TRICARE is the worldwide health care program for uniformed service members and their eligible family members*. Depending on your eligibility, you can choose among TRICARE Prime, TRICARE Select, TRICARE For Life (TFL) or certain optional premium-based plans. Most TRICARE medical program options include comprehensive health care coverage and a pharmacy benefit.
TRICARE Select is a self-managed, preferred-provider option for eligible beneficiaries (except ADSMs and TFL beneficiaries) not enrolled in TRICARE Prime. TRICARE Select allows beneficiaries to choose their own TRICARE- authorized provider and manage their own health care. On Jan. 1, 2018, TRICARE Select replaced TRICARE Standard and TRICARE Extra.
Beneficiaries may receive enhanced TRICARE Select benefits from any TRICARE-authorized provider without a referral. You will have lower out-of-pocket costs if care is provided by a TRICARE-authorized network provider. Some services require prior authorization. They can also receive certain services from non-network, TRICARE-authorized providers, but will pay higher cost sharing amounts for out-of-network care. Care received from non-authorized, non-network providers will not be reimbursed by TRICARE.
Under a TRICARE Select option, you pay a fixed fee for care from a network provider instead of paying a percentage of the allowable charge. Using a non-network, TRICARE- authorized provider will result in both a higher deductible and out-of-pocket costs.
In overseas locations, TOP Select is available to eligible family members not enrolled in TOP Prime. Where the TRICARE network has not been established in an overseas location, TRICARE Select beneficiaries who receive medically necessary covered services from a non-network, TRICARE-authorized provider shall be subject to cost- sharing amounts applicable to out-of-network care.
You are in Group A if your or your uniformed services sponsor’s initial enlistment or appointment began before Jan. 1, 2018.
You are in Group B if your or your uniformed services sponsor’s initial enlistment or appointment began on or after Jan. 1, 2018.
Includes TRICARE Select, TRICARE Overseas Program (TOP) Select, TRS, TRR, TYA Select and CHCBP plans.
No yearly enrollment fee for ADFMs. For retirees, their families and others:
Group A: No yearly enrollment fee
Group B: $450 per individual/$900 per family
You must meet a deductible before TRICARE cost-sharing begins. Refer to the charts below:
|Group A Individual||Group A Family||Group B Individual||Group B Family
|Pay Grades E-4 & Below||$50||$100||$50||$100|
|Pay Grades E-5 & Above||$150||$300||$150||$300|
Scroll table to see E-5 & above deductables
|Group A Individual||Group A Family||Group B Individual||Group B Family|
|$150||$300||$150 Network, $300 Out-of-Network||$300 Network, $600 Out-of-Network|
Scroll table to see full deductable information
TRICARE Prime is a managed care option and is a health maintenance organization (HMO)-like program. It generally features the use of military hospitals and clinics and substantially reduces out-of-pocket costs for authorized care provided outside military hospitals and clinics by TRICARE network providers. TRICARE Prime is mandatory for active duty service members (ADSMs) and is an option for their family members and certain TRICARE-eligible beneficiaries located in Prime Service Areas (PSAs) in the U.S. In geographical areas where TRICARE Prime is not offered, TRICARE Prime Remote for Active Duty Family Members (TPRADFM) may be available as an enrollment option for eligible family members. In overseas locations, TRICARE Overseas Program (TOP) Prime and TOP Prime Remote are available to ADSMs and their command-sponsored family members.
The US Family Health Plan (USFHP) is an additional TRICARE Prime option available through networks of community-based, not-for-profit health care systems in six areas of the U.S. To enroll in USFHP, you must live in one of the designated services areas†.
Under a TRICARE Prime option, your health care is managed by an assigned primary care manager (PCM) and provided by a military or civilian network provider. Non- active duty enrolled beneficiaries will select or be assigned a PCM. TRICARE Prime PCMs may be: (1) at a military hospital or clinic; (2) a civilian TRICARE network provider within a PSA; or (3) a primary care provider in the USFHP, depending on your location and sponsor status. Whether you receive care in the civilian sector or at a military hospital or clinic will depend on your location and the capacity at nearby military facilities.
