Haris Ashley
Military insurance in the United States is called TRICARE. It is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for U.S. Armed Forces military personnel, military retirees, and their dependents, including some members of the Reserve Component. The program offers comprehensive coverage, health plans, special programs, prescriptions, and dental plans.
| Characteristics | Values |
|---|---|
| Name | TRICARE |
| Administering Organization | U.S. Department of Defense Military Health System |
| Managed By | Defense Health Agency |
| Coverage | Active-duty service members, retirees, and their families worldwide |
| Coverage Includes | Health plans, prescriptions, dental plans, and special programs |
| Pharmacy Options | Military pharmacies, home delivery, network pharmacies, and non-network pharmacies |
| Additional Services | Mental health support, applied behavior analysis, cancer clinical trials, durable medical equipment, hospice care, skilled nursing facility care |
| Regions | North, South, West, Overseas |
| Claims Processors | PGBA, LLC (North, South, West); Wisconsin Physicians Service Insurance Corporation (Overseas and Tricare for Life) |
| Dental Programs | United Concordia Dental, Delta Dental |
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What You'll Learn
TRICARE: Military health insurance program
TRICARE is the health care program for service members, retirees and their families worldwide. It is a program of the United States Department of Defense Military Health System, which brings together the healthcare resources of the Military Health System with a network of civilian healthcare professionals, institutions, pharmacies, and suppliers. The Military Health System is a global, comprehensive, integrated system. Depending on your plan, you may be able to get care from a military hospital or clinic, or a civilian network of providers.
TRICARE provides comprehensive coverage, health plans, special programs, prescriptions, and dental plans. The TRICARE Pharmacy Program provides prescription drugs for eligible beneficiaries in a safe, easy, and affordable way. There are four pharmacy options: military pharmacies, home delivery, network pharmacies, and non-network pharmacies. Each option is available worldwide, but there are some limits overseas.
TRICARE offers several services for beneficiaries with special needs, including applied behavior analysis, cancer clinical trials, durable medical equipment, home health care, hospice care, mental health care, and skilled nursing facility care. TRICARE also offers a number of programs and services, such as the Making Healthy Changes for Life class, which teaches participants how to determine their readiness for change, prepare for change, and make healthy changes last.
TRICARE Reserve Select is a premium-based health plan for selected reserve members (and their families) who qualify. Children enrolled in TRICARE under a parent's plan may purchase TRICARE Young Adult when their coverage ends at age 21 (or 23 if enrolled in college) if they meet certain eligibility requirements.
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Eligibility: Who can access TRICARE?
Military insurance in the US is called TRICARE. It is the healthcare program for service members, retirees and their families worldwide. Eligibility for TRICARE is determined by the service personnel office.
TRICARE is available to active-duty service members and their families, including those stationed overseas. This includes members of the National Guard and Reserve, as well as retirees and their families, survivors, and certain former spouses. TRICARE also offers coverage for individuals with special needs, such as applied behaviour analysis, cancer clinical trials, durable medical equipment, and home health care.
TRICARE Reserve Select is a premium-based health plan for selected reserve members and their families who qualify. Retired Reserve Component members can purchase TRICARE Reserve Retired but must pay the full cost of the premium plus an administrative fee. This option is open to all eligible retired Reserve Component personnel under the age of 60.
Children enrolled in TRICARE under a parent's plan may purchase TRICARE Young Adult when their coverage ends at age 21 (or 23 if enrolled in college) if they meet certain eligibility requirements. To confirm eligibility, individuals can check their information in DEERS and then log in to milConnect to see if they are eligible for TRICARE.
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Coverage: What does TRICARE cover?
Military insurance is called TRICARE. It is the health care program for service members, retirees and their families worldwide. TRICARE offers comprehensive coverage to help beneficiaries get and stay healthy. This includes health, dental, and pharmacy services.
TRICARE covers services that are medically necessary, meaning they are appropriate, reasonable, and adequate for the patient's condition. This includes immunizations, mental health care, and durable medical equipment when prescribed by a doctor. TRICARE also offers special programs such as cancer clinical trials and home health care.
TRICARE has four pharmacy options: military pharmacies, home delivery, network pharmacies, and non-network pharmacies. Each option is available worldwide, but there may be some limits overseas. The TRICARE Pharmacy Program provides prescription drugs for eligible beneficiaries in a safe, easy, and affordable way.
Dental coverage is separate from TRICARE's medical coverage and is based on the patient's eligibility. TRICARE also offers several services for beneficiaries with special needs, including applied behavior analysis and skilled nursing facility care.
TRICARE brings together the healthcare resources of the Military Health System, including military hospitals and clinics, with a network of civilian healthcare professionals, institutions, and suppliers. This allows TRICARE to provide global, comprehensive, and integrated care to those entrusted to their care.
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TRICARE Pharmacy Program: Accessing prescriptions
TRICARE is the health care program for service members, retirees and their families worldwide. It offers comprehensive coverage, health plans, special programs, prescriptions and dental plans. The TRICARE Pharmacy Program provides prescription drugs for eligible beneficiaries in a safe, easy and affordable way. TRICARE has four pharmacy options: military pharmacies, home delivery, network pharmacies and non-network pharmacies. Each option is available worldwide, but there are some limits overseas.
The TRICARE Pharmacy Program works with the Express Scripts® Pharmacy mobile app, which allows users to track orders, refill prescriptions, and set reminders to take their medications. The app also provides access to vaccination records with the SMART Health Card. The online Formulary Search Tool can be used to check which medications are covered, look for generic equivalents, and review coverage requirements.
TRICARE brings together the healthcare resources of the Military Health System, including military hospitals and clinics, with a network of civilian healthcare professionals, institutions, pharmacies, and suppliers. This includes the TRICARE Overseas program, which is the Defense Department’s health care program for active-duty service members and their families stationed outside of the continental US (OCONUS).
To be eligible for TRICARE, individuals must first ensure their information is fully updated in DEERS. They can then log in to milConnect to check their eligibility.
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TRICARE Reserve Select: Premium-based health plan
Military insurance in the US is known as TRICARE. It is the health care program for service members, retirees and their families worldwide. TRICARE Reserve Select (TRS) is a premium-based health plan for selected reserve members and their families who qualify.
TRS is available worldwide, but there are some limits overseas. To qualify for TRS, members of the Selected Reserve and their families must meet the following criteria:
- Not on Active Duty orders for more than 30 days
- Not covered under the Transitional Assistance Management Program
- Not eligible for, or enrolled in the Federal Employees Health Benefits (FEHB)
If a member of the Selected Reserve qualifies to purchase TRS coverage but is not eligible for, or enrolled in FEHB, their spouse may be covered under TRS through their enrollment. Survivor coverage is not affected by FEHB eligibility. It is important to note that those in the Individual Ready Reserve, including Navy Reserve Voluntary Training Units, do not qualify to purchase TRS.
TRICARE offers a number of programs and services by bringing together the health care resources of the Military Health System, including military hospitals and clinics, with a network of civilian healthcare professionals, institutions, pharmacies, and suppliers. This allows eligible individuals to receive care from a military hospital or clinic, a civilian network of providers, or TRICARE-authorized non-network providers, depending on their plan.
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Frequently asked questions
Military insurance in the US is called TRICARE.
TRICARE is the health care program for service members, retirees and their families worldwide. It also applies to National Guard and Reserve members and their family members, survivors, and certain former spouses.
TRICARE provides comprehensive coverage, health plans, special programs, prescriptions and dental plans.
