TRICARE - Health Care for Service Members and Others

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TRICARE - Health Care for Service Members and Others

Overview: Which Government Programs Provide Healthcare to Active Duty Military, Retirees and Veterans?

TRICARE provides health coverage for active duty and retired service members, their families, and survivors. TRICARE is run by the Department of Defense (DoD). CHAMPVA is a VA health program.

These two programs are often confused.  This confusion is made worse by the fact that TRICARE used to be called CHAMPUS.   In some cases veterans may look to be eligible for both programs on paper. However, if you are a military retiree, or the spouse of a veteran who was killed in action, you are and will always be a TRICARE beneficiary. You can’t choose between the two.

Get more details about who is eligible for which program at the VA website here

The rest of the information on this page is about TRICARE.

What is TRICARE?

TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. TRICARE offers comprehensive, affordable health coverage with several health plan options, a robust pharmacy benefit, dental options and other special programs.

Who is eligible to participate in TRICARE?

All active duty members and their families in the seven uniformed services (Army, Navy, Air Force, Marines, Coast Guard, National Oceanic and Atmospheric Administration, and Public Health Service), retirees, family members and survivors of active duty servicemembers, and others who are registered in the Defense Enrollment Eligibility Reporting System (DEERS)  are eligible for TRICARE.

TRICARE beneficiaries can be divided into two main categories: sponsors and family members.  Sponsors include active duty service members, retired service members and National Guard/Reserve members. Family members are dependent spouses and children who are registered in DEERS.

Other eligible beneficiaries include Medal of Honor recipients and their family members, surviving family members and former spouses.

Go here to learn more about eligibility for TRICARE

Comprehensive coverage for all beneficiaries includes:

  • Outpatient visits,
  • Hospitalization, 
  • Preventive services,
  • Maternity care,
  • Immunizations, and
  • Mental/Behavioral health services

View a list of TRICARE covered services here

Additionally, TRICARE offers special programs and demonstrations for specific health care needs for some beneficiaries such as: smoking cessation, weight loss, cancer treatment or chiropractic care. Go here to learn more about these special services.

You must enroll or be enrolled in one of ten different health plan options under TRICARE. Each option provides different coverage for different reasons. SOME of these reasons include whether you are active duty, retired, overseas, or a member of the National Guard or Reserves.

What Health Plan Options are Available Through TRICARE?

TRICARE offers ten different health plan options to provide coverage to millions of beneficiaries around the globe. 

TRICARE Prime (Enrollment required)

  • Most comprehensive and affordable coverage
  • Most care received from an assigned primary care manager (PCM); referrals required for specialty care
  • Providers coordinate your referrals/authorization and file health care claims
  • Easy to transfer when you move
  • Available in the U.S. in Prime Service Areas

TRICARE Prime Remote (Enrollment required)

  • TRICARE Prime option in designated remote locations in the United States
  • Most care received from an assigned PCM; referrals required for specialty care
  • Providers coordinate your referrals/authorization and file health care claims
  • Easy to transfer when you move
  • Only available to active duty service members* and their families

TRICARE Prime Overseas (Enrollment required)

  • TRICARE Prime option in overseas areas near military treatment facilities
  • Most care received from an assigned PCM; referrals required for specialty care
  • Providers coordinate your referrals and authorization and file health care claims
  • Easy to transfer when you move
  • Only available to active duty service members* and command-sponsored family members

TRICARE Prime Remote Overseas (Enrollment required) 

  • TRICARE Prime option in designated remote overseas locations
  • Most care received from an assigned PCM; referrals required for specialty care
  • No claims to file (in most cases)
  • Easy to transfer when you move
  • Only available to active duty service members* and command-sponsored family members

TRICARE Standard and Extra

  • Most flexibility; visit any TRICARE-authorized provider (network or non-network)
  • Schedule appointments at your convenience
  • No referrals; authorization required for some services
  • You pay a percentage of the total cost (cost share)
  • May have to file your own claims
  • Not available to active duty service members*

US Family Health Plan (Enrollment required) 

  • An additional TRICARE Prime option
  • Same coverage; includes enhanced local services
  • Enroll with not-for-profit health care systems in six U.S. areas
  • Available to all non-active duty beneficiaries, including those 65 years of age and over, regardless of whether or not they participate in Medicare Part B.

