07 Feb How to Get the Most Out of Your TRICARE Benefits
Getting the most out of your TRICARE benefits means saving money and taking care of your health. The problem is, it’s a big program, with many different plans, regions, and eligibility. There’s a lot to know and do when it comes to enrolling and getting care.
TRICARE is comprehensive medical care for the military. It covers service members, retirees, and family members. TRICARE’s role is to keep the military mission-ready—fit to fight.
I’m going to break down what TRICARE is, who’s covered, the benefits, and how to enroll. Here’s how to get the most out of your benefits.
Table of Contents
What is TRICARE?
It’s the biggest benefit available to those serving the nation. Health care is provided through a combined network of military treatment facilities (MTF) and civilian health care providers. Three contractors manage the networks for each of TRICARE’s regions.
TRICARE falls under the Defense Health Agency (DHA), led by the Military Health System (MHS). And all of those offices fall under the Office of the Secretary of Defense for Health Affairs (OASD (HA)). Don’t worry, there’s not going to be a quiz on that.
Is TRICARE Good Health Insurance
People often ask me if TRICARE is good insurance. The answer is yes, TRICARE is excellent insurance. Of course, nothing is perfect, or one size fits all but in general, TRICARE provides some of the most affordable health care in the U.S.
Who is Covered by TRICARE Insurance?
To be eligible for TRICARE, you must be registered in the Defense Enrollment Eligibility Reporting System—better known as DEERS. If you’re not in DEERS, you’re not getting TRICARE benefits. Your benefits depend on your status. Eligibility to be a TRICARE beneficiary usually is for:
- Service members and their dependents
- National Guard/Reserve members and their dependents
- Former spouses
- Medal of Honor recipients and their dependents
- Dependent parent or ward
More on health: Investing in Your Health
What Are the Types of Health Plans?
There are lots of TRICARE plans. The plan you choose or are eligible for depends on you and your location. There are two types of TRICARE beneficiaries: Group A and Group B.
Group A is for those who started serving before January 1, 2018.
Group B is for those who started serving after January 1, 2018.
TRICARE Prime is the go-to health plan for most military families. It’s a managed care plan and, therefore, the lower-cost option, but you’ll have fewer choices when it comes to providers. With Prime, you’re assigned a Primary Care Manager (PCM) who provides most of your health care. If you need to see a specialist, they’ll refer you.
There are other Prime options: Prime Remote, Prime Overseas, Prime Remote Overseas.
Is TRICARE Free For the Military?
Another question people ask is if TRICARE is free for the military. Yes, TRICARE Prime is free for service members, and in most cases, it’s free for family members. When dependents use a point-of-service option, there’s a cost unless you have a referral. If you’re on active-duty, you have to enroll in Prime—it’s your only option—but it’s at zero cost.
There are costs and fees for other plans. Read below to learn more about their costs.
TRICARE Select is the plan my family is on. We’ve used it ever since our first son was born. At the time, it was known as TRICARE Standard. Select has since replaced both TRICARE Standard and Extra. We selected it to have more provider options during my pregnancy since I wasn’t living near a military installation.
TRICARE Select is a fee for service plan which allows you to pick your preferred provider. In most cases, you don’t need a referral to schedule appointments with a TRICARE-authorized provider. You just call and make an appointment.
With the Select plan, you pay an annual outpatient deductible and cost shares for visits. Your deductible cost depends on your duty status and rank. For retirees, there’s a yearly enrollment fee. The amount depends on whether you’re in Group A or B.
What is TRICARE For Life?
TRICARE for Life is health coverage for retirees eligible for Medicare Part A and B. It’s wraparound coverage meaning that TRICARE pays after Medicare if you live in the U.S. If you’re overseas, TRICARE pays first. Your enrollment into TRICARE for Life is automatic once you start Medicare.
You don’t pay enrollment fees with the Life plan, but you have to pay Medicare Part B monthly premiums.
What is TRICARE4u?
TRICARE4u is an online resource portal for TRICARE for Life beneficiaries and providers. Through the hub, you can view your claims, review benefits, and update your information.
