TRICARE is a worldwide healthcare program for the U.S. military. It provides health benefits to active duty service members, National Guard and Reserve members, military retirees, and eligible family members. Globally, 9.6 million people get health coverage through TRICARE.
To meet the needs of military personnel and their family members, there are several types of TRICARE health plans. The costs and benefits of TRICARE can vary, depending on the plan. Learn how TRICARE works, including who is eligible and what TRICARE plans cover to see how this program could work for you and your family.
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Do Veterans Need to Have Health Insurance?
Veterans do not have to have health insurance based on federal regulations, but some states still require health coverage. The federal mandate requiring Americans to have health insurance coverage or pay a tax penalty was effectively repealed in 2019, but some states have created their own mandates. As of 2022, California, New Jersey, Massachusetts, Rhode Island, and Washington D.C. impose a tax on uninsured residents.
What is TRICARE?
TRICARE is a healthcare program for active duty service members, National Guard and Reserve members, military retirees, and eligible family members. It’s sometimes confused with the Veterans Affairs (VA) healthcare system, but the two programs are distinct. Veterans may be eligible for both VA healthcare and TRICARE.
There are several types of TRICARE plans. Coverage is not limited to military hospitals and clinics, so members may see civilian healthcare providers. Like other types of private health insurance plans, TRICARE offers coverage for eligible family members, such as spouses and children.
On the other hand, the VA healthcare system provides care to eligible veterans, and those with low incomes or service-connected disabilities are prioritized for care. Coverage with VA is also typically limited to VA hospitals and facilities, and unlike TRICARE, family members are not generally eligible for VA health benefits.
How Does TRICARE Work?
TRICARE covers care in military healthcare facilities and a network of TRICARE-authorized civilian healthcare providers. Care costs and rules for accessing care can vary depending on a TRICARE member’s health plan and military status.
The types of providers TRICARE members can see depends on the health plan selected, but generally providers that accept TRICARE include:
- Network and non-network providers
- Military hospitals and clinics worldwide
- Veterans Affairs healthcare facilities
- Any Medicare-participating provider in the U.S.
- Designated US Family Health Plan providers
- Overseas providers
- Network dentists
Rules for getting care from covered providers can vary. Some TRICARE plans work like a private Health Management Organization (HMO) plan. They require members to have a primary care manager and get referrals for specialist care. Other TRICARE plans work like Preferred Provider Organization (PPO) plans” data-wpil-keyword-link=”linked”>Preferred Provider Organization (PPO) plans, where members can see any TRICARE-authorized provider, but may have higher cost-sharing requirements for non-network providers.
Active duty service members do not pay out-of-pocket costs for TRICARE-covered services. However, others with TRICARE may pay the following costs:
- Enrollment fees and premiums: Fees to keep TRICARE coverage active
- Deductibles: Amount paid before TRICARE begins covering services
- Copayment: Fixed dollar amount paid for a covered service
- Cost-share: Percentage paid for a covered service, like coinsurance in a civilian health plan
Who is Eligible for TRICARE?
TRICARE is a Department of Defense healthcare program, so eligibility is limited to people with a connection to the U.S. military. This includes active duty and retired members of the Uniformed Services, National Guard and Reserve members, and their family members.
Eligibility for Active Duty Service Members
TRICARE coverage is mandatory for active duty members of the Uniformed Services. Under federal law, active duty refers to people who serve full-time in the U.S. military, except for full-time Reserve members. This full-time duty can be in any of the Uniformed Services:
- U.S. Army
- U.S. Navy
- U.S. Air Force
- U.S. Marine Corps
- U.S. Space Force
- U.S. Coast Guard
- National Oceanic and Atmospheric Administration Commissioned Officer Corps
- U.S. Public Health Service Commissioned Corps
After 20 years of active service, service members typically become eligible for retirement and can receive TRICARE benefits for retirees. Veterans who leave active duty before reaching retirement may be eligible for TRICARE in some situations, including receiving the Medal of Honor or being on the Temporary Disabled Retirement List.
