime, much like their automatic enrollment in the Thrift Savings Plan or active duty Survivor Benefit Plan. TRICARE Prime allows servicemembers to visit in-network physicians (typically at a military treatment facility, unless the care needed isn’t offered at a military treatment facility) and requires no out-of-pocket fees. Those who choose to visit an out-of-network provider may be required to pay for those visits and care and individuals are required to obtain referrals for specialty treatment.

Active duty family members are also eligible for TRICARE Prime, as are retired servicemembers and their families (provided they are not eligible for Medicare), certain survivors, and qualified former spouses.

Within TRICARE Prime are options for active duty individuals and their families who live more than 50 miles from a military hospital or clinic (TRICARE Prime Remote), who live overseas (TRICARE Prime Overseas), and who live in a remote overseas location (TRICARE Prime Remote Overseas). Family members are able to enroll in TRICARE Prime Remote provided they live with their sponsor who is also enrolled, but family members must be command-sponsored to enroll in one of the overseas programs. There are no TRICARE-remote options for retirees.

TRICARE Prime Option: U.S. Family Health Plan

The U.S. Family Health Plan is an additional TRICARE Prime option available through networks of community-based, not-for-profit healthcare systems in six areas of the U.S. You must live in the one of the designated U.S. Family Health Plan service areas to enroll and the costs are the same as TRICARE Prime. However, individuals using this plan are not eligible for any services at military treatment facilities.

TRICARE Select

TRICARE Select is an option available to active duty family members and retired servicemembers and their families, as well as survivors and qualified former spouses.

Unlike TRICARE Prime, TRICARE Select is a PPO plan, meaning that individuals can receive services from any provider that accepts TRICARE – not just from military treatment facilities. Further, referrals aren’t typically required for specialty appointments. However, TRICARE Select is more expensive than TRICARE Prime. Those enrolled may be liable for certain costs, including enrollment fees, premiums, deductibles, and copayments – costs are determined by the sponsor’s service status.

TRICARE Select Overseas is available to individuals who live outside of the United States.

TRICARE for Life

Before age 65, retirees and their eligible family members can enroll in any of the options above. Once they reach age 65, though, a retiree must sign up for Medicare to keep their TRICARE eligibility. At that point, there are no enrollment fees for TRICARE and the program is called TRICARE for Life.

TRICARE For Life provides supplemental coverage to Medicare for retirees who participate in Medicare Part A and Part B. Retirees must pay Medicare Part B premiums to keep their TRICARE coverage. If an individual has Medicare Part A, they must also have Part B to remain eligible for TRICARE. TRICARE for Life will pick up some or all of the cost of services that are covered by both TRICARE and Medicare after Medicare has been billed or those that are covered by TRICARE only, thereby lowering personal financial responsibility.

Reserve Servicemembers

Reserve servicemembers may be eligible for TRICARE Reserve Select and TRICARE Retired Reserve. Both are premium-based plans, meaning that those enrolled are required to pay monthly premiums to maintain their coverage. They are also liable for an annual deductible and copayments or cost-sharing for covered services.

TRICARE Reserve Select is available to members of the Selected Reserve who are not on active duty orders, not covered under the Transitional Assistance Management Program, and neither eligible for nor enrolled in the Federal Employees Health Benefits Program.

TRICARE Retired Reserve is available to members of the retired Reserve who are qualified for non-regular retirement, under age 60, and neither eligible for nor enrolled in the Federal Employees Health Benefits Program, as well as their family members and some survivors.

TRICARE Young Adult

Unmarried adult children can purchase TRICARE Young Adult coverage after they age out of coverage provided by their servicemember sponsor (which happens at either age 21 or age 23 if enrolled in college). To qualify, adult children cannot be otherwise eligible for TRICARE (for instance, if they joined the military on their own) or eligible for an employer-sponsored health care plan through their own job.

This coverage bridges the gap from adulthood through to age 26, when a child is no longer eligible to be listed as a dependent on their parent’s health care coverage. Adult children may be able to choose between TRICARE Young Adult Prime and TRICARE Young Adult Select, which function the same as described above.

Those enrolled are required to pay monthly premiums, copayments or cost-sharing for covered services, and, for those enrolled in TRICARE Young Adult Select, an annual deductible.