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TRICARE is the uniformed services healthcare program for active-duty service members, active-duty family members, and more. There are several types of TRICARE plans available, each with different costs for care and coverage. Depending on your TRICARE plan, you may be able to see a non-network TRICARE-authorized provider, but you may have higher costs and you may have to file your own claims. You can enroll in or change your plan within 90 days following a qualifying life event (QLE), such as marriage or the birth of a child. You can purchase premium-based plans at any time.
| Characteristics | Values |
|---|---|
| Enrollment | Enrollment is mandatory for active-duty service members. Family members of active-duty personnel, National Guard and Reserve members, retirees and their family members, survivors, and certain former spouses are also eligible. |
| Plans | TRICARE Prime, TRICARE Select, TRICARE Young Adult, TRICARE Retired Reserve, Continued Health Care Benefit Program, and US Family Health Plan. |
| Costs | Different plans have different costs for care and coverage. There are enrollment fees, plan premiums, and copayments. |
| Providers | Military hospitals and clinics, civilian TRICARE-authorized providers (network and non-network), and TRICARE-authorized non-network providers. |
| Dental | The TRICARE Dental Program is separate from health plans and is voluntary. |
| Timing | Enrollment or plan changes must be made within 90 days of a Qualifying Life Event (QLE), such as marriage, the birth of a child, or retirement. Premium-based plans can be purchased at any time. |
| Payment methods | Electronic funds transfer (EFT), credit card, or debit card. |
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What You'll Learn
Eligibility criteria
Eligibility for Tricare insurance is determined by the beneficiary category of the applicant and their sponsor. The following categories of people are eligible for Tricare:
- Active-duty service members and their family members. Active-duty service members are required to enroll in Tricare Prime and pay nothing out of pocket. Their family members also pay nothing unless they use the point-of-service option.
- National Guard and Reserve members and their family members.
- Retirees and retiree family members.
- Survivors.
- Certain former spouses.
Tricare is available worldwide, and beneficiaries can access the same benefits no matter where they live.
Additionally, Tricare For Life provides automatic coverage for those registered in the Defense Enrollment Eligibility Reporting System with Medicare Part A and Part B. Enrollment in the Tricare Dental Program is separate from health plan options and is a voluntary dental insurance plan.
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Costs and coverage
Tricare is available worldwide, and your benefits remain the same regardless of where you live. Prescription drug coverage is included in any Tricare health plan. However, if you are enrolled in the US Family Health Plan, you have separate pharmacy coverage.
Tricare Prime offers fewer out-of-pocket costs than Tricare Select, but you have less freedom in choosing your providers. If you have other health insurance, Tricare Prime might not be suitable. As a non-network Tricare user, you may have to pay additional costs and file your own claims.
You can only enroll in or switch to Tricare Prime or Tricare Select after a Tricare Qualifying Life Event (QLE) or during the annual fall Tricare Open Season. A QLE refers to specific life changes, such as marriage, the birth of a child, or retirement from active duty, which may unlock different Tricare options. In contrast, you can purchase premium-based plans like Tricare Reserve Select, Tricare Retired Reserve, Tricare Young Adult, and the Continued Health Care Benefit Program at any time.
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Enrollment deadlines
Tricare Open Season
Tricare open enrollment, also known as Tricare Open Season, is an annual period when beneficiaries can make changes to their Tricare coverage for the upcoming year. The open season typically runs from mid-November to mid-December. For instance, the dates for 2024 are November 11 to December 10. During this period, eligible individuals can enroll in a new Tricare plan or switch their coverage. Any changes made during the open season will take effect in the following year. It is important to note that Tricare Open Season does not apply to Active Duty Service Members (ADSMs), Tricare For Life, or premium-based plans like Tricare Retired Reserve, Tricare Reserve Select, and Tricare Young Adult.