Eligibility for National Guard and Reserve Members
Members of the National Guard and Reserve may be eligible for TRICARE coverage, depending on their military status.
- Not activated: This includes members on inactive duty or on active duty for 30 days or less. Members of the Selected Reserve may be eligible for TRICARE health coverage while they’re not activated. Individual Ready Reserve members are not eligible in this status.
- Pre-activation/Activated: This includes members called to active duty for more than 30 days. Members in this status are eligible for active duty TRICARE coverage, and this coverage may start as early as 180 days before active duty begins.
- Deactivated: This includes members who have been released from active duty. TRICARE eligibility may continue for 180 days through the Transitional Assistance Management Program.
- Retired: This includes members who have left the National Guard or Reserve after 20 years of active service. Retirees become eligible for the same TRICARE coverage as other retired service members when they reach age 60.
Eligibility for Military Spouses and Family Members
Active duty family members, National Guard and Reserve family members, and family members of retirees may also be eligible for TRICARE coverage. Eligible dependents may include:
- Spouses: Spouses of active duty service members, National Guard/Reserve members, and retired service members are eligible for TRICARE. This includes same-sex spouses. Former spouses who have not remarried may also be eligible, depending on the length of the marriage and the service member’s creditable service.
- Children: Service members’ unmarried children are generally eligible for TRICARE until they turn 21, though college students remain eligible until they turn 23 years old. This includes adopted children and step-children.
- Dependent parents: Parents and parents-in-law of active duty service members may be eligible for TRICARE with proof of financial dependency. Their TRICARE coverage is limited to primary care in military healthcare facilities.
What Does TRICARE Cover?
TRICARE offers several health plans, and covered services can vary depending on the plan. In general, TRICARE offers coverage for medically necessary healthcare services, dental benefits, mental health services, and other health services.
TRICARE Health Care Coverage
TRICARE offers coverage for a broad range of medically necessary tests, items, and services. Covered services may vary depending on a beneficiary’s TRICARE plan selection, location, and military status, but typically includes the following:
- Primary care
- Preventive and wellness services
- Urgent care
- Emergency care
- Inpatient hospital care
- Outpatient surgeries
- Lab tests and X-rays
- Home health care
- Skilled nursing facility care
- Medical equipment and supplies
- Physical, occupational, and speech therapy
TRICARE does not cover health services that it considers unproven or medically unnecessary. Some examples of excluded healthcare services and supplies include acupuncture, massage, long-term custodial care, blood pressure monitors, and home accessibility modifications.
TRICARE Dental Care Coverage
TRICARE covers care in military dental clinics for active duty service members. There are also three optional dental plans available to people with TRICARE:
- Active Duty Dental Plan: This program covers care in civilian dental clinics for eligible active duty service members. It covers dental services members need to be ready for deployment, from routine cleanings to complete dentures.
- TRICARE Dental Program: This optional dental plan is for military family members and National Guard and Reserve members who are not on active duty. It’s administered by a private dental insurance company and covers a wide range of dental services, including preventive and restorative services.
- FEDVIP Dental: The Federal Employees Dental and Vision Insurance Program may provide coverage to retired service members, retired National Guard and Reserve members, and their families. FEDVIP plans are offered by private companies, so covered services can vary.
TRICARE Prescription Care Coverage
The majority of TRICARE’s health plans include prescription drug coverage. Plan members can choose to get covered drugs through military pharmacies, participating civilian pharmacies, and home delivery.
TRICARE’s prescription coverage includes a variety of drugs approved by the U.S. Food and Drug Administration, including brand-name and generic medications. The list of covered drugs is updated each quarter. Drugs that are not on this list may still be covered, but with a higher copayment.
Some medications are excluded from TRICARE prescription drug coverage, so members who take these drugs are responsible for the full cost. Non-covered drugs include:
- Over-the-counter drugs, with limited exceptions
- Vitamins, except for prescribed prenatal vitamins
- Homeopathic and herbal remedies
- Drugs used for cosmetic purposes, such as hair growth
TRICARE Mental Health Care Coverage
TRICARE health plans cover a wide array of inpatient and outpatient mental health services to support service members, retirees, and their family members. Some of the medically necessary mental health services available through TRICARE include:
- Psychological testing
- Individual, group, and family therapy
- Inpatient psychiatric hospitalization
- Intensive outpatient programs for psychiatric or substance use disorders
- Substance use disorder treatment
- Eating disorder treatment
- Mental health medications
Referrals and pre-authorizations may be required for some non-emergency mental health services, depending on the TRICARE health plan.
