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TRICARE 101: Military Health Benefits Basics in Five Minutes or Less

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TRICARE is the health care program for almost 9.4 million service members, retirees and their families around the world that provides military health benefits and health care support to ensure mission readiness. Whether you already have TRICARE or are just starting the enrollment process, take the next five minutes to learn the basics, including how to navigate recent changes.

TRICARE enrollment: Important information before getting started

There is a lot to know about the military health care program before you decide which plan is best for you and your family. TRICARE has implemented an open season for enrolling in its healthcare plans. Here are important items to know.

Available TRICARE plans

There are many different TRICARE plans, but TRICARE Prime and TRICARE Select are the two primary options for active-duty service members and their families. TRICARE Prime Remote works like TRICARE Prime for active-duty service members and their families assigned to geographical regions where there is no military hospital or clinic nearby. In fact, all active-duty service members must enroll in TRICARE Prime – and will never pay out-of-pocket for any type of care within the network. Their family members and other beneficiaries, though, may choose other TRICARE plans and may incur out-of-pocket fees depending on the plan they choose.

See below for brief descriptions of the most common TRICARE plans available for service members, families and retirees. You can also visit the Plans & Eligibility section on TRICARE’s website to find information on all TRICARE plans and to compare plans.

TRICARE Prime is a managed care option health plan, which is similar to a health maintenance organization, or HMO. This military health plan centers around receiving care within a given network of medical facilities and providers, called a Prime Service Area. You may incur additional costs if you seek care outside of the provider network.

TRICARE Select is a fee-for-service health plan, which is similar to a preferred provider organization, or PPO. You’ll pay a set fee (copayment) or percentage (cost-sharing) every time you go to the doctor, but it’ll be less for in-network providers than out-of-network providers. Also, unlike TRICARE Prime, TRICARE Select does not require you to get a referral from your primary care physician for specialist treatment like surgeries or physical therapy.

TRICARE Young Adult is a military premium-based health plan designed to cover qualified adult children who have aged out of their sponsor’s regular TRICARE coverage at age 21 – or 23 if attending college. TYA is available in either TRICARE Prime or TRICARE Select formats, depending on the option chosen at the time of enrollment. You can enroll in this benefit until age 26, or until you otherwise become ineligible.

TRICARE For Life is Medicare-wraparound coverage for those TRICARE beneficiaries who have Medicare Part A and B. You don’t have to enroll in this, as it is an entitlement earned as part of military service. However, in order for you to be automatically enrolled by the DEERS, you must be eligible for both Medicare Part A and B, and be paying Medicare Part B premiums.

TRICARE eligible retirees and their families are newly eligible to enroll in the Federal Dental and Vision Insurance Program, currently offered to all federal government employees. FEDVIP has its own open season for new enrollments that occurs at the same time as TRICARE open season in the second week of November to the second week of December. FEDVIP offers a choice of 10 dental insurance carriers. The singular TRICARE Retired Dental Program ended Dec. 31, 2018. And, for the first time ever, retirees and active-duty family members are eligible to purchase vision insurance from four carriers through FEDVIP. Beneficiaries must enroll during open season or after a qualifying life event at the official website.

TRICARE Reserve Select is a premium-based plan for qualified Selected Reserve members and their families. When reserve service members go on active duty, they must enroll in TRICARE Prime, and their families may enroll, too. However, when leaving active duty, TRICARE Reserve Select can replace TRICARE Prime.

For a comprehensive list of plan details and changes to the TRICARE program, visit the main TRICARE website and see how your health care may be impacted.

While Military OneSource does not directly manage or facilitate any part of the TRICARE health benefits program, we want to make sure that you have all the information you need to make the best decision for you and your family to live your best MilLife.

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