TRICARE Provider

Military TRICARE

TRICARE is a worldwide government-managed comprehensive medical care (that offers “minimum essential coverage”) for the military.

It covers service members, retirees, and their family members. Its role is to keep the military mission-ready—fit to fight.

It’s available in different plans:

• Preferred provider plans (PPOs)
• Health maintenance plans (HMOs).
• Plans for families.
• Plans for retirees (including Medicare Supplemental Covers).
• Plans for young adults.
• Supplemental Plans.
• Plans for Servicemen living overseas.

This plan also offers dental, drug prescriptions, and certain special plans.

TRICARE beneficiaries are grouped into:

Group A

Individuals who served before January 1, 2018.

Group B

Individuals who served before or after January 1, 2018.

Programs under TRICARE

Tricare Prime

This is a managed care option available in Prime Service Areas (military hospitals and clinics around the Base Realignment and Closure sites or a civilian network PCM)

It’s available to ADSMs, ADFMs, surviving spouses (first three years), and surviving dependent children with no enrollment costs (no premiums, no deductible, and no out-of-pocket costs).

With Prime, you will be assigned a Primary Care Manager (PCM) to provide most of your health care (including referrals). If on travel or between duty stations, all non-emergency care should be received at a military hospital or clinic if one is available, or through a referral from your PCM.

Other Prime options available include Prime Remote, Prime Overseas, and Prime Remote Overseas.

Tricare Select (formerly TRICARE Standard and Extra)

This is a fee-for-service plan that allows members to pick their preferred provider (network or non-network authorized provider).

With the Select plan, Enrollment costs apply (annual outpatient deductible, applicable copayments, and cost shares) and will depend on your duty status and rank.

Retirees are charged a yearly enrollment fee. This amount will depend on whether they fall in Group A or B.

Select has no requirements for referrals. Care may be available at a military hospital or clinic subject to the availability of space. Some services may require pre-authorization.

TRICARE for life

TRICARE for Life (TFL) is wraparound health coverage for beneficiaries entitled to Medicare Part A and B. TFL members are also eligible for plan Pharmacy benefits.

Enrollment into TFL is automatic once you qualify for Medicare.

TFL does not attract enrollment fees with the Life plan, but the beneficiary will have to pay Medicare Part B monthly premiums.

Care is available at Medicare participating and non-participating providers, Military hospitals, and clinics (if space is available). Medicare will pay first if care is sought within U.S. TRICARE will pay first if outside the US.

TRICARE Reserve Select

It’s a premium-based health plan available for purchase (monthly premiums, an annual deductible, applicable copayments, and cost-sharing) by qualified members of the Selected Reserve of the Ready Reserve, their family members, and qualified survivors.

Reserves can receive care from authorized providers (network or non-network) and sometimes may require pre-authorization for certain services.

Reserve members are not eligible if on active-duty orders, covered by the Transitional Assistance Management Program (TAMP), or the Federal Employees Health Benefits (FEHB) program.

Retired Reserve

The Retired Reserve plan is for Reserve members and their families under non-regular retirement (under the age of 60).

Tricare Young Adult

TRICARE Young Adult(TYA) is a premium-based health plan available for purchase by qualified adult children who have aged out of their parent’s coverage.

Selected Reserve or Retired Reserve members may be TYA sponsors if they are either eligible for premium-free TRICARE or covered by a premium-based TRICARE program (TRS or TRR).

To be qualified, the TYA must be between the 21-26 age range, not married, and not eligible for other TRICARE or employer-based health plans.

TYA is usually available in both Prime and Select plans.

TYAs location and sponsor status determine whether they qualify for TYA Prime and/or TYA Select. TYA covers medical and pharmacy benefits, but not dental or vision coverage.

Coverage, provider lists, and costs for TYA are in the same range as Prime and Select.

WHO’S ELIGIBLE FOR TRICARE INSURANCE

To be eligible you must be registered in the Defense Enrollment Eligibility Reporting System (DEERS).

• Service members and their dependents
• National Guard/Reserve members and their dependents
• Survivors
• Former spouses
• Medal of Honor recipients and their dependents
• Dependent parent or ward

Beneficiaries (Certain National Guard and Reserve members) eligible for TRICARE Reserve Select or TRICARE Retired Reserve include those who are not:

• Not in Active National Guard and Reserve members (activated status for more than 30 days)
• Not In TAMP
• Not Eligible for or enrolled in the FEHB Program
• Lost other coverage under another plan option due to the sponsor’s change in status(should be done within 90 days)
• Purchase of Survivor coverage
• Qualifying Life Event (QLE) occurs in a family (getting married, having or adopting a child, or losing a family member), and the beneficiary may request changes to the TRS or TRR coverage
• If the servicing contractor did not receive the TRS or TRR premium payment when it was coverage may be terminated, and the beneficiary may be subjected to a 12-month lockout.
• TRS or TRR coverage ends automatically when the beneficiary is activated for more than 30 days for a federal preplanned mission or in support of a contingency operation. Unused premiums may be refunded in case there are no pending claims. The 12-month purchase lockout is not applicable in this case
• The sponsor will dis-enroll from TRS or TRR when the beneficiary becomes eligible for or enrolls in the FEHB Program. No purchase lockout will go into effect.

