TRICARE

TRICARE is a health insurance program of the Department of Defense (DOD), providing qualifying military members and their families with comprehensive medical benefits.

TRICARE insurance provides qualifying beneficiaries with access to affordable health care that meets or exceeds the minimum requirements of the Affordable Care Act (ACA), as well as other services such as dental care, mental health services, vision coverage and discounts on prescription medications. Special benefits such as hospice care, home health aide and behavioral analysis are also available to recipients with specialized needs.

To enroll in TRICARE health insurance, applicants may submit an application online, or they may do so by telephone or fax. In some cases, applicants may enroll in person. However, beneficiaries of the TRICARE for Life program do not need to enroll in the plan as long as they are registered in the Defense Enrollment Eligibility Reporting System (DEERS). To learn more about this health insurance program, service members and qualifying dependents of service members can review the information below.

What are the TRICARE eligibility requirements?

TRICARE health insurance is available to two main types of eligible beneficiaries. These beneficiaries include military sponsors such as active duty or retired Uniformed Service Members and qualifying family members such as current spouses, dependent children, and unmarried former spouses. Additionally, this DOD health program is available to members of the National Guard and Reserve, Medal of Honor recipients, Foreign Force Members, and the surviving spouses or children of these beneficiaries. Generally, military health insurance is available to the dependent parents or parents-in-law of servicemembers as well.

To receive TRICARE benefits, sponsors and their qualifying family members must meet several important eligibility requirements. However, these requirements vary by beneficiary type. For instance, TRICARE eligibility for dependents include the following requirements:

  • Children who receive coverage under a military parent’s insurance policy must remain unmarried and be younger than 21 years of age (or 23 if attending college).
  • Former spouses of benefit-eligible military members must meet the requirements of the 20-20-20 or 20-20-15 Rule.
  • Dependent parents or parents-in-law may only obtain coverage under this program if the military member served on active duty for at least 30 days.
  • Surviving spouses may obtain benefits under their deceased sponsor’s policy for up to three years, as long as they remain unmarried during this time.

What does TRICARE cover?

TRICARE coverage varies by plan type, as several options are available to qualifying beneficiaries. For instance, active duty servicemembers may obtain coverage under the Prime plan or other programs such as Prime Remote, Prime Overseas and Prime Remote Overseas. Moreover, the family members of active duty sponsors may obtain coverage under TRICARE for Life, Select plans, the US Family Health Plan, and the DOD Young Adult plan for dependent adult children. For assistance in finding a policy, applicants may use the online Plan Finder tool under the website of the Defense Health Agency (DHA).

Related Article: Tricare Costs and Coverage

In most cases, TRICARE standard coverage provides veterans and their families with essential health benefits such as primary, preventative and emergency care services, hospital care, X-rays and diagnostic tests, and various types of mental health treatments. These plans also cover birth control, antepartum services, breast examinations, cancer screenings, and more.

Moreover, TRICARE insurance also includes dental and vision care. For instance, program beneficiaries receive dental benefits such as adjunctive services and X-rays, as well as vision benefits such as eye surgery and disease prevention examinations. Pharmacy benefits often include flu vaccinations, diabetic supplies, hormone replacement therapy, and immunizations. As for mental health services, treatments may include Cognitive Rehabilitation Therapy, treatments for eating disorders, inpatient hospital services, and detoxification.

How much does TRICARE cost?

Most TRICARE standard costs vary by plan and beneficiary type, as some program participants need to pay annual deductibles, monthly premiums and co-payments, while others do not. For TRICARE Prime plans, costs also vary depending on whether beneficiaries use the program’s point-of-service option to obtain urgent or routine medical care. For instance, qualifying family members who use the point-of-service option under their Prime plan must pay an annual deductible of $300 per individual or $600 per family. If beneficiaries do not use the point-of-service option, there is no annual deductible.

In comparison, TRICARE costs for Select plans vary depending on the rank of the active duty military member. For example, these costs vary depending on whether:

  • Sponsors rank at E-4 or above. If sponsors rank at E-4 or above, their annual deductible amounts will be $50 per individual or $100 per family.
  • Sponsors rank at E-5 or above. If sponsors rank at E-5 or above, their annual deductible amounts will be $150 per individual or $300 per family.

For all other Select Tricare health insurance beneficiaries, the annual deductible amount for in-network services is $150 per individual or $300 per family. For out-of-network services, the deductible amount is $300 per individual or $600 per family.

How do I complete the TRICARE enrollment process?

Applicants may sign up for TRICARE online or by mail, fax or telephone. However, the specific enrollment process varies by plan type and the region in which applicants reside. If enrolling online, for instance, applicants may do so through the website of the Defense Financial and Accounting Services (DFAS). However, they must provide their DOD Self-Service Logon credentials, a DFAS MyPay login ID and password, or they may provide the identification details from their Common Access Card (CAC). If applicants cannot complete the process online, they may apply by mail, fax or telephone.

While the process of how to enroll in TRICARE varies by plan type, applicants who wish to enroll in the Prime, Prime Remote, Select, Reserve Select, Retired Reserve, Young Adult, or the US Family Health Plan may enroll by mail. In most cases, however, the specific process of enrolling by mail varies depending on whether applicants reside Overseas or in the Western or Eastern U.S.

To obtain TRICARE military health insurance, qualifying sponsors and their family members may also enroll in a plan by telephone or fax. However, specific fax and telephone numbers vary by plan type and region. As another option for overseas applicants, beneficiaries of the Reserve Select plan may also apply in person at a participating Service Center in their area.

Related Article: How to Apply for Tricare

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