Qualifying Life Events (QLEs)
Outside of the Tricare Open Season, enrollment and changes to Tricare Prime or Tricare Select are typically allowed following a Qualifying Life Event (QLE). A QLE refers to significant life changes, such as marriage, the birth of a child, adoption, a sponsor's death, or retirement from active duty. A QLE triggers a 90-day window during which eligible individuals can make enrollment changes or enroll in a plan. This period is applicable to all eligible family members, not just the individual experiencing the life event.
Payment Deadlines
Payment deadlines for Tricare insurance vary depending on the payment method and the specific plan. For TYA, TRS, and TRR plans, enrollees have until January 15 to set up their payment information if using EFT, credit card, or debit card. For Tricare Prime or Tricare Select, the deadline is extended to January 30. Missing these deadlines will result in disenrollment back to January 1. For those in the Tricare West Region or moving to this region, there may be specific deadlines for setting up payment information with TriWest to avoid disenrollment. For example, for the year 2024, the deadline was set as December 31, 2024.
Enrollment Forms
Tricare enrollment can be done online, by phone, mail, or fax, each with its own considerations. When completing the enrollment form online, individuals can select their desired start date for coverage, choosing between the first of the next month or the first of the following month. To obtain the requested start date, the form must be received or postmarked by the last day of the current month. For enrollment by mail or fax, individuals need to download the appropriate region-specific or overseas-specific form for their desired plan and send it to the designated regional contractor or provider.
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Plan options
TRICARE Prime is for those on active duty. All others can choose between TRICARE Prime and TRICARE Select. TRICARE Prime offers fewer out-of-pocket costs than TRICARE Select but offers less freedom of choice when it comes to providers. If you have other health insurance, TRICARE Select may be a better option.
There are also premium-based plans that can be purchased at any time: TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and the Continued Health Care Benefit Program.
Dental coverage is separate from medical coverage and is based on who you are. The TRICARE Dental Program is a voluntary dental insurance plan with separate enrollment from any of the health plan options.
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Dental insurance
Dental coverage under Tricare is separate from medical coverage and requires special enrollment. The Tricare Dental Program (TDP) is a voluntary dental plan for active-duty family members, National Guard and Reserve members, and their families. It is administered by United Concordia.
To enrol in the TDP, you will need a Department of Defense Self-Service Logon to create your account. After enrolling, you can create an account with United Concordia to manage your plan. You can enrol online, on the phone, or through the mail. If you would like an enrollment card, you can download one from the milConnect website.
Your sponsor can enrol you into the TDP by logging into the Beneficiary Web Enrollment website. The minimum enrollment period is 12 months and can then be continued on a month-to-month basis. If you enrol by the 20th of the current month, your coverage will start on the first day of the next month. If you enrol after the 20th, your coverage will begin on the first day of the second month.
It is important to note that Tricare dental coverage does not start automatically upon enrollment. There is an out-of-pocket monthly fee, and you will have to pay the full cost of any dental care received before your start date.
Certain retirees may be eligible to enrol in a dental plan through the Federal Employees Dental and Vision Insurance Program (FEDVIP), offered by the Office of Personnel Management.
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Frequently asked questions
Tricare is the healthcare program for active-duty service members, active-duty family members, National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide.
You can enroll in Tricare Prime or Tricare Select after a Tricare Qualifying Life Event (QLE) or during the annual fall Tricare Open Season. You can purchase premium-based plans (Tricare Reserve Select, Tricare Retired Reserve, Tricare Young Adult, and the Continued Health Care Benefit Program) at any time.
A QLE is a certain change in your life, such as marriage, the birth of a child, or retirement from active duty, which may mean different Tricare options are available to you.
Tricare offers different plans depending on your status. You can use the Tricare Plan Finder and Compare Plans tools on the Tricare website to determine which plan is best for you.
Each Tricare plan has different costs for care and coverage. You can use the Tricare Covered Services tool to see if something is covered, and the Tricare Formulary to check if your prescription drugs are covered.
