TRICARE Costs and Coverage

Veterans receive TRICARE coverage if they are active or retired members of the Uniformed Services, National Guard or Reserve. Several available plans for servicemembers include TRICARE Prime, Select, or Retired Reserve.

Additionally, Medal of Honor recipients and the qualifying family members of veterans may obtain coverage under TRICARE. These include the current or former spouses and unmarried children of benefit-eligible servicemembers. For instance, the adult children of military members may obtain coverage under TRICARE Young Adult.

While TRICARE standard coverage meets the minimum requirements of the Affordable Care ACT (ACA), many plans for veterans and their families provide recipients with additional benefits such as preventative care services, vision coverage, and low annual deductibles. For some plans, no annual deductible must be met. However, most costs and coverages vary by plan and beneficiary type. To learn more about TRICARE plans and the types of services it provides veterans and their families, beneficiaries can review the information below.

What do TRICARE plans cover?

Most types of TRICARE coverage for dependents and benefit-eligible sponsors provide recipients with comprehensive medical and dental services, low out-of-pocket costs, prescription drug coverage and supplemental benefits for patients with special medical needs. Additionally, most TRICARE plans under the Department of Defense (DoD) meet or exceed the requirements of the ACA unless beneficiaries are only eligible to receive direct care at participating military clinics or hospitals. Examples of these beneficiaries may include dependent parents or parents-in-law.

Moreover, different types of TRICARE coverages include the following: TRICARE Prime, Prime Remote, Prime Overseas and Prime Remote Overseas; TRICARE Select, Select Overseas and Reserve Select; TRICARE for Life; TRICARE Retired Reserve; and the US Family Health Plan. Other plans may include the Transitional Assistance Management Program or the Continued Health Care Benefit Program. Of these plans, premium-based policies include TRICARE Reserve Select, Retired Reserve, Young Adult and the Continued Health Care Benefit Program. Additional information about TRICARE coverage can be found in the sections that follow.

Prime TRICARE Coverages

Many TRICARE standard coverages are available to active duty or retired servicemembers and their families under TRICARE Prime, Prime Remote, Prime Overseas and Prime Remote Overseas. To learn more about these managed-care TRICARE plans, review the following information.

TRICARE Prime

Prime Tricare coverage is available to active duty or retired servicemembers and their dependents, as well as non-activated National Guard or Reserve members who qualify for coverage under the Transitional Assistance Management Program. This managed care option provides beneficiaries in the U.S. with affordable, comprehensive coverage, no annual deductible, and fewer out-of-pocket expenses.

TRICARE Prime Remote and Remote Overseas

As another type of TRICARE spouse coverage, qualifying veterans and their families may enroll in this managed care option if they reside in a remote part of the U.S. To qualify for this plan, however, sponsors must live and work at least 50 miles from a participating military clinic or hospital.

Related Article: VA Health Costs and Coverage

Moreover, other TRICARE covered services are available under TRICARE Prime Overseas and Prime Remote Overseas. To obtain coverage under TRICARE Prime Overseas, for instance, active duty servicemembers and their families must reside near an overseas military hospital or clinic. To enroll in TRICARE Prime Remote Overseas, however, sponsors and their families must reside in a remote overseas location such as Eurasia, Africa, Latin America, Canada or in various Pacific Remote locations.

TRICARE Coverages for Select Plans

TRICARE coverage for dependents, spouses and retired or non-activated sponsors is also available under TRICARE Select. As part of these fee-for-service plans, qualifying beneficiaries pay a percentage of their covered services and an annual deductible for outpatient care. To learn more about TRICARE Select plans, review the sections below.

