TRICARE is the Department of Defense's health care program for active duty military members, retirees, eligible National Guard and Reserve service members and their families. With TRICARE, beneficiaries can choose from several different health care options in both the United States and overseas, making the program easy for military families to use. Understanding how TRICARE works will help you and your family take advantage of this benefit.
Eligibility and enrollment
Although TRICARE manages the program, eligibility is determined by the service branches. Your installation's personnel office can help you with your eligibility determination and enrollment.
- Eligibility. All active duty service members, activated National Guard and Reserve members, retirees, their spouses and unmarried children (including stepchildren) under the age of 21 (or 23 if attending school full-time) are eligible for TRICARE.
- Defense Eligibility and Reporting System. Eligibility for health care benefits is validated by DEERS. While active duty members and retirees are enrolled automatically in DEERS, eligible family members must be enrolled in the system to receive care. Enrollment in DEERS can be confirmed through your installation's personnel office or by calling DEERS at 800-538-9552. More information is available on the TRICARE DEERS website.
Through TRICARE, service members and their families have access to military treatment facilities as well as to civilian health care providers. These TRICARE options are available:
- TRICARE Prime. As a managed care option, TRICARE Prime offers the most affordable and comprehensive coverage to beneficiaries living in a Prime service area. Active duty service members are enrolled automatically but other eligible beneficiaries must complete an enrollment application. With TRICARE Prime, an MTF is often the primary source of medical care. There is no deductible and co-payments are kept to a minimum when using the Prime network. Prime also offers an option for care received outside the network but costs are higher. Beneficiaries receive their health care through a primary care manager who oversees their care and provides referrals for specialty care.
- TRICARE Prime Remote. TRICARE Prime Remote provides active duty service members and their families with TRICARE Prime services when the sponsor lives and works at least 50 miles from an MTF. Family members must live with the service member. Family members of National Guard and Reserve service members called to active duty may be eligible for Prime Remote if the sponsor was living in a Prime Remote area on the effective date of orders.
- TRICARE Standard. TRICARE Standard is a fee-for-service plan available to family members and retirees. The plan offers the most flexibility of any TRICARE option but the deductibles and cost shares are higher. With TRICARE Standard, you can choose your provider and you are not required to use the TRICARE network.
- TRICARE Extra. TRICARE Extra is an option for TRICARE Standard beneficiaries that allows them to choose providers within the TRICARE network, where available, and receive discounted cost-shares.
- TRICARE Reserve Select. National Guard and Reserve service members not on active duty for 30 or more have access to TRICARE health benefits through a program called TRICARE Reserve Select. To qualify, you must be a member of the selected reserve and not be eligible for the Federal Employee Health Benefits program. More information is available on the TRICARE Reserve Select website.
- U.S. Family Health Plan. The USFHP provides coverage for individuals who live in six specific regions of the country. You can enroll at any time and you must agree to get care only at a USFHP facility (unless referred to another facility by a USFHP provider). More information is available on the USFHP website. Regional facilities include:
- Johns Hopkins Medical Services Corporation serves central Maryland, Washington D.C., and parts of Pennsylvania, Virginia and West Virginia.
- Martin's Point Health Care serves Maine, New Hampshire and northeastern New York.
- Brighton Marine Health Center serves Massachusetts, Rhode Island and northern Connecticut.
- CHRISTUS Health serves southeast Texas and southwest Louisiana.
- Pacific Medical Clinics serves the Puget Sound area of Washington.
- Saint Vincent Catholic Medical Centers of New York serves New York, New Jersey, southeastern Pennsylvania and western Connecticut.
Contracted medical administrators in three regions in the United States manage TRICARE benefits. TRICARE benefits are also available to beneficiaries stationed overseas.
- Within the United States. Each of three TRICARE regions in the United States has a regional contractor that coordinates medical services through MTFs and civilian health care providers.
- TriWest Healthcare Alliance serves the western United States. More information is available on the TriWest Healthcare Alliance website or phone at 888-874-9378.
- Humana Military Healthcare Service serves the southeastern United States. More information is available on the Humana Military Healthcare Service website or by phone at 800-444-5445.
- Health Net Federal Services, Inc. serves the northeastern United States. More information is available on the Health Net Federal Services website or by phone at 877-874-2273.
- TRICARE Overseas Program. Families living in Europe, the Pacific, Latin America or Canada may be eligible for TRICARE Overseas. Like TRICARE beneficiaries living stateside, eligible family members may be able to choose TRICARE Prime or Standard. Eligible beneficiaries living in more remote regions have access to TRICARE Overseas Remote. The area is divided into three regions: Latin America and Canada, Pacific, and Eurasia and Africa. Contact information is available on the TRICARE Overseas website.
- Dental care. The TRICARE Dental Program provides care for active duty family members, National Guard and Reserve members and their families and retirees. More information on the TRICARE Dental Program for active duty family members, National Guard and Reserve members and their families is available on the TRICARE Dental Program Providers website. More information on the dental program for military retirees and their family members is available on the Delta Dental website, by phone at 888-838-8737 or for international toll-free, dial (AT&T USADirect Access Number) plus 866-721-8737.
- Pharmacy. All TRICARE eligible beneficiaries also receive TRICARE's pharmacy benefit, through which prescriptions are filled at MTFs, through the TRICARE Mail Order Pharmacy, through TRICARE's network of retail pharmacies or through a non-network retail pharmacy. For specifics on pharmacy benefits, visit TRICARE Pharmacy Program.
- Extended Care Health Option. TRICARE ECHO is a new supplemental program providing financial assistance to eligible active duty family members who have a qualifying mental or physical disability. To take advantage of ECHO, the family member must be enrolled in the Exceptional Family Member Program. Qualifying conditions include moderate or severe mental retardation, a serious physical disability or a physical or psychological condition that causes the beneficiary to be homebound. More information is available on the TRICARE ECHO website.