TRICARE provides military service members and their families with great health insurance options to meet the specific needs of the military. TRICARE has additional benefit programs that provide assistance when transitioning from TRICARE insurance to civilian health insurance. Some of these programs help with travel expenses for medical care, autism care costs, and cancer clinical trial expenses. TRICARE also provides Medicare insurance to eligible individuals that offers coverage throughout the world.

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The Good

  • Plan Options Designed for Military Needs
  • Special Additional Programs

Plan Options Designed for Military Needs

TRICARE offers 11 kinds of health insurance plans to meet the needs of military service members and their families:

  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Select
  • TRICARE Select Overseas
  • TRICARE for Life
  • TRICARE Reserve Select
  • TRICARE Retired Reserve
  • TRICARE Young Adult
  • U.S. Family Health Plan

With all four of the TRICARE Prime plans, members work with a Primary Care Manager (PCM) who coordinates their care. A Primary Care Manager has a similar function to a Primary Care Physician, which is a term used more commonly on other health insurance plans.

The cost specifics vary plan to plan. Most of the TRICARE Prime plans do not have premiums, annual enrollment fees, copays, or out-of-pocket costs for active duty or command sponsored military members as long as the care is from the member’s PCM or from a specialist referred by the PCM. Some of these same features apply to their family members depending on the eligibility rules of the specific plan.

With the two TRICARE Select plans there is an annual deductible and cost sharing for medical care received.

The TRICARE Select Overseas plan does not require referrals to specialists from a PCM. However, prior authorization is required for some kinds of medical care.

The TRICARE Reserve Select plan is designed for members of the Selected Reserves. It has premiums and an annual deductible. It is connected to a network of doctors. Using this network gives plan members access to larger discounts and coverage than visiting out-of-network doctors.

The TRICARE Retired Reserve Plan is similar to the TRICARE Reserve Select plan, but is intended for retired Reserve members under age 60 and their families.

TRICARE also offers Medicare parts A and B to TRICARE-eligible beneficiaries through its TRICARE For Life plan. Those enrolled pay monthly premiums and have medical coverage in the United States and abroad.

For unmarried children ages 21-26 of eligible sponsors, the TRICARE Young Adult plan offers medical insurance coverage if children are not eligible for any other kind of health insurance.

There are two options with the TRICARE Young Adult plan: Prime and Select. The Prime options works like the TRICARE Prime plans. The Select option works like the TRICARE Select plans.

The U.S. Family Health plan has no enrollment fees or out-of-pocket costs for care received from a U.S. Family Health Plan provider. This plan can be combined with Medicare coverage if individuals were enrolled in the U.S. Family Health plan before October 1, 2012.

Special Additional Programs

TRICARE offers the following additional programs to benefit its members:

  • Autism Care Demonstration: provides coverage for applied behavior analysis
  • Cancer Clinical Trials: provides coverage for eligibility screening tests and participation costs
  • Chiropractic Health Care Program: covers chiropractic care from some military hospitals and clinics
  • Combat-Related Special Compensation Travel Benefit: reimburses travel expenses for injury-related care for travel of more than 100 miles
  • Computer/Electronic Accommodations Program: provides technology assistance to qualifying Federal employees and managers to ensure that jobs are accessible to people with disabilities or injuries
  • Continued Health Care Benefit Program: provides health care coverage for 18-36 months after losing TRICARE eligibility
  • Extended Care Health Option: extends health care coverage for military family members who are transitioning out of TRICARE and are in the Exceptional Family Member Program (EFMP)
  • Provisional Coverage Program: provides coverage for emergency services and supplies with prior authorization
  • Transitional Assistance Management Program: provides 180 days of premium-free transitional health care benefits after TRICARE benefits end
  • TRICARE Plus: offers additional coverage for primary care services at military hospitals and clinics
  • Women, Infants, and Children Overseas Program: provides support to qualifying military families for living healthy lives. A WIC counselor determines eligibility and works with families on nutrition. The program also helps with health screenings.

The Bad

  • Eligibility Rules
  • Exclusions

Eligibility Rules

TRICARE only offers health insurance to individuals who are registered in the Defense Enrollment Eligibility Reporting System, including the following:

  • Uniformed Service members and their families
  • National Guard members and their families
  • National Reserve members and their families
  • Survivors
  • Former spouses
  • Medal of Honor recipients and their families

Because each of TRICARE’s health insurance plans are designed with specific groups in mind, each plan has its own eligibility requirements. Details about plan-specific requirements can be viewed easily from TRICARE’s website.

Exclusions

TRICARE health insurance also has some exclusions. These exclusions can be viewed on TRICARE’s website.

The Bottom Line

While TRICARE has some exclusions and specific eligibility requirements, its health insurance plans are excellent choices for those serving as part of the U.S. military and their families.

TRICARE’s plans are designed with specific military needs in mind, like being stationed overseas.

TRICARE also offers additional programs that help military families lead healthy lives, provide access to new cancer treatments, and transition from TRICARE health insurance.

If you are a military member, TRICARE is a great choice.

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KayCee Belka

September 6th, 2019 Derby, KS DETAILS arrow_drop_down
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Generally, we have had good experience with Tricare. We typically don't have issues with being able to find in network providers or having our insurance paid out. They are usually timely in their processing and taking care of payments. Unfortunately, we have had a couple of occasions when things have been miscommunicated and have had to jump through hoops for Tricare to pay their portion. Overall, we have had a good experience though.

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BNJ

August 1st, 2018 DETAILS arrow_drop_down
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I appreciate Tricare for the quickness of getting our family taken care of! I like everything about Tricare. The only issue that I think that they could improve on is taking care of meeting the deductible better and keep us in formed about our Catastrophic Cap.

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