TRICARE Select

TRICARE spouse and dependent coverage is also available under TRICARE Select. In some cases, sponsors may qualify for TRICARE Select benefits as well, as long as they are not currently serving on active duty. While TRICARE Select covered services meet the minimum essential requirements under the ACA, these plans are only available to the following beneficiaries:

  • The families of active duty servicemembers
  • Retired servicemembers and their dependents
  • The families of activated Guard or Reserve members
  • Non-activated Guard or Reserve members as well as any dependents who qualify for benefits under the Transitional Assistance Management Program
  • Surviving spouses and children (including qualifying former spouses)
  • Retired Guard or Reserve members and their families (if retired servicemembers are at least 60 years of age)
  • Medal of Honor recipients and their dependents

TRICARE Reserve Select and Select Overseas

Other types of TRICARE coverage for non-activated Guard or Reserve members and the families of active duty servicemembers include TRICARE Reserve Select and Select Overseas. TRICARE Reserve Select, for instance, is premium-based plan that benefits qualifying Reserve members and their dependents. To receive benefits under this plan, recipients must pay monthly premiums, an annual deductible and a percentage of their covered services. Moreover, TRICARE Select Overseas provides qualifying beneficiaries in overseas areas with comprehensive medical coverage.

Other Types of TRICARE Coverages

Other types of TRICARE coverage for spouses, dependents and sponsors include TRICARE Retired Reserve, TRICARE for Life, TRICARE Young Adult and the US Family Health Plan. For instance, these TRICARE plans include coverages such as:

  • TRICARE Retired Reserve is a premium-based plan that benefits qualifying retired Reserve members and their dependents. Beneficiaries pay monthly TRICARE premiums, an annual deductible, and a percentage of all covered services.
  • TRICARE for Life is available to applicants who receive coverage under Medicare Part A and B, but also qualify for TRICARE enrollment. As part of this plan, beneficiaries do not pay any TRICARE enrollment fees, but they do need to pay monthly premiums for Medicare Part B.
  • TRICARE Young Adult is available to the unmarried adult children of benefit-eligible sponsors. However, beneficiaries must be between 21 and 26 years of age, unmarried, and they must not qualify for coverage under an employer-sponsored medical plan.
  • The US Family Health Plan (USFHP) is a type of TRICARE coverage for veterans and their families who qualify for coverage under TRICARE Prime. However, beneficiaries must reside in a USFHP service area. Service areas include the following: Maryland; Washington D.C.; parts of Delaware, West Virginia, Pennsylvania and Virginia; Maine; New Hampshire; Vermont; Upstate or Western New York; Massachusetts; Northern and Southern Connecticut; Rhode Island; New York City; Long Island; New Jersey; Southeast Texas; Southwest Louisiana; and Washington State’s Puget Sound region.

How much does TRICARE cost?

TRICARE standard costs and coverages vary by plan and service type. Some plans require a TRICARE copay, while others only include an annual deductible and/or a monthly premium. To learn more about these costs, refer to the following chart.

Plan Type TRICARE Deductible Amounts TRICARE Deductibles for Point-of-Service Options Maximum Annual Out-of-Pocket Expenses Plan Details
TRICARE Prime None $300 per beneficiary; $600 per family $1,000 per active duty family; $3,500 for all others Managed care; affordable and comprehensive
TRICARE Select Between $50 and $300 per individual; Between $100 and $600 per family* N/A $1,000 per active duty family; $3,500 for all others Preferred provider network; referrals not required
TRICARE for Life None N/A $1,000 per active duty or Guard/Reserve family; $3,000 for retired families Secondary coverage for Medicare Part A and B beneficiaries
TRICARE Retired Reserve $150 per individual; $300 per family for in-network services N/A $3,500 per family Premium-based; referrals not required
TRICARE Young Adult – Select Between $50 and $300 per individual* N/A $1,000 per active duty family member; $3,500 for all others Premium-based; referrals not required
TRICARE Young Adult – Prime None $300 per individual $1,000 per active duty family member; $3,500 for all others Premium-based; enhanced preventative and vision services

 

Note: TRICARE deductibles for Select plans vary depending on the rank of the military sponsor.

Which TRICARE covered services are right for me?

To compare TRICARE coverages and standard costs, applicants may use the online Plan Finder tool under the website of the Defense Health Agency (DHA). When using the tool, applicants must provide their relationship to the sponsoring servicemember and the sponsor’s current military status. Depending on their relationship to the sponsor, they may need to provide their marital status, current zip code and country of residence, as well as their eligibility for Medicare insurance or an employer-sponsored health plan.

Related Article: VA Family Health Care

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