Alyssa Lane
TRICARE is a healthcare program that provides comprehensive coverage, health plans, special programs, prescriptions and dental plans to service members, retirees and their families worldwide. TRICARE is not an agency and does not determine eligibility -- eligibility is determined by the sponsor's uniformed service, which could be Active Duty, Retired and National Guard and Reserve members. TRICARE brings together the healthcare resources of the Military Health System with a network of civilian healthcare professionals, institutions, pharmacies and suppliers to foster, protect, sustain and restore health for those entrusted to their care.
| Characteristics | Values |
|---|---|
| Type | Healthcare program |
| Eligibility | Service members, retirees, and their families worldwide, including active duty family members, National Guard and Reserve members, survivors, and certain former spouses |
| Sponsors | Active duty, retired, and National Guard and Reserve members |
| Family members | Spouses and children who are registered in DEERS |
| Plan options | TRICARE Prime, TRICARE Select, TYA, TRS, and TRR |
| Dental coverage | Separate from medical coverage; based on eligibility |
| Pharmacy options | Military pharmacies, home delivery, network pharmacies, and non-network pharmacies |
| Provider types | Military hospitals and clinics, civilian network of providers, TRICARE-authorized network and non-network providers |
| Services | Comprehensive coverage, health plans, special programs, prescriptions, and dental plans |
| Special needs services | Applied behavior analysis, cancer clinical trials, durable medical equipment, home health care, hospice care, mental health care, and skilled nursing facility care |
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What You'll Learn
Eligibility
Tricare is a healthcare program for service members, retirees, and their families worldwide. It is not an agency and does not determine eligibility. Instead, the sponsor's uniformed service decides who is eligible for Tricare and reports it in the Defense Enrollment Eligibility Reporting System (DEERS).
Those eligible for Tricare include 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 certain others. Your benefits and plan options will vary depending on your beneficiary category.
To check your eligibility, first make sure your information is fully updated in DEERS. Then, you can log in to milConnect to check if you're eligible for Tricare. Your service personnel office can also determine your Tricare eligibility.
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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Types of plans
TRICARE is a healthcare program that offers a range of plans to cater to different needs. The specific plans available to an individual depend on their beneficiary category. The beneficiary categories include active-duty service members and their families, National Guard and Reserve members and their families, retired service members and their families, retired reserve members and their families, beneficiaries eligible for TRICARE and Medicare, survivors, children, former spouses, Medal of Honor recipients and families, dependent parents and parents-in-law, and foreign force members and families.
TRICARE Prime, TRICARE Select, TYA, TRS, and TRR are some of the plans offered. Each plan has different costs for care and coverage, and prescription drug coverage is available with any TRICARE health plan. The TRICARE Compare Costs tool allows individuals to view and compare costs for covered services, enrollment fees, and plan premiums.
TRICARE brings together the healthcare resources of the Military Health System with a network of civilian healthcare professionals, institutions, pharmacies, and suppliers. Depending on the plan and an individual's location, they may receive care at military hospitals and clinics or from civilian or TRICARE-authorized non-network providers. There are two types of TRICARE-authorized providers: network and non-network. Generally, non-network providers may result in higher costs and require individuals to file their own claims.
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Dental and prescription coverage
TRICARE is a healthcare program that provides comprehensive health coverage, health plans, special programs, prescriptions, and dental plans to service members, retirees, and their families worldwide. The program brings together the healthcare resources of the Military Health System, such as military hospitals and clinics, with a network of civilian healthcare professionals, institutions, pharmacies, and suppliers.
Dental coverage is separate from TRICARE's medical coverage, and your eligibility for dental coverage is based on your identity. If you are eligible, you can enroll in the TRICARE Dental Program (TDP) online, on the phone, or through the mail. The TDP is a voluntary dental plan. You must complete the first 12 months of enrollment unless you have a valid reason to end coverage. After the 12-month period, you can continue on a month-to-month basis. To find a dentist in the United States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, or the U.S. Virgin Islands, search the United Concordia network. If you're overseas, use the Find a Dentist Tool.
TRICARE also offers prescription drug coverage through the TRICARE Pharmacy Program, which provides prescription drugs for eligible beneficiaries in a safe, easy, and affordable way.
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. The Extended Care Health Option (ECHO) provides additional financial assistance to help cover the cost of services and supplies beyond what is offered by standard TRICARE plans.
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Authorised providers
TRICARE is a healthcare program for active-duty service members, retirees and their families worldwide. It brings together the healthcare resources of the Military Health System, such as military hospitals and clinics, with a network of civilian healthcare professionals, institutions, pharmacies, and suppliers.
TRICARE-authorised providers are individuals, institutions, or suppliers that are licensed by a state, accredited by a national organisation, or meet other standards of the medical community. They are certified to provide benefits under TRICARE. There are two types of TRICARE-authorised providers: network and non-network.
Those eligible for TRICARE can get care from a military hospital or clinic, a civilian network of providers, or TRICARE-authorised non-network providers, depending on their plan. Military hospitals and clinics are operated by the Department of Defense, and their availability depends on location, plan, and beneficiary category.
TRICARE-authorised providers include civilian healthcare professionals, institutions, and suppliers. This means that TRICARE beneficiaries can access healthcare from a wide range of providers, including those outside of the military healthcare system.
Referrals are not typically required for primary and specialty appointments with TRICARE-authorised providers. However, some services may require pre-authorisation from the regional contractor. Costs for TRICARE-authorised providers vary based on the sponsor's military status and the type of provider (network or non-network).
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Payment options
TRICARE is a health care program that provides coverage for service members and their families. It offers a range of services, including mental health care, substance use disorder (SUD) treatment, and prescription drugs. TRICARE has several payment options available for those enrolled in its plans.
- Electronic Funds Transfer (EFT): TRICARE accepts electronic funds transfers from a bank account. This can be set up as an automatic payment for enrollment fees and monthly premiums.
- Credit Card: TRICARE allows users to pay their enrollment fees and monthly premiums by credit card. This can also be set up as an automatic, recurring payment.
- Debit Card: TRICARE accepts debit card payments for enrollment fees and monthly premiums.
- Online Payments: One-time premium payments can be made online through electronic funds transfer or credit card.
- Phone: TriWest Healthcare Alliance assists with enrollment and premium payments over the phone.
- Military Retirement Pay: Retired sponsors under the age of 65 can sign up to have their TRICARE Prime enrollment premium payments deducted from their military retirement pay.
- Health Care Flexible Spending Account: This option allows users to set aside pre-tax earnings to help cover health care costs.
It is important to note that TRICARE has specific payment restrictions and limitations for certain diagnostic services, utilization limits on visits, consultations, and procedures. It is recommended to contact the insurance carrier prior to services to determine these plan requirements. After each visit, patients will receive an itemized statement of charges and a monthly statement listing the payments and adjustments made.
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Frequently asked questions
Tricare is a healthcare program for active-duty service members, retirees, and their families worldwide.
Eligibility for Tricare is determined by the sponsor's uniformed service, which could be the Army, Navy, Air Force, etc. Eligible sponsors include active duty, retired, and National Guard and Reserve members. Eligible family members include spouses and children who are registered in the Defense Enrollment Eligibility Reporting System (DEERS).
Tricare provides comprehensive coverage, health plans, special programs, prescriptions, and dental plans. 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.
To check your eligibility, make sure your information is fully updated in DEERS. Then, log in to milConnect to confirm your eligibility for Tricare.
