Eligibility for Tricare

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.

Who qualifies for TRICARE coverage?

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.

What are the TRICARE eligibility requirements for sponsors?

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.

Active Duty Service Members

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

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 and Medically-Retired Service Members

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

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.

Related Article: Eligibility for VA Disability

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.

Medal of Honor Recipients

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.

Foreign Force Members

“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:

  • Reside in a country that participates in the North Atlantic Treaty Organization (NATO), Partnership for Peace Agreement (PFP) or the Reciprocal Health Care Agreement
  • Are registered in DEERS and hold a valid military identification card
  • Conduct business with the DOD and stay within the continental U.S. on military orders

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.

What are the TRICARE medical insurance eligibility requirements for families?

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:

  • Surviving spouses and children. When an active duty service member passes away, surviving spouses and children may continue their TRICARE coverage for up to 3 years. To qualify for TRICARE eligibility, however, the spouse must remain unmarried. After 3 years, surviving unmarried spouses may qualify for coverage as a retired family member, just as they would if the retired veteran passed away after retiring from the military. Moreover, surviving children may continue their benefits until they marry or turn 21 years old (or 23 if they attend college).
  • Former spouses. Tricare eligibility for dependents varies for the former spouses of military members. For instance, former spouses may qualify for TRICARE medical insurance if they are unmarried during the time of enrollment, can present proof of their eligibility (such as a divorce decree, marriage certificate, or a Statement of Service or DD Form 214), and if their former spouse has at least 20 years of credible military service. Additionally, former spouses must qualify for coverage under the 20-20-20 or 20-20-15 Rule.
  • Children. The unmarried biological, adopted, or step children of service members may obtain coverage under TRICARE until they turn 21 years of age or until they turn 23 years old if they are enrolled in college. After meeting the age limits, children of service members may obtain coverage under TRICARE Young Adult.
  • Dependent parents and parents-in-law. To qualify for TRICARE insurance as a dependent parent or parent-in-law, the servicemember must have served on active duty for at least 30 days. Then, parents may obtain coverage under TRICARE Plus.

Who qualifies for TRICARE under the 20-20-20 or 20-20-15 rule?

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:

  • Under the 20-20-20 Rule, the former spouses of military members may qualify for coverage if their sponsor has at least 20 years of credible military service, they were married to the sponsor for at least 20 years, and all 20 years of the marriage overlap with the sponsor’s 20 years of military service.
  • Under the 20-20-15 Rule, former spouses may qualify for TRICARE if their sponsor has at least 20 years of credible service, they were married to the sponsor for at least 20 years, and at least 15 years of the marriage overlaps with the sponsor’s 20 years of military service.

How do you add TRICARE eligible dependents in DEERS?

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.

Related Article: VA Family Health Care

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