TRICARE: What You Need To Know

TRICARE is an important health care program for American service members and their families. The versatile program can be used both in the United States and around the world. In fact, there is a specially tailored health insurance plan for almost every kind of service member and his or her family. Retirees moving abroad may qualify for TRICARE for Life Overseas or TRICARE Select Overseas. A National Guard member who has recently left active duty may qualify for the TRICARE Transitional Assistance Management Program after they deactivate. There are even certain programs for surviving spouses and active duty families.

Basic health services are included in the TRICARE program including dental care, prescriptions and some supplementary special plans for qualified veterans and service members. In addition, some plans include specific vision and mental health services. The fullest extent of benefits a veteran can claim and what benefits they can extend to their families is dependent on his or her rank, category, time spent on active duty and regional location.

TRICARE Benefits: How Does It Work

TRICARE insurance includes health coverage, a robust pharmacy program and separate dental care programs for eligible candidates. Additionally, all of the health plans offered meet the minimum essential coverage standards set by the Affordable Care Act. The TRICARE mission is to “be a world-class health care system that supports the military mission,” and it offers a comprehensive range of benefits for service members, retirees and their families. The extent of benefits offered by each plan are dependent on which plan the beneficiary qualified is eligible to claim.

TRICARE co-pays and out-of-pocket costs are all determined by whether the sponsor who is eligible for benefits is serving active duty, retired or a reservist. The costs are further affected by the sponsor’s rank and whether the beneficiary enrolled as a single recipient or part of a family.

Almost every medicine approved by the FDA is covered by the TRICARE pharmacy program. Approved medication must also be part of a medical producer covered by the beneficiary’s health plan and associated with the diagnosis or treatment of an illness. Further, vision benefits, special needs benefits and a full set of mental health services are available through TRICARE. Before claiming the value of available health benefits, a service member needs to determine which plan is available to their location, status and rank.

TRICARE requirements: What You Need To Know

The Defense Enrollment Eligibility Reporting System (DEERS) determines who qualifies for Tricare. Qualified reservists, active duty members and veterans are automatically registered to DEERS, but service members must register their family in the system. Dependent parents and parents-in-law are also eligible to be added to the beneficiary’s plan as benefitting family members.

Categories of service members who are eligible as TRICARE sponsors include:

  • Uniformed service members
  • National Guard members
  • Reserve members
  • Medal of Honor recipients
  • Foreign force members
  • Surviving Spouses

Surviving spouses qualify for TRICARE unless they remarry, in which case they are asked to report the new marriage and return their ID cards to the nearest card facility. Also, dependent children are also no longer eligible for coverage after they have married.

There are several TRICARE plans, and the one a service member can claim depends on his or her status and location. For example, TRICARE Prime is available to those service members who live within a prime service area or those who are willing to waive the TRICARE drive time standards and live within 100 miles of a prime service area. Retirees who plan to move overseas are only eligible for TRICARE for Life Overseas or TRICARE Select Overseas. Meanwhile, active duty members are eligible for TRICARE Overseas or TRICARE Remote Overseas.

TRICARE Dental benefits are available in a more narrow set of programs that are not dependent on location. Those eligible for dental care are:

  • Active duty members are covered by Active Duty Dental Program
  • Active duty family members are eligible to purchase the TRICARE Dental Program
  • Retired service members and their families can purchase the TRICARE Retiree Dental Program
  • National Guard and reservist families can purchase the TRICARE Dental Program
  • Surviving Spouses are eligible for TRICARE Dental Program Survivor Benefit Plan
  • Surviving children may remain on the TRICARE Dental Plan until they lose eligibility for other reasons
  • National Guard members and reservists qualify for:
    • The TRICARE Dental Program when not active
    • Active Duty Dental Care when activated for more than 30 days
    • The Transitional Assistance Management Program for 180 days after deactivation
    • The TRICARE Dental Program if deactivated but not qualified for TAMP

Guide to Apply for Tricare

Step one to apply for Tricare is to select a military or network as the primary care manager of your account. If you live within the service area of a military hospital or clinic, you may be required to enroll for a military provider. You can find the location of the nearest military hospital on the TRICARE website.

If you do not live within the enrollment area of a local military clinic, the TRICARE regions are also available primary care managers. There are three regions: East, West and Overseas. As the name suggests, everywhere that is not part of the United States is considered the “overseas region.” These three regions are “network providers” of health care for veterans, and the unique regional programs can be established as the primary care service.

