TRICARE: What Military Families Need to Know

TRICARE Insurance: What Military Families Need to Know

Even if you’re active duty, you may not know much about your TRICARE benefits

Active service members, reservists, retirees, veterans and family members are all eligible for different care plans under TRICARE. These plans can include health insurance, dental and vision, and even pharmacy options to get your meds covered.

It’s important to know exactly what coverage you’re entitled to. Here’s a breakdown of TRICARE’s top programs, and what each of them offers:

 

TRICARE Prime

Prime is considered the go-to out of all the TRICARE plans. Active duty members are automatically enrolled, and many others have the option.

If you are not in a Prime Service Area, you have the option to be on Prime Remote, Prime Overseas, or Prime Remote Overseas plans.

Who is eligible?

  • Active duty and their families
  • Retirees and their families (unless they’re on TRICARE For Life)
  • Guard/Reservists and their families
  • Retired Guard/Reservists (age 60 and getting retired pay) and their families
  • Survivors
  • Medal of Honor recipients and their families
  • Qualified former spouses

Active duty + family costs

  • Minimal out-of-pocket expenses
  • No enrollment fees
  • No network copayments
  • No point-of-service fees
  • $1,000 catastrophic cap, or maximum out-of-pocket pay per year

Non-active duty + family costs

Those who entered service before 2018:

  • $297 single member annual enrollment fee
  • $594 for family package
  • $3,000 catastrophic cap

If they entered after 2018:

  • $360 for single member annual enrollment
  • $720 for family package
  • $3,598 catastrophic cap

Copays range from $20 for primary care, up to $150+ for maternity care.

How it works

As a TRICARE beneficiary, you have an assigned primary care manager (PCM). They are your main doctor and can refer you to specialists if needed.

You can find your PCM or request to change to a specific PCM on the TRICARE site.

Care is almost always provided at the military treatment facility nearest you. It can sometimes be arranged in civilian clinics, in which case there will be a copay.

 

TRICARE Select

Select is a fee-for-service plan that lets you see any doctor. When visiting a network doctor, you will only have to make a small copay. (If you see a non-network doctor, you will need to pay all charges and file a claim with TRICARE for later reimbursement).

Who is eligible?

  • Active duty family members (active service members are a part of Prime)
  • Veterans and their families
  • Retirees and their families

Active family member costs

No enrollment fee, and a $1,000 catastrophic cap.

Deductibles:

  • $50 individual (sponsor rank E-4 and below)
  • $100 family (E-4 and below)
  • $150 individual (E-5 and above)
  • $300 family (E-5 and above)

Copay amounts for sponsor who entered service before 2018:

  • $21 for primary care
  • $31 for specialist
  • 20% of allowable charge on non-network care

Copay amounts for sponsor who entered on or after 2018:

  • $15 for primary care
  • $25 for specialist
  • 20% of allowable charge on non-network care

Veteran, retiree + family costs

No enrollment fee and a $3,000 catastrophic cap for those who joined before 2018. For those who joined on or after 2018, there is a $460 individual or $924 family enrollment fee each year, and a $3,598 catastrophic cap.

Deductibles:

  • $150 individual
  • $300 family
  • $300 individual (out-of-network and joined after 2018)
  • $600 family (out-of-network and joined after 2018)

Copay amounts:

  • $29 for primary care
  • $41 for specialist
  • 25% of allowable charge on non-network care

 

TRICARE for Reserve & Guard

There are different plans for military members in the Reserve and Guard, or those who have retired.

TRICARE Reserve Select (TRS)

This program is available for members of the Selected Reserve and their families. It requires a monthly premium and only covers health and vision benefits.

Who is eligible?

  • Not on active duty
  • Not under the Transitional Assistance Management Program
  • Not eligible for the Federal Employees Health Benefits (FEHB) program or currently covered under FEHB

Costs

  • Monthly premium
  • Copays for certain medical services
  • Annual deductible

TRICARE Retired Reserve

This plan is available to retired reservists, Guard members and their families until they reach the age of 60. When they begin collecting retirement pay, they will be disenrolled and have the option to enroll in another TRICARE plan.

Guard members or reservists who have been on active duty for at least 30 days can enroll in a standard TRICARE plan or Prime.

 

TRICARE For Life (Retirees)

Retirees who are 65 and older are eligible for TRICARE For Life. It is a Medicare supplement, and works in conjunction with Medicare to provide your healthcare.

You can be treated at any military care facility, or from any Medicare-participating provider.

Costs

There are no enrollment fees, but you must pay monthly premiums for Medicare Part B.

The only out-of-pocket costs will come from procedures not covered by both Medicare and TRICARE For Life. If one covers it and the other doesn’t, you are responsible for deductibles and cost shares from the component that doesn’t provide coverage.

 

TRICARE Young Adult

Young Adult can cover dependents who have aged out of regular TRICARE coverage, but are not yet 26. It provides comprehensive medical and pharmacy benefits.

Who is eligible?

  • Dependents of an active or retiree military sponsor
  • Unmarried
  • At least 21 but not yet 26 years of age
  • If you are enrolled in a full course of study at an institution of higher learning and your sponsor provides more than half of your financial support, you aren’t eligible until graduation or age 23. Prior to that, you are eligible for Prime or Select.
  • Not otherwise eligible for TRICARE coverage
  • Not eligible for employer-sponsored healthcare

Costs

This is determined by your sponsor’s status and your choice of enrollment into Prime or Select. Expect monthly premiums based on these factors, and copays outside of military facilities.


Pick your plan

Now that you have all the necessary information, you can pick the plan that best suits you as a retired service member, or family of a service member.

TRICARE dental plans, overseas plans and pharmacy options exist for those who need these services.

For more information about TRICARE, visit: https://www.tricare.mil/


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