Individuals eligible for TRICARE Standard and TRICARE Extra include:

• Active duty family members (ADFMs)
• Active National Guard and Reserve members and family members(activated status for more than 30 days)
• Retired service members and their families
• Survivors
• ADFMs, retired service members(and their families) who have Medicare Part B but are not yet eligible for Part A
• Former spouses,
• Medal of Honor recipients

Beneficiaries not eligible to use TRICARE Standard and TRICARE Extra include:

• Active duty service members (ADSMs)
• Active National Guard and Reserve members
• Beneficiaries in the Prime option (have to be dis-enrolled first)
• Retired service members and their family members are entitled to Medicare Part A and Part B, or are entitled to Part A only
• Dependent parents and parents-in-law

The major difference between TRICARE Standard and TRICARE Extra is in the providers that are provided for members to use for care.

TRICARE Standard makes use of authorized non-network hospitals and providers hence associated with higher cost-shares.

On the other hand, TRICARE Extra makes use of TRICARE network hospitals and providers and hence highly discounted cost-shares.

Dental plan TRICARE

Program Options include

TRICARE Active Duty Dental Program (ADDP)

Eligible for:

• Active duty service members (ADSMs- referred for care by a military dental clinic to a civilian dentist or have a duty location and live greater than 50 miles from a military dental clinic)
• National Guard and Reserve members(active for 30+ consecutive days)

TRICARE Dental Program (TDP)

Eligible for:

• Active duty family members
• Survivors
• National Guard and Reserve members and their families
• Individual Ready Reserve members and their families

 TRICARE Retiree Dental Program (TRDP)

• Retirees and eligible families (worldwide )
• National Guard and Reserve retirees(until age 60)

Enroll TRICARE

Online TRICARE enrollment

The Beneficiary Web Enrollment website can allow:

• Enrollment into Plans.
• Update personal information (i.e. Addresses, phone numbers, e-mail addresses, etc.) or update other health insurance information.
• Request service (e.g. Change PCP, request for cards, etc.)

Access can be made via Common Access Card (CAC), DS Login, or a DFAS myPay login.

Open enrollment

TRICARE Open Season starts in the fall (Nov. 14 to Dec. 13, 2022.).

It’s the period for members to enroll or make changes in their Prime or Select health plans.

Three choices are available at open enrollment:

• You can choose to stay in the current plan.
• Enroll in a new health plan.
• Change health plans or switch between individual and family covers.

Open Season is not applicable to TRICARE for Life or any of the premium-based plans. The transition to TRICARE Life is automatic with Medicare.

Other premium-based plans can initiate changes outside open enrollment.

Outside of Open Season

Outside of Open Season, you can enroll in or change enrollment if the beneficiary is subject to Qualifying Life Event (QLE). A TRICARE QLE will open a 90-day period for beneficiaries to perform eligible enrollment changes.

A QLE for one family member may open an opportunity for all eligible family members to make enrollment changes.

Optometry TRICARE

Tricare offers limited vision benefits. Coverage will depend on the beneficiary status and the type of coverage. Medically necessary vision benefits are available under this plan (under referral and/or pre-authorization).

Coverage Includes;

• Eye Exams
• Glasses and Contacts

Active Duty Members & Activated Guard/Reserve

• Annual eye exams
• Military-issued glasses. Sunglasses are available if mission necessary.

Dependents of Active Duty Members

• Qualify for an eye exam every two years at a Military Treatment Facility or authorized location.
• Glasses are only available if certain serious medical conditions.

Tricare Select beneficiaries are not eligible for vision benefits unless it’s a result of an underlying condition.

Most dependents and retirees may be eligible for vision insurance through the FEDVIP program.

Retirees & Their Dependents

• Annual eye exam (Tricare Prime enrollees can get an eye exam every two years).
• Military-issued glasses. Sunglasses are available if mission necessary.

Retirees & their dependents who enroll in a FEDVIP vision insurance program are eligible for annual eye exams and free or discounted glasses or contact lenses depending on their plan.

Veterans

Some veterans may be eligible for vision benefits from the VA

Veterans with VA disabilities and also getting compensation are eligible for a free eye exam and glasses from the VA.

Also, veterans with a Purple Heart, getting a VA pension, and more qualify for this as well.

Supplemental insurance for TRICARE

Supplemental insurance will only pay after TRICARE pays its portion of the costs.

This Supplement Insurance accords the beneficiary the ability to seek care from any TRICARE-authorized civilian provider without costs

This insurance covers;

• The full cost for Doctors Visits, Drugs, and Hospital Co-payments
• All the out-of-pocket costs
• Full excess charges from the legal limit up to 15% above the TRICARE rates

Bottom Line

Is TRICARE free for the military?

Prime is free for members on active duty, and in most cases, free for family members as well (if they don’t opt for the point-of-service option).