TRICARE West, or Health Net Federal Services, LLC, controls the area west of the Mississippi River, with some exceptions. Arkansas, Louisiana, Oklahoma and most of Texas are still part of the Eastern Network. The full list of states included in Health Net Federal Services is Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, El Paso in West Texas, Utah, Washington, and Wyoming.

TRICARE East, or Humana Military is the network responsible for the eastern states not listed above. The states includes in this network are Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Rock Island Arsenal area of Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, the St. Louis area of Missouri, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Virginia, West Virginia and Wisconsin. However, the El Paso area of Texas is part of the Health Net Federal Services region.

After you select your primary care manager then complete the TRICARE enrollment form. Place all family members should be on one application. The enrollment form can be submitted:

  • Online. You may only enroll online if you live in a TRICARE prime service area, and you will need a Common Access Card, DFAS My Pay Account and DoD self-service login. Log into the Beneficiary Web Enrollment website and select “Medical” to enroll.
  • By mail. The enrollment forms for both the eastern and western regions are online and can be completed and mailed back to the service offices. The Health Net Federal Services application should be mailed to Health Net Federal Services, PO Box 8458, Virginia Beach, VA 23450-8458. The Humana Military application should be mailed to Humana Military, Attn: PNC Bank, PO Box 105858, Atlanta, GA 30348-5838.
  • By phone. Complete your enrollment over the phone by calling your primary care manager. Call Health Net Federal Services at 1-844-866-9378, and call Humana Military at 1-800-444-5445.

To complete your TRICARE enrollment, fees are required with the submission of your application, unless you satisfy the requirements for one of the few excluded classes. Those who do not have to pay enrollment fees include the following:

  • Active duty service members
  • Active duty family members
  • Transitional survivors
  • Beneficiaries younger than 65 years old and enrolled in Medicare Parts A and B

All other applicants to TRICARE will be asked to pay a certain amount as their enrollment fee, but this fee varies based on the payment group: monthly, quarterly or annually. It is also dependent on whether the veteran enrolled is part of Group A or Group B. TRICARE beneficiaries enrolled before January 1, 2018 are considered Group A. Those who enrolled or whose sponsor enrolled after January 1, 2018 are Group B.

Based on your group and payment type, the enrollment fees are as follows:

Annual Payment Quarterly Payment Monthly Payment
Group A Single $289.08 $72.27 $24.09
Group A Family $578.16 $144.54 $48.18
Group B Single $350.00 $87.50 $29.17
Group B Family $700.00 $175.00 $58.34

Annual payment plan: your TRICARE enrollment fees will be prorated from your enrollment date to December 31. Additionally, the fee can only be paid with a credit or debit card. The fee will be due each year on January 1.

Quarterly payment plan: your enrollment fee is prorated to cover the period until the next calendar year. You can pay the quarterly fee with a credit card, debit card or electronic funds transfer. Payments are due on January 1, April 1, July 1 and October 1.

Monthly payment plan: you can pay the first 3 months by personal check, cashier’s check, traveler’s check, money order or a debit or credit card. After the first 3 months, you are required to establish an automatic direct deposit to pay your fees.

TRICARE vs Medicare: What Are The Differences

Medicare is a federal health insurance plan for seniors and Americans with severe disabilities. There are four parts of Medicare insurance. Most retired veterans will become eligible for Medicare Part A, which provides hospital and inpatient care, while Part B covers outpatient and medical care. Part D is pharmacy care. Veterans, reservists and active service members may use both Medicare and TRICARE if they have dual eligibility, but Medicare will function as their primary care plan.

However there are a few exceptions, veterans who have Medicare Part A must also have Medicare Part B to remain eligible for TRICARE coverage. The exceptions to this rule are the following:

  • Active duty service members do not have to sign up for Part B.
  • Active duty family members do not have to sign up for Part B.
  • Beneficiaries enrolled in TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult or The U.S. Family Health Plan.

As of October 2012, the rule for the U.S. Family Health Plan has an exception. Families that enrolled in USFHP after October 1, 2012 do not remain eligible for the family plan after the qualifying family member becomes eligible for Medicare at 65 years of age. Families that enrolled in USFHP before October 1, 2012 remain eligible for benefits and will experience no break in coverage.

Beneficiaries do not need Medicare Part D to stay enrolled in TRICARE. Moreover, beneficiaries who have TRICARE and Medicare Parts A and B are qualified for TRICARE for Life. In this plan, Medicare is the primary coverage provider, but TRICARE pays out-of-pocket fees to reduce the veteran’s personal health costs. TRICARE also covers Medicare’s co-pays and deductible costs. When retired veterans and their families become eligible for TRICARE for Life, they no longer qualify for TRICARE Prime.