Reserve Select is a premium plan for Reserve members and their families. Under this plan, you pay monthly premiums, an annual deductible, and cost shares. You’re not eligible if you’re on active-duty orders, are covered by the Transitional Assistance Management Program (TAMP), or the Federal Employees Health Benefits (FEHB) program.
The Retired Reserve plan is for Reserve members and their families that have a non-regular retirement and are under the age of 60.
TRICARE Young Adult (TYA)
Young Adult is a plan available for qualifying adult children to purchase after the typical coverage ends. Typically, coverage ends when turning 21, or if you’re in college, it’s 23 years old. TYA is available in both Prime and Select plans.
To qualify, you must be between the ages of 21-26, not married, and not eligible for other TRICARE or employer health care. The coverage cost depends on the plan you choose, your sponsor’s duty status, and your medical care received. You can find an example of how Young Adult TRICARE works in this Military Money Show episode.
TRICARE Plus is for dependent parents or parents in law. The plan allows the beneficiary to receive care at military hospitals or clinics at zero cost. Whether or not TRICARE Plus is accepted at a hospital is up to that particular hospital. You have to call to find out. If the provider refers a patient off post for specialty care, TRICARE does not pay for that expense.
You can use TRICARE’s comparison tools to review each of the plans side-by-side. Then you can pick the best plan to fit your budget and health care needs. The comparison tool.
How Do I Know Which TRICARE Plan I’m On?
If you don’t know which plan you’re enrolled in, you can either call the contractor for your region or log into your DEERS account.
Cost and Fees for 2021
Your costs and fees will depend on the plan you’re on and your duty status. You can download their cost and fees sheet to find your plan costs. The 2021 costs and fees sheet.
What are the TRICARE Regions?
TRICARE is broken down into three regions—East, West, and Overseas—and is run by three separate contractors. Each of the contractors administers TRICARE’s health plans, pharmacy, and dental benefits.
You can find a provider and get assistance through the contractor for the region you’re currently located in.
TRICARE East – Humana
Humana Military runs the East region. In the past, there was TRICARE South and North, but they merged to form what is now the East Region.
Tricare West – Health Net
Health Net runs the second U.S. region, which is the West Region.
TRICARE Overseas – International SOS
International SOS runs TRICARE Overseas. The overseas programs are broken down into three international regions: Eurasia-Africa, Latin American and Canada, and Pacific.
What TRICARE Covers
Most primary, preventative, and hospital care are covered. The quickest and most accurate way to find out what’s covered under your plan is to use TRICARE’s search feature. You can search by keyword or category of care to find if your treatment or care is covered. Additionally, you can review what care is excluded. TRICARE’s covered services search.
TRICARE does not cover treatment and services that aren’t medically necessary. There is no coverage for things like acupuncture, LASIK, hair removal, or your gym membership by any plan.
Dental and Vision Coverage
Eligibility for dental and vision coverage depends on your duty status and your plan.
For active-duty members and activated Guard and Reserve members, you’re covered under active-duty benefits. If you’re a family member of active duty, then you fall under the TRICARE Dental Program. Guard and Reserves members that are not activated can also enroll in the TRICARE Dental Program. Retirees are eligible for coverage under the Federal Employees Dental and Vision Insurance Program (FEDVIP).
Eligibility for vision coverage depends on your duty status, age, and plan. Vision is covered under FEDVIP for family members of active duty, Guard, and Reserve members. It’s also available for retirees and their dependents.
The coverage and cost of vision depend on the plan you select. Most of the vision plans cover eye exams, glasses, or contacts.
The pharmacy contractor, Express Scripts, runs TRICARE’s pharmacy program. The program is intended to meet the medication needs of TRICARE beneficiaries. There are three ways to get your prescriptions filled: a military pharmacy, Express Scripts home delivery, and a retail network pharmacy.
To find out what prescriptions are covered, costs, and pharmacy locations, you can search via their formulary search tool. Express Scripts also has a mobile app. You can manage your prescriptions right from your phone.
TRICARE or the VA
There’s already a lot to know when it comes to your benefits. When you throw in the Veterans Administration (VA) into the mix, it can get a little confusing. Here are the high points.
VA facilities are also network providers for TRICARE. Active duty, Guard and Reserve members can receive emergency care at VA facilities without a referral. If it’s not an emergency, you need authorization from your PCM for care.
