Your Free Guide to TRICARE

Your Free Guide to TRICARE

What is TRICARE? 

TRICARE is a comprehensive health care program available to uniformed U.S. military and service members, retired U.S. military and service members, and their families. TRICARE offers a variety of free or low-cost health coverage plans, each designed to fit the unique needs of qualifying beneficiaries. Depending on military status, age, and other qualifying factors, beneficiaries may be eligible for one or more of the following health insurance plans:

• TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
• TRICARE Select
  • TRICARE Select Overseas
• TRICARE Reserve Select
• TRICARE Retired Reserve
• TRICARE for Life
• TRICARE Young Adult
  • TRICARE Young Adult Prime
  • TRICARE Young Adult Select
• U.S. Family Health Plan  

To learn more about each of these plans, refer to TRICARE Plans. 

Basic TRICARE Eligibility

TRICARE eligibility requirements vary based on the type of TRICARE health care plan and the beneficiary’s military status. But, there are general guidelines all applicants must meet in order to enroll in any available plan. 

To become a beneficiary of any TRICARE plan, applicants must identify as one or more of the following:

• A uniformed service member
• A member of the National Guard or the Reserve
• A retired U.S. military member
• A family member of a current or retired military, National Guard or Reserve member
• A dependent parent or parent-in-law of an active-duty military member
• A former spouse or child of a deceased active-duty military member 
• A survivor of a deceased active-duty military member
• A medal of honor recipient or a family member of one such individual 

For more information about eligibility for each type of TRICARE plan, refer to Eligibility for TRICARE by Military Status.

TRICARE Program Contact Information

If you have questions about TRICARE plans, eligibility, and more, contact one of the phone numbers below for more information. Note that the number you should contact will be based on your location and specific TRICARE plan. 

Provider/Agency	Phone Number
TRICARE East Provider: Humana Military Coverage in Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin	1 (800) 444-5445
TRICARE West Provider: Health Net Coverage in Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excludes Rock Island arsenal area), Kansas, Minnesota, Missouri (except St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (southwestern corner including El Paso), Utah, Washington and Wyoming	1 (844) 866-9378
TRICARE Overseas Provider: International SOS	Find country-specific phone numbers here: https://www.tricare-overseas.com/contact-us
TRICARE For Life Provider: WPS-Military and Veterans Health	1 (866) 773-0404
Active Duty Dental Program Provider: United Concordia	1 (866) 984-2337
TRICARE Dental Program Provider: United Concordia	1 (844) 653-4061
TRICARE Pharmacy Program Provider: Express Scripts, Inc.	Stateside: (1) 877-363-1303 Overseas: (1) 866-275-4732 (where toll-free service is established)
USFHP – Brighton Marine Health Center	1 (800) 818-8589
USFHP – CHRISTUS Health	1 (800) 678-7347
USFHP – Johns Hopkins Medicine	1 (800) 808-7347
USFHP – Martin’s Point Health Care	1 (888) 241-4556
USFHP – Pacific Medical Centers (Pacmed Clinics)	1 (888) 958-7347
USFHP – St. Vincent Catholic Medical Centers	1 (800) 241-4848
Continued Health Care Benefit Program	(1) 800-444-5445
Military OneSource	(1) 800-342-9647
Eurasia-Africa Area Coverage in European and African continents, all Middle Eastern countries, Pakistan, Russia and several former Soviet Republics. This includes Baltic States, Ukraine, Georgia, Kazakhstan, Kyrgyzstan and Uzbekistan	Find country-specific phone numbers here: https://www.tricare-overseas.com/contact-us/eurasia-africa
Latin America & Canada Area Office	Find country-specific phone numbers here: https://www.tricare-overseas.com/contact-us/latin-america-canada
Pacific Area Coverage in Guam, Japan, Korea, Asia, Australia, New Zealand, India and Western Pacific remote countries	Find country-specific phone numbers here: https://www.tricare-overseas.com/contact-us/pacific

TRICARE Plans

TRICARE offers a variety of health insurance plans for military members, retirees and families that provide free or low-cost medical care. Plans differ in eligibility criteria, services and costs. 

TRICARE Prime

TRICARE Prime is the primary health care plan for all active duty service members and their families. Beneficiaries enrolled in Prime are assigned a Primary Care Manager (PCM), which is a doctor or other health care professional who provides the majority of their health care. The PCM is either affiliated with the military health care system or an in-network provider.

For more information about network providers, refer to After Enrolling in TRICARE.

TRICARE Prime is only available to active duty members younger than 65 years of age and their live-in family members who reside in a Prime Service Area, which is a geographic region in the United States where TRICARE Prime coverage is available. These are areas that have a military base or facility.

Active duty service members who do not qualify for TRICARE Prime due to their location may qualify for one or more alternate versions. There are three versions of the Prime insurance plan that extend coverage to members residing outside of a Prime Service Area: 

• TRICARE Prime Remote
• TRICARE Prime Overseas
• TRICARE Prime Remote Overseas

Active duty beneficiaries pay nothing out of pocket to receive health care services with any Prime plan, including Prime Remote, Prime Overseas and Prime Remote Overseas. To learn more about the costs for family members and other military personnel, refer to TRICARE Costs.

TRICARE Prime Remote

TRICARE Prime Remote is available to active duty service members, activated Guard or Reserve members, and live-in family members residing in remote areas of the United States. To qualify for Prime Remote, active duty service members must live either:

• 50 miles away from a military hospital or clinic, OR 
• A one-hour driving distance away from a military hospital or clinic. 

