Who is Eligible for Tricare – Overview
TRICARE is a healthcare program designed exclusively for US military personnel. Tricare offers healthcare coverage to active duty members of the US military, including members of the National Guard and Reserve, as well as their family dependents, survivors, and retirees.
The Defense Health Agency DOD (Department of Defense) manages the Tricare health program. US military members are posted worldwide, usually with their families, and Tricare ensures they get medical benefits worldwide. There are over a dozen health and dental benefit plans for eligible members or Tricare Beneficiaries.
Depending on the type of Tricare healthcare plan you are eligible for, you may receive medical care at a medical office, civilian hospital or an MTF (Military Treatment Facility), an umbrella term used for military clinics and hospitals.
An individual can often be eligible for enrollment in multiple Tricare health programs. The specifics depend on your status in the armed forces, where you serve or live, and your own choices for receiving medical care.
In this article, we will look closely at who is eligible for Tricare and some of the major benefits of the military-centric healthcare plan.
Tricare Eligibility General Rules
Determining the kind of Tricare health plan you are eligible for is essential, as each has different benefits and advantages.
Types of Tricare Beneficiaries
Let’s check out the standard eligibility criteria for Tricare health plans:
1 – Sponsors
Sponsors are active-duty and retired Uniformed Services members, including from the National Guard and Reserve, depending on their specific status and situation.
2 – Family Members
Family members include spouses and children registered in DERS (Defense Enrollment Eligibility Reporting System).
Commonly, you can be eligible for Tricare benefits if you are one of the following:
- Medal of Honor recipient
- Spouse or a child of a Medal of Honor recipient
- Survivor of a deceased military member
- Former spouse of a military member
However, not every military vet is eligible for Tricare:
- Separated service personnel are exempt from eligibility, though Tricare offers benefits to Medal of Honor recipients, retirees, and their families.
- Veterans not eligible for Tricare generally qualify for medical and healthcare services through the Veterans Affairs (VA) healthcare.
- VA care for service-connected injuries and illnesses is free, but other medical care may not be included in their Tricare benefits.
- Depending on your priority group, you may be charged copays for different services, treatments, prescriptions, etc.
To learn more about VA health benefits, visit the official website here https://www.va.gov/health-care/about-va-health-benefits/.
Tricare-Eligible US Uniformed Services Personnel
The following US military personnel are considered to be eligible for Tricare benefits:
- US Army
- US Air Force
- US Navy
- US Coast Guard
- US Marine Corps
- Commissioned Corps of the US Public Health Service
- Commissioned Corps of the National Oceanic and Atmospheric Association
Sponsors Need to Enroll Family-Members for Tricare Benefits
The DOD’s secure DEERS database contains an extensive list of sponsors and their dependents (family members) who receive Tricare benefits in the US and worldwide. Sponsors (armed forces members) get automatically registered in the DEERS system by their personnel office.
This is why the sponsor is responsible for enrolling/deleting their family members as dependents, for instance, to reflect a marriage, birth or divorce. The sponsors are also responsible for ensuring their dependents have their Tricare ID cards. Every time Tricare beneficiaries seek coverage, they must submit proper documentation.
Here are three different ways to update your DEERS details:
- You can visit your personnel office (ID card facility) or contact the Defense Manpower Data Center Support Office at – 800 538 9552.
- You can choose to visit the DEERS website directly at this link https://milconnect.dmdc.osd.mil/milconnect/.
- Or, you can go to the Tricare website to update your information directly with this link http://www.tricare.mil/DEERS.
4 Types of Tricare Plans (Beneficiary Categories)
There are four types of Tricare plans that active-duty military members can enroll in, namely:
#1. Tricare Prime
#2. Tricare Prime Remote
#3. Tricare Prime Overseas
#4. Tricare Prime Remote Overseas
Active duty military members cannot choose their plan as the selection is based on their current service location. Enrollment is free of charge and includes no out-of-pocket expenses to active duty members for receiving medical care. However, the member has to carry their ID to receive medical care under Tricare.
Tricare Prime plans cover managed care like a Health Maintenance Organization (HMO) civilian plan. Every enrollee in the Tricare plans is assigned to a Primary Care Manager. Members need to go through their PCM to receive any medical benefits or get a referral to a specialist when needed.
Most Tricare Prime beneficiaries need to use an MTF (Military Treatment Facility, clinic or a military hospital) to receive medical care unless the MTF lacks the facilities to provide the required medical care.
However, there is a different set of Tricare health plans for dependents/family members of Tricare beneficiaries in the armed forces. So, a spouse or child (and sometimes parents) of an active duty military member are eligible to receive Tricare benefits, which include:
Sponsors can choose the Tricare Prime plan for their dependents without enrolling in the same Prime plan. For instance, if the sponsor serves overseas and the dependent lives in the US, the sponsor would enroll in Tricare Prime Overseas. At the same time, the dependent can enroll in Prime or Prime Remote, depending on their residential address. Instead, dependents can also enroll in Tricare Select Overseas if not command-sponsored.
This health benefit plan is similar to a PPO (Preferred Provider Organization) civilian health plan and can be chosen for a family dependent living in the US. Under this type of Tricare health plan, dependents can seek medical care at non-MTFs, such as civilian hospitals and clinics, with the point-of-service option.
Once personnel or dependents are registered in DEERS, they are issued a uniformed services identification card or ID Card. Every healthcare provider will ask to see this ID card before providing medical care benefits. This ID card is proof of eligibility and must be carried out whenever you wish to use Tricare health benefits services.