What is TRICARE?

TRICARE is a health care program for active duty and retired members of the armed services, their families, and survivors. This program is available worldwide and connects military hospitals and clinics with civilian healthcare professionals. 

As a family caregiver for a TRICARE beneficiary, you will get the caregiving help and support you need. Is your family eligible? And how do you apply?

What is TRICARE?

Understanding healthcare options is crucial for family caregivers of veterans, and TRICARE stands out as a cornerstone of support for military families. Administered by the Department of Defense, TRICARE is more than just a healthcare program; it's a comprehensive coverage system designed to meet the unique health needs of active-duty service members, retirees, and their families.

Core aspects of TRICARE

• Comprehensive coverage: TRICARE extends its benefits globally, ensuring you have access to quality healthcare services whether you're stationed overseas or residing in the U.S. This worldwide coverage is particularly beneficial for military families who move frequently or live in remote areas.
• Plans for every stage: From active-duty service members to retirees, TRICARE offers tailored plans. Active-duty members and their dependents are automatically enrolled in TRICARE Prime, where they receive most of their care at military treatment facilities, minimizing out-of-pocket costs. This automatic enrollment simplifies the process, ensuring families don't need to navigate complex signup procedures during transitions or deployments.
• Retiree benefits: TRICARE provides continued access to quality care for retired veterans. While retirees may see higher out-of-pocket costs than active-duty families, especially when using non-network providers, TRICARE still offers significant savings compared to civilian health plans. This ensures that the sacrifices made during active service are acknowledged through sustained health benefits into retirement.

Eligibility for TRICARE

Here's a breakdown of who qualifies for TRICARE:

Uniformed service members and their families

• Active duty service members (ADSMs): Members of the Army, Navy, Air Force, Marine Corps, Coast Guard, Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA), and the U.S. Public Health Service (USPHS).
• Active duty family members (ADFMs): Spouses and children of ADSMs.
• National Guard/Reserve members: Including members of the Army National Guard, Air National Guard, Army Reserve, Navy Reserve, Marine Corps Reserve, Air Force Reserve, and Coast Guard Reserve.
• Family members of National Guard/Reserve members: Spouses and children of National Guard/Reserve members are eligible for TRICARE when the service member is called to active duty for more than 30 days.

Retirees and their families

• Military retirees: Service members who retire from active duty or reserve service, including those under the Temporary Early Retirement Authority (TERA).
• Retiree family members: Spouses and children of military retirees.
• Medal of Honor recipients and their families: Medal of Honor recipients and their family members are eligible for TRICARE.

Others

• Former spouses: Under certain conditions, former spouses of service members or retirees may qualify for TRICARE.
• Survivors: Family members of deceased service members or retirees may be eligible for TRICARE benefits.
• TRICARE young adult: Unmarried adult children (up to age 26) of eligible TRICARE beneficiaries may qualify for TRICARE Young Adult.

Special circumstances

• Certain former members of the Armed Forces: Individuals separated from active duty under specific conditions may also be eligible for temporary health benefits.
• Department of Defense Civilian Employees: In specific circumstances, such as during an international assignment, DoD civilian employees and their family members may be eligible for TRICARE.

The Defense Enrollment Eligibility Reporting System (DEERS) determines eligibility for TRICARE. All eligible individuals and their families should register in DEERS to access TRICARE benefits. 

Eligibility can vary based on the specific TRICARE program, so it's advisable to consult the official TRICARE website or contact TRICARE directly for the most accurate and detailed information regarding individual eligibility and enrollment procedures.

The role of TRICARE for family caregivers

For family caregivers, navigating healthcare can be one of the most challenging aspects of their role. TRICARE's structure and benefits provide a solid foundation to ease this burden. By offering a range of plans with various coverage levels and facilitating access to both military and civilian healthcare providers, TRICARE ensures that caregivers have the resources they need to support the health and well-being of their loved ones. Whether it's routine care, specialty services, or emergency treatment, TRICARE's comprehensive approach addresses the diverse healthcare needs of military families, allowing caregivers to focus more on care and less on coverage concerns.

