TRICARE is a healthcare program for military members, retirees, and their families. It offers affordable coverage for nearly 10 million people. There are different plans for various needs, like active duty, retirees, or families.
This guide explains TRICARE’s benefits, who can get it, and what it costs. It helps you understand this important healthcare program.
What is TRICARE?
TRICARE is a health insurance program for military members and their families. It covers medical, dental, and pharmacy services. It’s designed to meet the needs of military personnel and their families, providing affordable care.
Eligibility for TRICARE
To get TRICARE, you must be active-duty, retired, or in the National Guard/Reserves. Family members, like spouses and children, can also get it.
Key Groups Eligible for TRICARE:
- Sponsors: Active duty, retired, and Guard/Reserve members.
- Family members: Spouses and children in DEERS.
- Retirees: Usually eligible, but some may not qualify.
Keep your family’s DEERS info up-to-date to stay eligible for TRICARE.
Types of TRICARE Plans
TRICARE has plans for different needs. These include:
TRICARE Prime (Active Duty)
This plan is for active-duty members. It offers care at MTFs with referrals needed for specialists.
TRICARE Prime Remote (Remote Locations)
For those in remote areas, it provides care when MTFs are not available.
TRICARE Select (Retirees and Family Members)
TRICARE Select lets you choose your providers without referrals, like a PPO plan.
TRICARE For Life (Medicare-eligible)
For those 65 and older with Medicare, it offers extra coverage.
TRICARE Young Adult (Adult Children)
Adult children under 26 can stay on TRICARE, with Prime or Select options.
TRICARE Reserve Select
For National Guard and Reserves, it’s like a civilian PPO, covering a lot.
TRICARE Costs and Coverage
TRICARE costs change based on the plan you pick. Active-duty folks don’t pay a thing for medical care. But, retirees and their families usually pay more.
| Plan Type | Enrollment Fees | Deductibles | Copayments/Cost-Shares |
|---|---|---|---|
| TRICARE Prime | $0 (Active Duty) | $0 | None (for most services) |
| TRICARE Select | Varies | $150-$300 | 20-25% |
| TRICARE For Life | None | None | Medicare Part B premium |
| TRICARE Reserve Select | Varies | Varies | Copays for visits |
The catastrophic cap limits what you pay each year for covered services. This cap helps keep costs down.
TRICARE Pharmacy and Dental Benefits
TRICARE also covers pharmacy and dental care. This helps you get the meds and dental care you need.
Pharmacy Coverage
You can get prescriptions at military pharmacies, retail pharmacies, or by home delivery. Active-duty folks don’t pay copays for covered drugs.
| Pharmacy Option | Copay (Generic Drugs) | Copay (Brand-Name Drugs) |
|---|---|---|
| Military Pharmacy | $0 | $0 |
| Retail Network Pharmacy | $10 | $29 |
| Home Delivery | $0 | $29 |
Dental Coverage
Active-duty folks get free dental care at military clinics. But, family members need to sign up for dental plans like TRICARE Dental Program. These plans have costs for things like cleanings and exams.
TRICARE for Active Duty Members and Families
Active-duty members must choose TRICARE Prime or Prime Remote. They get care mainly at Military Treatment Facilities (MTFs). Family members can pick TRICARE Prime or TRICARE Select for care from non-military providers.
TRICARE Prime for Families
Family members in TRICARE Prime don’t pay fees or out-of-pocket costs for most services. This is if care is from their Primary Care Manager (PCM).
Point-of-Service Option
Family members can also get care without referrals. But, they’ll pay more, including deductibles and cost-shares.
TRICARE for National Guard/Reserves and Families
National Guard and Reserve members can get TRICARE Reserve Select when not on duty for 30 days or more. This PPO-style plan covers members and their families well.
TRICARE Retired Reserve
Retired National Guard and Reserve members under 60 can get TRICARE Retired Reserve. It offers good coverage but costs more than active-duty plans.
TRICARE for Retired Members and Families
Retired service members need to sign up for a TRICARE plan within 90 days of retirement. This is to keep their health coverage. They can choose from TRICARE Prime, Select, or For Life if they’re Medicare-eligible.
| Retiree Plan | Enrollment Fee | Deductibles | Copayments/Cost-Shares |
|---|---|---|---|
| TRICARE Prime | $351.96 (Individual), $703.92 (Family) | $150-$300 | 20-25% |
| TRICARE Select | Varies | $150-$300 | 20-25% |
| TRICARE For Life | None | None | Medicare Part B premium |
How to Enroll in TRICARE
To sign up for TRICARE, log into the Beneficiary Web Enrollment system on MilConnect or the TRICARE website. It’s important to keep DEERS updated to keep your coverage.
Steps to Enroll:
- Log into MilConnect: Go to the enrollment system and pick the right TRICARE plan.
- Update DEERS: Make sure your personal info is current to stay eligible.
- Select a Plan: Choose the best TRICARE plan based on your needs and status.
Conclusion
TRICARE is a strong and flexible healthcare system for military folks, retirees, and their families. Knowing your eligibility, coverage, and costs helps you choose wisely. TRICARE offers great coverage for active duty, reserves, and retirees, making sure they get the best healthcare.
