TRICARE is the healthcare program for uniformed service members, retirees, and their families around the world. Managed by the Defense Health Agency, it provides comprehensive coverage that includes health plans, dental programs, and prescription drug benefits. Understanding how these plans work is essential for ensuring you and your family receive the best possible care while managing out-of-pocket costs.
Who Is Eligible for TRICARE?
Eligibility for TRICARE is determined by the different branches of the military services and is managed through a database called the Defense Enrollment Eligibility Reporting System (DEERS). Generally, those eligible include active duty service members and their families, retired service members and their families, and members of the National Guard or Reserve.
Survivors, former spouses, and Medal of Honor recipients and their families also qualify for coverage. It is vital to keep your information updated in DEERS, as any change in status—such as marriage, birth of a child, or retirement—can affect your plan options and costs.
Understanding the Main TRICARE Plans
TRICARE offers several different plans depending on your status and where you live. Most beneficiaries choose between two primary types of coverage: TRICARE Prime and TRICARE Select.
TRICARE Prime
TRICARE Prime is a managed care option similar to a Health Maintenance Organization (HMO). It is generally the most cost-effective choice for active duty families because it has the lowest out-of-pocket expenses.
- Primary Care Manager: You are assigned a Primary Care Manager (PCM) who handles your routine care and provides referrals for specialists.
- Availability: This plan is primarily available in “Prime Service Areas,” which are usually located near military hospitals and clinics.
- Costs: Active duty service members and their families pay no enrollment fees and no out-of-pocket costs for covered services when using their PCM.
TRICARE Select
TRICARE Select is a self-managed, preferred provider organization (PPO) plan. It offers more flexibility than Prime but typically involves higher out-of-pocket costs.
- Provider Choice: You do not need a PCM and can see any TRICARE-authorized provider without a referral. You will save money by choosing providers within the TRICARE network.
- Flexibility: This plan is ideal for those who live away from military installations or prefer to manage their own specialist appointments.
- Costs: Beneficiaries pay an annual deductible and cost-shares (a percentage of the cost) for covered services.
Specialized Plans for Specific Groups
Beyond the standard Prime and Select options, TRICARE offers specialized plans tailored to the needs of retirees and members of the National Guard and Reserve.
TRICARE For Life (TFL)
TRICARE For Life is Medicare-wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Part A and Part B. There are no enrollment fees for TFL, but you must pay your Medicare Part B premiums.
When you use TRICARE For Life, Medicare acts as the primary payer, and TRICARE pays the remaining out-of-pocket costs for TRICARE-covered services. This plan is available worldwide, though the way it interacts with Medicare may vary if you are living overseas.
TRICARE Reserve Select (TRS)
TRICARE Reserve Select is a premium-based plan available to qualified members of the Selected Reserve and their families. It functions similarly to TRICARE Select, offering a PPO-style structure where you can see any authorized provider.
Members must pay a monthly premium to maintain coverage. This is often a very competitive option for part-time service members who do not have access to employer-sponsored health insurance.
TRICARE Young Adult (TYA)
TRICARE Young Adult is a plan that qualified adult children can purchase after they “age out” of regular TRICARE coverage at age 21 (or age 23 if enrolled in a full-time course of study). It provides coverage until the age of 26 and is available in both Prime and Select versions.
Pharmacy and Prescription Benefits
All TRICARE plans include a comprehensive prescription drug benefit. The program is managed by Express Scripts and offers several ways to fill your prescriptions depending on your needs and location.
- Military Pharmacies: You can fill prescriptions for free at any military hospital or clinic pharmacy, though formulary availability may vary.
- TRICARE Pharmacy Home Delivery: This is a convenient and cost-effective way to receive maintenance medications (drugs you take regularly) delivered right to your door.
- Retail Network Pharmacies: You can use thousands of authorized retail pharmacies, though you will typically pay a higher copayment than you would through home delivery or a military pharmacy.
Dental and Vision Coverage
While TRICARE covers most medical needs, dental and vision benefits are often handled separately through the Federal Employees Dental and Vision Insurance Program (FEDVIP).
Active duty family members and retirees are generally eligible to enroll in a FEDVIP dental plan. For vision, most TRICARE health plans include routine eye exams, but more comprehensive coverage for glasses or contacts usually requires enrollment in a FEDVIP vision plan.
How to Enroll in a TRICARE Plan
Enrolling in a TRICARE plan is a straightforward process, but it requires you to be proactive about your status and deadlines. Follow these steps to ensure you are covered:
- Update DEERS: Visit a local ID card office or use the MilConnect website to ensure your personal information and eligibility status are correct.
- Choose Your Plan: Evaluate your needs based on your location, budget, and preferred level of flexibility. Use the TRICARE Plan Finder tool on the official website to compare options.
- Submit an Enrollment Application: You can enroll online through the Beneficiary Web Enrollment (BWE) portal, by mail, or by calling your regional contractor (Health Net Federal Services for the West Region or Humana Military for the East Region).
Note that most beneficiaries can only enroll or change plans during the annual TRICARE Open Season or following a Qualifying Life Event (QLE). QLEs include things like moving, getting married, or having a baby.
Understanding TRICARE Costs
TRICARE costs are categorized based on when the sponsor joined the military. Those who entered service before January 1, 2018, are in “Group A,” while those who joined on or after that date are in “Group B.”
Group B beneficiaries generally have different enrollment fees and higher out-of-pocket costs than Group A. However, all TRICARE plans feature a “catastrophic cap,” which is the maximum amount you will pay out-of-pocket for covered services each year. This provides significant financial protection for families facing serious medical issues.
Choosing the Right Plan for Your Family
When deciding between TRICARE Prime and TRICARE Select, consider how often you visit the doctor and how much you value choosing your own specialists. If you prefer a low-cost, structured environment and live near a military base, Prime is likely the best fit.
If you prefer to see specific doctors outside the military system or live in a rural area, the flexibility of Select might be worth the additional cost-shares. Always review the current year’s cost tables, as copayments and deductibles can change annually.
TRICARE provides a robust safety net for the military community, ensuring that health concerns do not become financial burdens. By staying informed about your options and keeping your DEERS record updated, you can make the most of these valuable benefits. For more information on navigating military benefits and everyday insurance questions, explore our other helpful articles on SearchAndHelp.com.