3 TRICARE plans

TRICARE is a comprehensive healthcare program serving military personnel, retirees, and their families. Recognizing that healthcare needs vary significantly among individuals, TRICARE offers several plans, each designed to cater to the diverse needs of its beneficiaries. Below is an overview of the primary TRICARE plans, which could serve as a valuable resource for family caregivers seeking the best healthcare options for their loved ones.

TRICARE Prime

TRICARE Prime operates similarly to a Health Maintenance Organization (HMO). This plan primarily benefits families looking for cost-effective healthcare solutions without sacrificing quality. Here's why it might be a good fit:

• Predictable Costs: Beneficiaries enjoy lower out-of-pocket expenses, with set co-pays for visits and treatments, making healthcare budgeting more straightforward.
• Primary Care Manager (PCM): Each beneficiary is assigned a PCM who oversees their care, making referrals to specialists as needed. This can simplify healthcare navigation for caregivers.
• Access to Military Hospitals and Clinics: Care is provided through military hospitals and clinics whenever available, ensuring that beneficiaries receive comprehensive care tailored to the military community's unique needs.

TRICARE Select

TRICARE Select is a fee-for-service plan designed for those who prefer more flexibility in choosing their healthcare providers. It's ideal for families who:

• Seek flexibility: Want the freedom to choose doctors and hospitals without referrals.
• Don't mind higher out-of-pocket costs: While no enrollment fees exist, beneficiaries typically pay more in cost-shares and co-pays than TRICARE Prime.
• Annual enrollment: Requires beneficiaries to enroll annually, a factor to consider in your healthcare planning.

TRICARE for Life (TFL)

TFL is tailored for TRICARE beneficiaries who are also Medicare eligible, typically those 65 and older. It serves as a Medicare wraparound coverage, providing additional benefits:

• Secondary coverage: TFL pays after Medicare, covering eligible out-of-pocket expenses like co-pays and deductibles, significantly reducing healthcare costs.
• Worldwide coverage: Offers peace of mind for traveling beneficiaries, covering both Medicare and non-Medicare-covered services worldwide.
• No enrollment fees: Beneficiaries are automatically enrolled in TFL upon becoming eligible for Medicare Part B, simplifying the transition for retirees and their caregivers.

Each plan is designed with the unique needs of the military community in mind, providing a range of options to ensure that family caregivers can find a plan that best suits their loved one's healthcare needs. Whether prioritizing cost, flexibility, or specific coverage types, TRICARE's variety of plans offers a solution to meet the diverse healthcare needs of military families.

Accessibility and flexibility

Choose the best option for your care recipient based on their financial and medical needs. As a family caregiver managing a loved one's medical needs, you have several options for care:

Military Treatment Facilities (MTFs)

For active-duty families, a military treatment facility is the primary source of care, offering a range of services at minimal costs. This direct access to military-centric healthcare ensures that treatment is tailored to the unique aspects of military life and service-related health needs.

Civilian network providers

Recognizing that military families cannot always access MTFs, TRICARE includes a comprehensive civilian provider network. This provider network ensures that beneficiaries have options even when away from military bases or living in civilian communities.

Low cost-sharing

TRICARE is designed to be financially accessible. With low co-pays and no premiums for active-duty families under TRICARE Prime, the program alleviates the financial burden of healthcare. Retirees benefit from structured cost-sharing that balances affordability with comprehensive care.

Non-network providers

Non-network providers are healthcare professionals and facilities that have not entered into a contract with TRICARE to provide services at agreed-upon rates. Beneficiaries might seek care from non-network providers for reasons like geographical limitations, urgency of care, or when a specialized provider is unavailable within the network. Receiving care from non-network providers usually results in higher out-of-pocket costs compared to network providers, and some TRICARE plans require prior authorization or referrals for services rendered by non-network providers. 

How to enroll in TRICARE

TRICARE Open Enrollment, also known as the TRICARE Open Season, is the annual period when beneficiaries can enroll in or change their healthcare plans for the upcoming year. 

