What You Need to Know About TRICARE: Comprehensive Guide to TRICARE Plans, Coverage and Services

The United States Armed Forces is entirely voluntary, and to entice young people to consider the military as a career option, the United States Department of Defense offers many enticing benefits to those who choose to serve in defense of the country. There are many benefits available to a service member for their willingness to join in whatever capacity they choose to serve, whether it be active duty or reserve. Most people know about the educational benefits of the G.I. Bill and the military benefits of restaurants and hotels, but it is the healthcare that entices many to consider the military. The establishment of the Veterans Administration aimed to provide affordable and often free healthcare to all military Veterans, particularly for illnesses and injuries sustained during their service. VA healthcare is available to most who serve in the military, but in recent years, there have been further expansions of Veterans healthcare into more detailed programs, such as the TRICARE program. TRICARE Insurance is available to all uniformed service members, but not all military personnel qualify. It is part of the military healthcare system and shares some benefits with VA healthcare, but it also differs in many other ways.

What is TRICARE?

TRICARE Insurance is a healthcare program within the United States Department of Defense military health system. This system provides civilian health benefits to uniformed military personnel, functioning as the civilian care component of the military health system. The benefit of this is that in addition to civilian services, all VA health centers are also TRICARE health centers, therefore, those in the TRICARE Insurance system can be treated in civilian locations and VA hospitals, offering more flexibility in treatment options. The Defense Health Agency currently manages the program.

In the past, healthcare for military personnel and their families was primarily provided by military medical facilities. However, problems arose when certain military facilities did not provide the particular healthcare required, forcing the Servicemember to pay out of pocket to see a civilian specialist. The TRICARE plan, a part of the single-payer healthcare system the United States offers to its military members, allows military personnel in need of healthcare not provided by a local VA facility to see a civilian specialist without incurring out-of-pocket costs.

Who can benefit from TRICARE?

While Veterans Administration healthcare is generally available to everyone who wears a United States military uniform, the specific benefits an individual qualifies for vary depending on their type of service or duty, length of time in the military, and other factors. Uniformed Servicemembers are primarily eligible for TRICARE Plans. Those who qualify for TRICARE Insurance include:

• Active-duty Servicemembers and their families
• National Guard and reserve members and their families
• Retired service members and families
• Retired reserve members and families
• Survivors of military personnel
• Children of service members
• Former spouses
• Medal of Honor recipients and families
• Dependent parents and in-laws

As with the VA and its different plans, the system also offers various plans.

TRICARE Coverage

Most TRICARE plans aim to lower out-of-pocket costs for preventative and maintenance care, as well as the treatment of chronic conditions. What the plan covers will depend on which one the participant is eligible for, but in general, most TRICARE for Veterans plans cover the following:

• Ambulance services
• Laboratory x-rays
• Emergency care is available in both military and civilian facilities.
• Eye exams and glasses
• Home healthcare
• Maternity and obstetric services
• Surgical care
• Mental and behavioral health
• Pediatric services
• Hospitalization
• Surgical care
• Substance misuse treatment
• Counseling
• Physical examinations
• Immunizations
• Screening tests such as mammograms, pap smears, prostate exams, colorectal, exams, etc.
• Vision and hearing screening
• Prescriptions
• Medical supplies
• Prosthesis devices
• Dental care

TRICARE Plans Overview

Most people are familiar with VA benefits and the fact that there are little to no out-of-pocket expenses for eligible Servicemembers, depending upon your income and service connection. However, in these plans, your service might vary, depending on your health plan, and some costs might apply for point-of-service visits outside of the military system. The basic TRICARE plans are:

TRICARE Prime

This plan is the military health maintenance organization, or HMO-style plan, available to active duty, retirees from active duty, reserve, and retirees from reserve. In this plan, beneficiaries select a primary care physician and obtain referrals and authorizations for specialty care. Beneficiaries are responsible for copayments during their visits, and there is an annual enrollment fee for retirees. Care must be provided exclusively in military treatment facilities.

TRICARE Select

This is available to all active duty, retired from active, reserve, retired from reserve, and eligible family members. In this plan, beneficiaries can use any civilian healthcare provider that participates in the system. The beneficiary is responsible for paying an annual deductible and coinsurance on certain out-of-pocket expenses.

US Family Health Plan

This is a health plan available through nonprofit healthcare providers in certain parts of the United States, but it is not available outside of these regions. It operates much like TRICARE Prime.

TRICARE Reserve Select

This is a premium-based health plan that is available primarily to National Guard and reserve members. There is a monthly premium, and it offers coverage similar to the standard plan. Both civilian and military facilities can provide care under a partial premium cost-sharing arrangement.

TRICARE Retired Reserve

This is a premium-based health plan for qualified, retired members of the National Guard Reserve under the age of 60 for themselves and eligible family members. It operates similar to Reserve Select, but there is no premium cost sharing with the DoD.

TRICARE for Life

TRICARE for Life is a Medicare coverage plan that participates in the Medicare system to help offset out-of-pocket costs that increased after 2001. The plan assists in covering patient liabilities following Medicare payments. There is no enrollment requirement, and those who are eligible for any of the military’s Medicare plans are eligible for this plan.

Understanding your regional coverage

The availability of certain benefits in the TRICARE Insurance system is dependent upon the region in which the beneficiary seeks medical care. The United States is divided into the western and eastern regions, and anywhere outside of the continental United States is considered overseas. Each region has a regional contractor to deliver medical care, and international facilities also have their own contractors. The East Region encompasses all states east of the Mississippi River, including Texas and Louisiana. All other states are in the Western region. Those who participate in TRICARE in the west visit this website; those who are in the TRICARE East region visit this website. For the TRICARE Overseas Program visit this website. Most TRICARE for Veterans plans offer the same coverage to qualifying service members, regardless of their region, but the type of medical care and the provider will differ between regions.

How to access your TRICARE benefits online

Make sure your DEERS information is current and accurate before signing up for TRICARE plans. To access your plan, first consider what region you are in, and then visit the TRICARE online website for either the TRICARE East region or the TRICARE West region, and login with your specific login criteria, or your military ID number and Social Security number.

Frequently Asked Questions about TRICARE Benefits