For members separating from the military, you qualify for benefits while you transition for 180 days through TAMP. If you retire, you can use VA and TRICARE benefits together. The VA handles service-connected conditions, and TRICARE covers the rest.
How to Enroll in TRICARE Benefits
Each of the plans has its own enrollment process, but you will need first to pick your plan and then fill out the application for most. If you choose Prime, you’ll also need to select a PCM. If it’s applicable, you’ll pay the enrollment fee when you apply. Active duty and family members do not pay an enrollment fee.
You can enroll in three ways: online at milConnect, phone, or by mail unless you live overseas. Then you can only enroll by phone, mail, or at a Service Center.
What is TRICARE Open Season/Enrollment?
Open Season is the annual period you can enroll or change your Prime or Select health plan. If you don’t want to change your plan, you don’t need to take any action. If you do want a different plan, you need to mark your calendar for the fall of 2021—unless you have a Qualifying Life Event (QLE).
A QLE is a change in your life or family that allows you to make changes to your health plan. QLEs are marriage, new baby, divorce, or retirement. Whenever you have a QLE, you first complete the change in DEERS. Then you can go online or call to change your enrollment.
Open Season doesn’t apply to TRICARE for Life or any of the premium-based plans. The change to TRICARE Life is automatic with Medicare. Under any of the premium-based plans, you can change your enrollment at any time.
MHS GENESIS and TRICARE Online
TRICARE Online Patient Portal (TOL) is currently being phased out and replaced with MHS GENESIS. While some areas in the Pacific Northwest have already made the switch, other regions will phase in MHS GENESIS by 2023.
TOL is the secure patient portal available to service members, retirees, and their dependents. The portal allows TRICARE beneficiaries to manage health care at their military hospitals and clinics. It also gives 24/7 access to your health care information.
With TOL, you can:
- Make and reschedule appointments
- Get appointment reminders
- Secure communication with your providers
- Mange prescription refills
- View lab results
- Mobile app access
The new patient portal for service members, retirees, and family members is MHS GENESIS. It works similar to TOL in that it’s a secure platform to manage your health care. One key difference is MHS GENESIS includes your dental care.
It will provide seamless care for service members on active duty and during transitions to separation or retirement.
With MHS GENESIS, you can:
- View, download, and transmit your health data
- Make and reschedule appointments
- Manage prescription refills
- Secure communication with your providers
- View lab results
As of now, MHS GENESIS is only available in Alaska, California, Idaho, Nevada, and Washington. If you’re in an area that currently uses GENESIS but PCS to a location where they are not using it, you will go back to TOL.
Telemedicine is a TRICARE benefit you’re able to use to get fast doctor care from the comfort of your home. There are two telemedicine platforms you can use.
Doctor on Demand
If you’re not feeling well like a cold or flu, you can use Doctor on Demand to video visit with a doctor 24/7.
Right now, Doctor on Demand is a pilot program and because of that, it’s not available to active-duty service members.
Telemynd provides care from behavioral health specialists if you’re dealing with stress, anxiety, or any other issue you need to talk with someone about. They offer behavioral health services, psychology, and psychiatry.
Active-duty service members need a referral to use Telemynd but family members do not.
To find the right phone number, address, or search FAQs, you can find them all via their Contact Us page. You can contact and get more information from the regional contractors below.
Humana Military (East Region)
You can contact them by phone at 1-800-444-5445 or their website at https://www.humanamilitary.com/beneficiary.
Health Net (West Region)
You can contact them by phone at 1-844-866-9378 or their website at www.tricare-west.com.
Overseas (International SOS)
Each of the region’s contact and support information can be found here.
You can also stay up-to-date on any changes to TRICARE by reviewing their changes webpage or by signing up for email alerts.
Here’s the Bottom Line
TRICARE health care is a major benefit to serving the service members and their family members. Knowing the plans you’re eligible for, what’s covered, and how to enroll, will help you make the most out of your benefits in a way that works for your health care needs.
If you want to “kickstart” your finances in the military, you can get access to my free Financial Kickstart Kit here.
Featured image by Petty Officer 1st Class Jacob Sippel