During this time, eligible beneficiaries have the opportunity to:

• Enroll in a TRICARE Prime or TRICARE Select plan if they are not currently enrolled.
• Change their plan, such as switching from TRICARE Prime to TRICARE Select or vice versa.
• Enroll in or change their TRICARE Prime Remote status.
• Enroll in or change their TRICARE Young Adult plan.

Enrollment

The primary beneficiary must submit enrollment forms and documents proving eligibility to enroll in or switch TRICARE plans. Some common scenarios are:

• Retiring military members transferring from active duty coverage
• Turning age 60 or 65 and needing new Medicare coverage
• Life events like marriage, birth, and adoption qualify new family members
• Moving and needing to change regional providers/plans

The TRICARE website explains all eligibility scenarios and walks through using online portals or paper forms for enrollment. Enrolling your veteran loved one in TRICARE for the first time is simple. There are three main ways to get started:

1. Online: Head to milConnect, a secure website for military families. You'll need a Common Access Card (CAC), MyPay account, or DoD Self-Service Logon to access it.
2. Phone: Call your regional TRICARE contractor to connect and apply. 
3. Mail/Fax: Download the enrollment form from the TRICARE website and mail it to the designated address, or fax it if you prefer.

Have your loved one's military ID number and other basic medical and financial information handy. With a few clicks, calls, or a trip to the mailbox, unlock valuable healthcare benefits for your care recipient.

Renewal

If beneficiaries do not wish to change their current TRICARE coverage, no action is required to maintain their existing plan. Still, it's important for beneficiaries and family caregivers to review their health care needs annually to decide if their current plan effectively meets those needs.

Outside of the Open Season, changes to TRICARE coverage can only be made following a Qualifying Life Event (QLE), such as moving to a new location, experiencing a change in family status (e.g., marriage, birth, divorce), or retiring from active duty.

To stay updated on the exact dates for the TRICARE Open Season and any changes to the enrollment process, it's advisable to check the official TRICARE website or contact TRICARE customer service directly. 

How Medicare, TRICARE, and Medicaid interact

An individual can be covered by Medicare, Medicaid, and TRICARE simultaneously. This situation can provide a comprehensive coverage network, ensuring broad protection across various healthcare needs. Here's how each program interacts and supports beneficiaries in such scenarios:

Medicare

Medicare is a federal health insurance program primarily for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). Medicare is divided into parts:

• Part A (hospital insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
• Part B (medical insurance) covers certain doctor services, outpatient care, medical supplies, and preventive services.
• Part D provides prescription drug coverage.

Medicaid

Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is administered by states, according to federal requirements. It covers a broad range of services, including many that may not be covered by Medicare, like nursing home care and personal care services.

TRICARE

TRICARE is the health care program for uniformed service members, retirees, and their families. TRICARE provides comprehensive coverage for a wide range of medical services, including healthcare plans, prescriptions, dental plans, and programs for special needs.

How they work together

• TRICARE and Medicare: When you have both TRICARE and Medicare, Medicare typically serves as the primary payer for Medicare-covered services, and TRICARE may act as a secondary payer that can cover Medicare's co-insurance and deductibles. Individuals with TRICARE who become eligible for Medicare must enroll in Medicare Parts A and B to maintain their TRICARE coverage. TRICARE for Life (TFL) is a Medicare wraparound coverage for TRICARE beneficiaries with Medicare Parts A and B.
• Medicaid as the payer of last resort: For those who are covered by Medicare, Medicaid, and TRICARE, Medicaid generally pays last after Medicare and TRICARE have paid their portions. This means that Medicaid can cover additional costs, such as co-pays or services that are not fully covered by Medicare and TRICARE.

All three—Medicare, Medicaid, and TRICARE—can almost wholly cover an individual's healthcare costs, from hospital stays and doctor visits to prescriptions and potentially long-term care. 

However, navigating the coordination of benefits between these programs can be complex. We recommend that beneficiaries in this situation seek guidance from each program and possibly consult with a healthcare advocate or social worker to understand how to maximize their benefits across these programs effectively.