Who is Eligible for Tricare?

Who is Eligible for Tricare – Overview

TRICARE is a healthcare program designed for US military personnel, retirees, and their dependents. It offers 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 (DHA), part of the Department of Defense (DoD), manages the TRICARE health program. TRICARE provides worldwide medical benefits to eligible US military members, their families, and other beneficiaries. TRICARE offers several health and dental plans to eligible beneficiaries, tailored to their status and location.

Eligible beneficiaries may receive care through various TRICARE plans at military, civilian facilities, or both, depending on their chosen plan and eligibility.

Eligible individuals may have options among multiple TRICARE plans based on their eligibility status. 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 without retirement benefits are generally not eligible for TRICARE, but TRICARE provides benefits to Medal of Honor recipients, retirees, and their families.
  • Veterans not eligible for TRICARE may receive care through the Department of Veterans Affairs (VA) healthcare system.
  • VA care for service-connected conditions is often free, while other types of care may incur costs separate from TRICARE benefits.
  • Your VA health care priority group determines copays for various services and prescriptions unrelated to TRICARE.

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:

Who is Eligible for Tricare

Who is Eligible for Tricare – Tricare-Eligible Personnel

  • 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 Administration (NOAA)

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 also ensure 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:

  1. You can visit your personnel office (ID card facility) or contact the Defense Manpower Data Center Support Office at – 800 538 9552.
  2. You can choose to visit the DEERS website directly at this link https://milconnect.dmdc.osd.mil/milconnect/.
  3. You can also go to the Tricare website to update your information directly at: 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 service members are enrolled in TRICARE Prime by default, but their dependents may have options based on the service member’s location. Enrollment is free of charge and includes no out-of-pocket expenses for active duty members 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 military hospital) to receive medical care unless the MTF lacks the facilities to provide the required 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:

Tricare Prime

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.

Tricare Select

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.

Conclusion

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.

See Also

Does Walgreens Take Tricare

Does Walgreens Deliver Prescriptions

Does Tricare Cover Dental

What is the Catastrophic Cap for Tricare

Does CVS Take Tricare

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