TRICARE For Life

  • Secondary coverage to Medicare when you have both Medicare Part A and Part B
  • Visit any Medicare provider
  • Medicare pays its portion to the provider
  • Medicare forwards the remaining amount to TRICARE
  • TRICARE pays the rest to your provider
  • You pay nothing out of pocket (in most cases)
  • Available worldwide, however, in most overseas locations, TRICARE becomes the primary payer.

TRICARE Standard Overseas

  • Visit any host nation provider
  • Schedule appointments at your convenience
  • No referrals; authorization required for some services
  • You pay a percentage of the total cost (cost-share)
  • May have to file your own claims
  • No enrollment required
  • Not available to active duty service members*

TRICARE Reserve Select (Must qualify and purchase)

  • Premium-based health plan that qualified National Guard and Reserve members may purchase
  • Member-only and Member-and-Family plans available
  • Schedule appointments at your convenience
  • No referrals; authorization required for some services
  • You pay a percentage of the total cost (cost share)
  • May have to file your own claims

TRICARE Retired Reserve (Must qualify and purchase)

  • Premium-based health plan that qualified retired National Guard and Reserve members may purchase
  • Member-only and Member-and-Family plans available
  • Schedule appointments at your convenience
  • No referrals; authorization required for some services
  • You pay a percentage of the total cost (cost share)
  • May have to file your own claims

Which TRICARE Health Plan Option is Right for Me?

First, review the plans described above. If you are not sure about which health plan option is right for you and your family, visit the TRICARE website’s Plan Finder, and answer a series of questions to see which plans you may be eligible for.

Or you can go here to check out the differences between plans you are considering. You can compare two plans side by side.

The comprehensive TRICARE health plan option information provided at this site came from the TRICARE website, at "How Much do I Pay for TRICARE?"

How much does it cost?

TRICARE coverage requires no fees or co-payments from active duty service members. Depending upon which health plan option they have, their family members may have to pay co-payments or a small percentage of the cost of services. Retired service members and their families may have to pay enrollment fees, co-pays and a percentage of the cost of services, depending upon their plan. . Here's an overview of beneficiary costs.

Active Duty Service Members
  • No enrollment fees or copayments for any plan.
Active Duty Family Members
  • $0 at military treatment facilities
  • No enrollment fees or copayments when enrolled in TRICARE Prime.
  • Low cost-shares when using TRICARE Standard and Extra.
Retired Service Members and Families
  • $0 at military treatment facilities
  • Low annual enrollment fees for TRICARE Prime ($230/individual or $460 per family)
  • Minimal network copayments (ranges from $12-$30)
  • Low cost-shares when using TRICARE Standard and Extra

Go to TRICARE website’s Summary of Beneficiary Costs Flyer to learn more details about the various health plan option costs.

What is the coverage for prescription drugs?

Prescription drug coverage is the same regardless of your beneficiary category or which health plan option you are using. Prescriptions can be filled worldwide, but there are some limitations to getting prescriptions overseas. You'll pay $0-$22 to fill prescriptions depending on the type of prescription you're filling. Learn more about the TRICARE Pharmacy Program.

Do I have to enroll in TRICARE? How do I Enroll?

Not all TRICARE plans require you to enroll to participate. If you are using the following health plan options, coverage is automatic as long as you are registered in the DEERS.

•    TRICARE Standard and Extra
•    TRICARE Standard Overseas
•    TRICARE For Life (you must have Medicare Part A & B)

The following options require you to enroll or purchase the plan to participate. Click on the links below to find out how: 

•    TRICARE Prime*
•    TRICARE Prime Remote*
•    TRICARE Prime Overseas*
•    TRICARE Prime Remote Overseas*
•    TRICARE Reserve Select
•    TRICARE Retired Reserve
•    US Family Health Plan

*Active duty service members must enroll in one of these Prime options.

May 2011