Some mental health services are excluded from TRICARE coverage, even if a mental health professional recommends them. These services include aversion therapy, nutritional or stress management counseling, and experimental mental health procedures.
Other TRICARE Benefits
TRICARE health plans may cover other benefits in addition to those described above. These benefits could include:
- Vision care: TRICARE covers medically necessary eye surgeries and treatments, and some TRICARE health plans include routine vision coverage, such as eye exams and prescription eyeglasses.
- Hearing care: TRICARE offers coverage for hearing exams for active duty service members and their families and, in some cases, hearing aids.
- Reproductive healthcare: TRICARE plans cover well woman exams, birth control, pregnancy and maternity care, and other reproductive health services. TRICARE may cover some treatments for infertility.
- Special needs: For beneficiaries with special needs, TRICARE plans cover several support services. These include home health care, hospice care, and skilled nursing facility care. Plans also cover participation in cancer clinical trials.
TRICARE Plan Types
Where Is the Plan Available?
Where Can Members Get Care?
Do Members Need a Primary Care Manager?
Are Referrals Required for Specialist Care?
U.S. Prime Service Areas
Military or network providers
Remote U.S. locations
Network provider, if available
Overseas areas near military hospitals
Military hospitals and clinics
Prime Remote Overseas
Designated remote overseas areas
Approved overseas providers
Any TRICARE-authorized provider
Any qualified overseas provider
Any authorized provider
Any TRICARE-authorized provider
Any TRICARE-authorized provider
Young Adult-Prime Option
U.S. Prime Service Areas
Military or network providers
Young Adult-Select Option
Any TRICARE-authorized provider
US Family Health Plan
6 U.S. Service Areas
Designed US Family Health Plan provider
People who are eligible for TRICARE may have access to multiple plan options, depending on their location and eligibility group. TRICARE’s health plans include:
- TRICARE Prime: This is a managed care plan that’s mandatory for active duty service members and available to other TRICARE-eligible people. Members who live outside of Prime Service areas could enroll in other TRICARE Prime options: Prime Remote, Prime Overseas, or Prime Remote Overseas.
- TRICARE Select: This is a preferred provider organization (PPO) plan for TRICARE-eligible people in the United States, except for active duty service members. TRICARE Select Overseas is available for those outside the United States.
- TRICARE Reserve Select: This is a PPO plan for Select Reserve members and their families. TRICARE Retired Reserve is a similar plan for retirees.
- TRICARE for Life: This is a supplemental plan for TRICARE-eligible people who are enrolled in Medicare Parts A and B.
- TRICARE Young Adult: This is a plan for unmarried adult children who have aged out of regular TRICARE coverage. Both Prime and Select versions of the Young Adult plan are available.
- US Family Health Plan: This is a TRICARE Prime option for military family members and retirees. It’s available through civilian healthcare systems in 6 designated service areas in the United States.
How to Enroll in TRICARE
Depending on the chosen plan, enrollment may be limited to certain times of the year. Generally, TRICARE Open Season is the annual opportunity to enroll in TRICARE or switch plans. For 2023 coverage, it runs from November 14 to December 13, 2022. However, some plans, including TRICARE Young Adult, are available for purchase throughout the year. Tricare for Life coverage is automatic, so enrollment is not required.
Enrollment applications can be submitted online through the milConnect website or by contacting your TRICARE regional contractor by phone, mail, or fax. However you choose to enroll, be prepared to provide your Social Security Number and details about any other health insurance coverage you have.
Outside of the TRICARE Open Season, members may not be able to make enrollment changes unless they experience certain qualifying life events. Before enrolling, carefully review your plan selection to ensure its benefits and costs meet your needs.