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Overview of TRICARE Military Health Coverage

May 31, 2025

TRICARE Military Health Coverage

Introduction to TRICARE

  • TRICARE Definition: Military health insurance program.
  • Eligibility: Automatically entitled for military personnel in all 7 US service branches: Navy, Marine Corps, Air Force, Army, Coast Guard, Public Health Service, National Oceanic and Atmospheric Administration.
  • Registration: Requires enrollment in DEERS (Defense Enrollment Eligibility Reporting System).
  • Beneficiaries: Includes military personnel and their immediate family members.

Types of TRICARE

  1. TRICARE Prime

    • Similar to an HMO.
    • Requires assignment to a Primary Care Provider (PCP), often at military facilities.
    • Annual enrollment fee + cost-share for care.
    • No need for filing reimbursement claims.
    • Most cost-effective option for those near military bases.

  2. TRICARE Extra

    • Offers more flexibility than Prime.
    • Auto-enrollment based on usage.
    • Access to any TRICARE Network Provider (TNP).
    • Annual deductible, then TRICARE pays 80% of costs.
    • Providers handle paperwork, no claims for reimbursement needed.

  3. TRICARE Standard

    • Highest flexibility but highest cost.
    • Allows seeing almost any provider.
    • Annual deductible + 25% of TRICARE allowable charges.
    • Two provider types: Participating (files claims) and Non-participating (may charge more & require member to file claims).

  4. TRICARE for Life

    • Applies to retirees and family members over 65.
    • Acts as secondary insurance to Medicare.
    • No annual deductible or cost sharing.

Services Covered

  • Covers hospitalization, outpatient visits, preventative care, maternity, immunizations, mental/behavioral health care.
  • Includes physical exams, surgeries, prescriptions (FDA-approved) but not over-the-counter drugs.

Services Not Covered

  • Certain procedures and services like elective abortions (unless life-threatening), cosmetic surgeries, non-prescription birth control, some dental work, etc.

Eligibility and Qualifications

  • Active duty members, reserves, retired personnel, Medal of Honor recipients, and certain veterans.
  • Dependents of these groups including spouses, children, and in some cases, parents and in-laws under specific conditions.

Family Coverage

  • Covers marital partners, children (including adopted), step-children (if legally adopted), and dependent parents in specific circumstances.
  • Coverage extends even if a spouse remarries (exceptions apply).
  • Coverage for children up to 23 if a full-time student.

Special Eligibility Cases

  • Covers NATO/PFP ambassadors' families in the U.S.
  • Former spouses of service members under certain conditions (e.g., not remarried, married to the same member for 20+ years).

This concludes the overview of TRICARE. It provides comprehensive coverage for military personnel and their families, with specific terms and conditions governing eligibility and benefits distribution. Always consult a health benefits advisor for the most tailored advice.

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