We all know how expensive healthcare insurance is these days on the civilian market. In light of that, military service members, retirees and the families of both have a benefit that is worth more than gold – TRICARE. But as good as it is, it can be a minefield trying to figure out which TRICARE plan is right for you and your family. In some cases, the decision is made for you. For some beneficiaries, there are choices.
Right now, TRICARE has nine main plans available, including ones for:
- Active Duty Members and Dependents
- Other Dependent Programs
- Reservists & Guard Members and Dependents
- Retirees (TRICARE for Life)
- Dependent Children Ages 18 – 26
- Dental
- Pharmacy
- Vision
- Transitional
This two-part series on TRICARE sorts out who is eligible for which plan(s) and the major differences between plans. Part one covers options for active duty service members and their dependents.
Active Duty Members and Dependents
Military service members currently serving stateside on active duty must enroll in TRICARE as their healthcare coverage. Whether they have either Prime or Prime Remote coverage from TRICARE depends on how far they live and work from a Military Treatment Facility. Fifty miles is the determining factor; less and they will have Prime; more and Prime Remote will be their healthcare plan. Both Prime and Prime Remote are free to the serving member, but there are costs for DEERS-enrolled dependents.
Both Prime programs only provide coverage when stationed within the US proper. If stationed overseas, Prime Overseas and Prime Remote Overseas provide coverage with cost-shares and deductibles similar to their stateside counterparts.
Other Dependent Programs
Dependents may be enrolled in either Prime or Prime Remote programs described above, or they may be eligible for one of four other TRICARE programs for dependents:
- Extra
- Standard
- Young Adult
- S. Family
Extra and Standard
Both Extra and Standard are fee-for-service programs. The main difference is with Extra, service is from a TRICARE-network provider selected by the covered individual. Under Standard, any TRICARE-network provider can be used giving the covered individual more provider and in some cases treatment flexibility.
Young Adult
Young Adult can be an option for unmarried dependent children between the ages of 21 and 26. However, if in school and parents are providing at least half of your financial support, then the minimum age for this program is 23 or upon graduation from college.
Coverage is the same as Prime or Standard; the biggest difference is cost. The monthly premium is determined by the plan selected, the sponsor’s military status and healthcare facility.
US Family
If stationed on the East, West or Gulf coasts, and in specific zip codes serviced by any of the six not-for-profit healthcare networks, this could be an option for family members. Coverage is about the same as Prime, except it is enhanced with extra benefits including more preventative care and screening coverage, discounts on hearing aids, and some vision and dental coverage. Family members, retirees and their families under the age of 65 are eligible, as are retirees 65 and older with or without Medicare Plan B, along with their eligible family members.
This little-known TRICARE healthcare plan is not new and has been around for over 28 years. Currently 100,000 members are enrolled and report a satisfaction rating 40% higher than with other health care providers.
US Family is free to service member families with no out-of-pocket costs, if care is from a Family Plan provider. Other eligible members pay yearly premiums of $277.92 for individual coverage or $555.84 for families. Copays are low and in many cases $0.00, depending on the service provided.
All TRICARE plans meet at least the minimum requirements currently in place under the Affordable Healthcare Act. With many families in the civilian world paying at least $1,000 per month (and in many cases significantly more), it is easy to see why coverage under TRICARE is pure gold.
