Tricare: Private Insurance Or Government-Sponsored Health Coverage?

TRICARE is a health care program for uniformed service members, retirees, and their families worldwide. It provides comprehensive coverage to all beneficiaries, including active-duty service members, National Guard and Reserve members, retirees and retiree family members, survivors, and certain former spouses. TRICARE can be used alongside other health insurance, such as Medicare or employer-sponsored health insurance, but it is always the secondary payer, except in specific cases. So, while TRICARE is not private insurance, it can work in conjunction with private insurance.

TRICARE is a health care program for uniformed service members, retirees, and their families

TRICARE brings together the health care resources of the Military Health System, such as military hospitals and clinics, with a network of civilian health care professionals, institutions, pharmacies, and suppliers. This collaboration ensures that TRICARE beneficiaries have access to quality health care worldwide. The Military Health System (MHS) is a global, comprehensive, and integrated system, allowing individuals to receive care from a variety of sources, including military hospitals, civilian networks of providers, or TRICARE-authorized non-network providers.

The specific TRICARE plan that an individual is eligible for depends on their status. For example, plans are available for active-duty service members, National Guard and Reserve members, retirees, and their respective families. It's important to note that eligibility for these plans is determined by the service personnel office, and individuals can check their eligibility through the DEERS system and milConnect.

TRICARE typically serves as secondary coverage to other health insurance programs, processing claims only after other insurance providers have done so. However, for active-duty service members, TRICARE is the primary payer, and coordination with other insurance carriers does not occur. This distinction is essential for understanding how TRICARE interacts with other forms of health insurance.

TRICARE offers a range of services, including reproductive health care, dental coverage, and vision coverage. It also provides a nurse advice line, accessible via phone, web chat, and video chat, which is available 24/7. Additionally, TRICARE publishes newsletters, fact sheets, handbooks, and other educational materials to keep beneficiaries informed and empowered to make the most of their health care options.

TRICARE is managed by the Defense Health Agency

TRICARE is a health care program of the United States Department of Defense Military Health System. It provides civilian health benefits for U.S. Armed Forces military personnel, military retirees, and their dependents, including some members of the Reserve Component. TRICARE is managed by the Defense Health Agency (DHA) under the leadership of the Assistant Secretary of Defense (Health Affairs). The DHA ensures that TRICARE enhances the Department of Defense and the nation's security by providing comprehensive health support for the full spectrum of military operations. It aims to foster, protect, sustain, and restore the health of all those entrusted to their care.

The DHA's management of TRICARE is focused on delivering world-class healthcare to the military community. This includes active-duty service members, their families, retirees, and certain other eligible beneficiaries worldwide. The DHA works to ensure that TRICARE meets the unique healthcare needs of the military population, including access to military hospitals and clinics, as well as a network of civilian healthcare professionals.

Prior to October 1, 2013, TRICARE was managed by the TRICARE Management Activity under the authority of the Assistant Secretary of Defense (Health Affairs). However, on that date, the management was transferred to the newly established Defense Health Agency. This transition was part of a restructuring initiative to improve the efficiency and effectiveness of the military healthcare system.

The Defense Health Agency, through its management of TRICARE, plays a crucial role in supporting the military mission. By providing comprehensive healthcare, the DHA contributes to the readiness and well-being of service members and their families. This includes ensuring that active-duty service members have priority access to military medical facilities and coordinating care with civilian healthcare providers when needed.

The DHA also oversees the administration of TRICARE, including contracting with large health insurance corporations to provide claims processing, customer service, and other administrative functions. The DHA's role in managing TRICARE demonstrates its commitment to ensuring that military personnel, retirees, and their families receive the healthcare they need and deserve.

TRICARE offers prescription drug coverage and dental coverage

TRICARE is a health care program for active-duty service members, active-duty family members, National Guard and Reserve members and their families, retirees and retiree family members, survivors, and certain former spouses worldwide. It offers prescription drug coverage and dental coverage.

TRICARE covers most prescription drugs approved by the U.S. Food and Drug Administration (FDA). Drugs may be covered under the pharmacy benefit or the medical benefit. To be covered by the TRICARE pharmacy benefit, a drug must be approved by the FDA, not be part of a procedure covered under the medical benefit, and be prescribed in accordance with good medical practice and established standards of quality. TRICARE does not cover drugs that are not medically or psychologically necessary for the diagnosis or treatment of a covered illness.

The TRICARE Formulary is a list of generic and brand-name prescription drugs that are covered. TRICARE reviews and updates the Formulary each quarter, and beneficiaries are notified if a drug they are prescribed is changing from a formulary to a non-formulary drug. Prescription drugs fall into four categories: generic formulary drugs, brand-name formulary drugs, non-formulary drugs, and non-covered drugs. Costs vary depending on the drug category.

Certain prescriptions require pre-authorization, such as those specified by the DoD Pharmacy & Therapeutics Committee, brand-name prescription drugs with generic substitutes, or prescriptions for an amount more than the normal limit. Quantity limits also vary by type of pharmacy, with military pharmacies and home delivery offering up to a 90-day supply, and network pharmacies offering up to a 30-day supply.

Dental coverage under TRICARE is separate from medical coverage and is based on the beneficiary's status. For example, active-duty service members can receive dental care at no cost through TRICARE, while other beneficiaries may have different coverage or cost-sharing requirements.

TRICARE is available worldwide

TRICARE is a health care 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, certain former spouses, and more, worldwide. It is available to those who are eligible in all overseas areas.

TRICARE is not a private insurance program. It is the primary payer for active-duty service members, and coordination with other insurance carriers does not occur. If you have any health insurance other than TRICARE, it is called "other health insurance". This can be through your employer or a private insurance program. By law, TRICARE pays after all other health insurance, except for State Victims of Crime Compensation Programs, Other Federal Government Programs identified by the Director, Defense Health Agency (i.e. Indian Health Service), and a few other exceptions.

There are two TRICARE regions in the US, and one overseas region with three areas: TRICARE Eurasia-Africa, TRICARE Latin America, and TRICARE Canada. The overseas region is supported by International SOS Government Services, Inc. and your benefits remain the same no matter where you live.

TRICARE Select Overseas provides comprehensive coverage in all overseas areas. To be eligible, you must be registered in the Defense Enrollment Eligibility Reporting System (DEERS).

TRICARE is the primary payer for active-duty service members

TRICARE is a health insurance 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. It is the primary payer for active-duty service members, meaning that it covers their medical costs before any other insurance provider. This includes activated National Guard and Reserve members.

As an active-duty service member, you can use other health insurance (OHI) under certain circumstances and when complying with DoD and Service regulations. However, TRICARE won't be the second payer, meaning there is no coordination of benefits with your OHI and TRICARE. Your OHI may have exclusions for your military duty status, so it's important to disclose your military status to avoid claim denials or recoupments. If you decide to get care from a civilian provider, you must comply with Service regulations, including providing all medical records to your current primary care manager.

If you have any health insurance other than TRICARE, it is classified as "other health insurance." This could be through your employer or a private insurance program. By law, TRICARE pays after all other health insurance, except for State Victims of Crime Compensation Programs and Other Federal Government Programs identified by the Director, Defense Health Agency (e.g., Indian Health Service). This means that your other health insurance processes your claim first, after which you or your doctor files a claim with TRICARE.

It is important to keep your TRICARE contractors and doctors informed about any other health insurance you have. If TRICARE receives your claim before your other health insurance processes it, they will deny it. If TRICARE pays first and then discovers you had other health insurance, they will take back any payments made and only reprocess your claim after your other insurance has paid.

Frequently asked questions