Applicants must meet TRICARE eligibility requirements before they may obtain medical coverage under this program of the Defense Health Agency (DHA) and the Department of Defense (DOD).
Generally, eligible beneficiaries include servicemembers and their families, surviving or former spouses and Medal of Honor recipients. For instance, program beneficiaries often include current or former servicemembers (known as sponsors) and family members (such as children or spouses).
Moreover, TRICARE eligibility for dependents of servicemembers varies by dependent type. For instance, children must be 21 years of age or younger (or 23 years old if attending college) to qualify for coverage, while the former spouses of military members may only obtain coverage if they are not remarried. Additionally, former spouses must meet the 20-20-20 or 20-20-15 Rule. As part of both rules, the sponsor must hold at least 20 years of military service. To learn more about these eligibility requirements, review the information below.
To meet TRICARE medical insurance eligibility requirements, applicants must be an active duty or retired Uniformed Service Member, National Guard or Reserve Member, or a Medal of Honor recipient. Foreign Force Members may also qualify for coverage in many cases. Additionally, TRICARE medical coverage is available to the families of these eligible servicemembers, including their dependent children, former or current spouses, dependent parents or their parents-in-law. To qualify for TRICARE coverage, however, beneficiaries must meet additional eligibility requirements depending on whether they are a sponsor or family member.
TRICARE-eligible applicants generally include two types of beneficiaries. These include sponsors and their family members. After becoming eligible for coverage, sponsors are automatically registered through the Defense Enrollment Eligibility Reporting System (DEERS), but qualifying service members must register their dependents in the DEER system. To learn more about these specific types of TRICARE sponsors, review the sections below.
Current active duty service members are eligible for TRICARE coverage through TRICARE Prime, Prime Remote, Prime Overseas or Prime Remote Overseas. These benefits are also available to the family members of current servicemembers. Additionally, active duty servicemembers can obtain dental coverage through the Active Duty Dental Program.
National Guard and Reserve members may qualify for TRICARE medical insurance if they can verify their eligibility through the Defense Manpower Data Center’s (DMDC) online Beneficiary Web Enrollment system. As proof of eligibility, they must hold a Common Access Card (CAC), a MyPay/Defense Finance and Account Service (DFAS) login ID and password, or a Level Two DOD Self-Service Logon. After verifying their TRICARE eligibility, these benefits are also available to the family members of current servicemembers.
Moreover, TRICARE eligible members of the Army National Guard and Navy Reserve include members of the Marine Corps Reserve, the U.S. Coast Guard Reserve and the Air National Guard or Air Force Reserve. While Individual Ready Reserve members may obtain dental coverage under the TRICARE Dental Program, they typically do not qualify for other types of medical benefits under this plan, unless they are on active duty or were recently deactivated from service.
Retired service members are eligible for TRICARE Prime, TRICARE Select, the U.S. Family Health Plan, TRICARE for Life and TRICARE Select Overseas. These plans are also available to their qualifying family members. Additionally, retired servicemembers may obtain dental coverage under the TRICARE Retiree Dental Program.
Moreover, these TRICARE eligibility requirements vary if servicemembers retire due to a medical condition. For instance, servicemembers with a disability rating of 30 percent or higher or those who hold a physical condition, disease or injury may obtain placement on the Temporary or Permanent Disability Retirement List (TDRL or PDRL). After the DOD places servicemembers on either of these lists, military members will need to undergo a medical evaluation every 18 months for up to five years to reexamine their eligibility for these benefits. As long as servicemembers remain on these lists, however, veterans and their families will qualify for DOD medical coverage.
Retired Reserve members may meet TRICARE medical insurance eligibility requirements, but the specific type of plan they qualify for varies depending on their age during the time of enrollment. If Reserve members are younger than 60 years of age when they retire, for instance, they may obtain coverage under TRICARE Retired Reserve.
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If Reserve members do not purchase this plan when they retire, they will not qualify for other TRICARE policies until they turn 60 years old. To qualify for TRICARE after turning 60 years old, however, retired reserve members will be eligible to enroll in the same types of plans as other retired military members.
Note: These same medical benefits are available to the families of retired reserve members.
To qualify for TRICARE insurance as a Medal of Honor recipient, service members may be on active duty, separated from active duty or retired. If Medal of Honor recipients are still on active duty during the time of enrollment, they may obtain the same type of TRICARE coverage as other active duty military members. Moreover, those who are separated or retired from active duty may obtain the same types of benefits as retired military members.
Note: These medical benefits are available to the family members of Medal of Honor Recipients.
“Who qualifies for TRICARE as a foreign force member?” veterans may wonder. While specific medical benefits vary for these servicemen and women, foreign force members and their families may qualify for coverage through the DOD if they meet the following requirements:
While foreign force members may be TRICARE-eligible, their families may not qualify for coverage through the DOD if servicemembers are from PFP or NATO nations.
To qualify for TRICARE coverage as the family member of a service member or veteran, beneficiaries must be related to the sponsor by marriage, blood or adoption. For instance, qualifying family members may include:
To qualify for TRICARE eligibility as the former spouse of a military member, the applicant must be unmarried during the time of enrollment and must meet the requirements of the 20-20-20 or 20-20-15 Rule. The rules are as follows:
To apply for Tricare as a qualifying family member, the sponsoring veteran must first register each eligible beneficiary in the electronic DEERS system. If both parents are benefit-eligible servicemembers, however, only one parent needs to be listed as a sponsor in DEERS.
To add TRICARE-eligible family members in DEERS, sponsors must visit a local ID card facility. To find a nearby office, sponsors may use the online Rapids Site Locator under the website of the DMDC. To save time, however, sponsors may schedule an appointment online before heading in, or they may contact the office by telephone. To schedule an appointment online, applicants may use the RAPIDS Appointment Scheduler under the DMDC’s website.
For assistance in scheduling an appointment, applicants may contact the DMDC Support Office at 1-800-538-9552.
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