Includes TRICARE Prime, TRICARE Prime Remote, the US Family Health Plan* (USFHP) and TYA Prime plans.
* Uniformed service members includes active duty and retired members of the: U.S. Army, U.S. Air Force, U.S. Navy, U.S. Marine Corps, U.S. Coast Guard, the Commissioned Corps of the U.S. Public Health Service and the Commissioned Corps of the National Oceanic and Atmospheric Administration.
No yearly enrollment fee for active duty service members (ADSMs), active duty family members (ADFMs) and transitional survivors (surviving spouses during the first three years and surviving dependent children) worldwide.
For retirees, their families and others†:
Group A: $289.08 per individual/$578.16 per family
Group B: $350 per individual/$700 per family
TFL is Medicare wrap-around coverage for TRICARE beneficiaries who have Medicare Part A and Medicare Part B, regardless of age or place of residence. TFL provides comprehensive health care coverage and beneficiaries are also covered under the TRICARE Pharmacy Program. You have the freedom to seek care from any Medicare-participating or non-participating provider, or military hospitals and clinics on a space-available basis. Medicare-participating providers file your claims with Medicare. After paying its portion, Medicare automatically forwards the claim to Wisconsin Physicians Service (WPS) Military and Veterans Health for processing (unless you have other health insurance [OHI]). TRICARE pays after Medicare and OHI for TRICARE covered health care services. For TFL overseas, when seeking care from a civilian provider be prepared to pay upfront for services and submit a claim to the TOP claims processor, International SOS. Overseas, TFL is the only payer unless you have OHI.
TRICARE Plus is a primary-care program offered at some military hospitals and clinics. You have access to get primary care at your military hospital or clinic and pay nothing out- of-pocket. TRICARE Plus doesn’t cover specialty care.
Each military hospital or clinic commander decides if TRICARE Plus is available. You must enroll to participate and your enrollment is only for the hospital or clinic where you enrolled.
You can enroll in TRICARE Plus if you are TRICARE-eligible (and not enrolled in a TRICARE Prime option or a civilian or Medicare Health Maintenance Organization) or a dependent parent or parent-in-law. If you’re an eligible dependent parent or parent-in-law, TRICARE won’t pay for care by civilian providers, even if the military hospital or clinic refers you for care. You’re responsible for the full cost of the care.
TRICARE offers other coverage options for purchase by qualified members of the Selected Reserve or Retired Reserve who aren’t in an activated status or for those who have eligibility changes, such as children aging out of regular TRICARE coverage.
TRICARE Reserve Select® (TRS) Qualified Selected Reserve members may purchase TRICARE Select coverage for themselves and eligible family members under TRS.
TRICARE Retired Reserve® (TRR) Qualified Retired Reserve members may purchase TRICARE Select coverage for themselves and eligible family members under TRR.
TRICARE Young Adult (TYA) This plan extends TRICARE benefits to certain family members under the age of 26 who have lost or will lose TRICARE eligibility due to age. Qualified adult children can purchase TYA after “regular” TRICARE coverage ends at either age 21 (or age 23 if enrolled in college full- time or at college graduation, whichever comes first).
TYA beneficiaries can enroll in either TRICARE Prime or TRICARE Select.
TRICARE offers benefits to help certain service members and their families transition to civilian life.
Transitional Assistance Management Program (TAMP) The Transition Assistance Management Program (TAMP) offers 180 days of premium-free health care after your sponsor separates from the military. If you’re eligible, TAMP starts the day after the sponsor separates from service.
Continued Health Care Benefit Program (CHCBP) This premium-based plan offers health coverage for 18–36 months after TRICARE eligibility or premium- based plan coverage ends for certain beneficiaries.
The TRICARE Pharmacy Program provides prescription drugs through military pharmacies, TRICARE Pharmacy Home Delivery, TRICARE retail network pharmacies and non-network pharmacies. Your options for filling your prescription depend on the type of drug your provider prescribes. If you’re in USFHP, you have different pharmacy coverage.
Registering and maintaining up-to-date information in the Defense Enrollment Eligibility Reporting System (DEERS) is essential for determining TRICARE eligibility. Only sponsors (or a sponsor-appointed individual with valid power of attorney) can add family members to DEERS. Family members age 18 and older may update their own contact information in DEERS. Visit www.tricare.mil/deers for more information.
For ADSMs located in areas where TRICARE Prime is available, enrollment in TRICARE Prime is mandatory. Stateside, ADFMs, retirees and their family members may also enroll in TRICARE Prime if they live in a PSA or, with a drive-time waiver, within 100 miles of an available PCM. It is typically an area near a military hospital or clinic. Within PSAs, TRICARE Prime is available to:
Retirees, retiree family members and survivors including, under limited circumstances, those who are TFL beneficiaries under age 65
National Guard and Reserve members who are called or ordered to active service for more than 30 days and their eligible family members
Medal of Honor recipients and their family members
Qualified former spouses
Note: Stateside ADSMs and their families, under limited circumstances, who don’t live in PSAs may enroll in a TRICARE Prime Remote.
In remote locations overseas, ADSMs and National Guard and Reserve members, called or ordered to active service for more than 30 days, are required to enroll in TOP Prime Remote.
The plan is also available to command-sponsored, eligible ADFMs. TOP Prime and TOP Prime Remote are not available for retirees, retiree family members and survivors overseas.
TRICARE Select is available to:
Certain retirees, retiree family members and survivors
Family members of activated National Guard and Reserve Members
Non-activated National Guard and Reserve members and their families who qualify under TAMP
Medal of Honor recipients and their families
Qualified former spouses
Qualified National Guard and Reserve members may purchase TRICARE Select coverage for themselves and their families under TRS or TRR plans.
For more information about beneficiary categories, visit www.tricare.mil/eligibility.
All beneficiaries other than ADSMs and TFL beneficiaries must enroll in a TRICARE Prime option or TRICARE Select to be covered for civilian care. This includes newborns, newly adopted children and children placed with beneficiaries as wards.
Beneficiaries may enroll and disenroll in TRICARE health plans at any time between Jan. 1, 2018 and Dec. 31, 2018. Eligible beneficiaries must be registered in DEERS to enroll in TRICARE Prime and TRICARE Select.
If you do not enroll in a TRICARE plan, you will only be able to receive care at military hospitals and clinics on a space- available basis. For more information on how to enroll in a TRICARE plan, go to www.tricare.mil/enroll.
TRICARE medical program costs are subject to change each Jan. 1 and are effective each year from Jan. 1 through Dec. 31. Whether you fall into Group A or Group B determines your costs (See the Group A and Group B Categories section). For more information, visit www.tricare.mil/costs.
The date your sponsor initially joined the military determines your enrollment fees and out-of-pocket costs. Depending on a sponsor’s initial enlistment or appointment, beneficiaries fall into either of two categories, Group A or Group B:
Group A: Enrollees whose military sponsor’s initial enlistment or appointment occurred before Jan. 1, 2018
Group B: Enrollees whose military sponsor’s initial enlistment or appointment occurred on or after Jan. 1, 2018.
Note: TRR, TRS, TYA and CHCBP enrollees have Group B cost-shares.
TRICARE Prime, TRICARE Select, TFL and TRICARE premium-based plans and transitional plans are considered Minimum Essential Coverage (MEC) for the Affordable Care Act. Direct care only is not considered MEC. Visit www.tricare.mil/about/mec for more information.
Your TRICARE benefit is the same regardless of where you are, but there are different customer service contacts for whether you are stateside or overseas. Each region is managed by a contractor who partners with the Military Health System to provide you with health, medical and administrative support including customer service, claims processing and prior authorizations for certain health care services.
International SOS Government Services, Inc.