TRICARE Prime Remote beneficiaries receive all the same benefits and coverage options provided through TRICARE Prime. 

TRICARE Prime Overseas

TRICARE Prime Overseas is the health plan for active duty service members, activated Guard or Reserve members, and their live-in family members stationed overseas. Like TRICARE Prime, a PCM provides the majority of health care services. 

TRICARE Prime Overseas beneficiaries receive all the same benefits and coverage options provided through TRICARE Prime.

TRICARE Prime Remote Overseas

TRICARE Prime Remote Overseas is the health plan for active duty service members, activated Guard or Reserve members, and their live-in family members stationed overseas in remote areas of the following regions:

• Eurasia
• Africa
• Latin America
• Canada
• Pacific

TRICARE Prime Remote Overseas beneficiaries receive all the same benefits and coverage options as TRICARE Prime.

TRICARE Select

TRICARE Select is a fee-for-service health care plan, which means beneficiaries are responsible for paying certain health care-related costs. To learn more about TRICARE Select plan costs, refer to TRICARE Costs.

TRICARE Select is available to the following individuals within the U.S.:

• Non active duty military personnel and their families
• Family members of active duty military personnel
• Retired service members and their families
• Family members of activated National Guard or Reserve members
• Retired Guard or Reserve members age 60 or older and their families 
• Survivors (dependents of deceased veterans)
• Medal of Honor recipients and their families 
• Qualified former spouses

When beneficiaries who are enrolled in TRICARE Select get called to active duty or become activated, TRICARE Select benefits are paused while TRICARE Prime benefits take over. This plan is only offered to individuals residing in the continental United States. TRICARE Select can be used as a supplement to other health insurance plans, especially for non active duty members residing in remote areas of the U.S. 

In this plan, beneficiaries are allowed to choose any TRICARE-authorized network provider to provide medical care. They do not need referrals for services. They may choose to see an out-of-network provider – a doctor or specialist that does not have an agreement with TRICARE – but their costs will increase. For more information, see Network vs. Non-Network Providers.

TRICARE Select Overseas

This health care plan is available to the following individuals outside of the U.S.:

• Non active duty military personnel and their families
• Family members of active duty military personnel
• Retired service members and their families
• Family members of activated National Guard or Reserve members
• Retired Guard or Reserve members age 60 or older and their families 
• Survivors 
• Medal of Honor recipients and their families 
• Qualified former spouses

TRICARE Select Overseas offers the same coverage options as TRICARE Select. It is available in all overseas locations. 

TRICARE Reserve Select

TRICARE Reserve Select is a premium health plan that is only available to members of the Selected Reserve and their qualifying family members. The Selected Reserve is a group of Army Reserve soldiers who are the first members to get called to active duty.

To qualify for coverage through this plan, members must currently be inactive (not on active military orders) and not receiving Transitional Assistance Management Program (TAMP) benefits and not enrolled in the Federal Employees Health Benefits (FEHB) program. Learn more about TAMP in TRICARE Special Programs.

Beneficiaries may choose to visit in-network health providers for the lowest cost options. They may seek medical services from out-of-network doctors, but will be subject to higher costs. For more information, see Network vs. Non-Network Providers. Referrals are not required for service. 

Some services may require prior authorization from the in-network provider. For more information, see TRICARE Referrals and Prior Authorizations.

TRICARE Retired Reserve

The TRICARE Retired Reserve health care plan is available to retired members of the Reserve branches and their qualifying family members. Beneficiaries can enroll in this plan as soon as they retire from service and receive coverage until they reach 60 years of age, after which they must choose another form of health coverage. 

TRICARE Retired Reserve is similar to the TRICARE Reserve Select plan, but is only available for retirees of the Reserves younger than 60 years of age. TRICARE Retired Reserve coverage automatically terminates once a retiree turns 60 and begins receiving retirement pay.

Through this plan, beneficiaries can seek medical care through in-network or out-of-network providers. Referrals for services are not required, but some procedures may require prior authorization from a primary health care provider. For more information, see TRICARE Referrals and Prior Authorizations.

TRICARE for Life 

TRICARE for Life is a Medicare-wraparound plan, which means it provides benefits and covers services that may not be covered by Medicare. To qualify for this plan, beneficiaries must:

• Be 65 years of age or older or have a qualifying disability, and
• Have Medicare Part A and Part B coverage, and
• Pay Medicare Part B premiums.

TRICARE for Life provides health care services in the United States and abroad. Those who meet the basic eligibility requirements for this plan above and have Medicare Part A and Medicare Part B coverage are automatically enrolled. 

TRICARE for Life beneficiaries can seek medical services from any authorized health care provider around the world. Services may be covered by Medicare, TRICARE, both programs or neither program. The costs associated with services depend on which program covers them. To learn more about TRICARE for Life costs, refer to TRICARE Costs.

TRICARE Young Adult 

TRICARE Young Adult is available to adult children of uniformed service members who have aged out of other TRICARE coverage. In most TRICARE plans, children age out of coverage upon reaching 21 years of age, or 23 years of age if they enrolled full-time in a college or university. TRICARE Young Adult is available to those who are at least 21, but not yet 26 years of age. To qualify, beneficiaries must not be eligible to enroll in any employer-sponsored health insurance plans on their own.

This health care plan is offered in two versions:

• TRICARE Young Adult Prime
• TRICARE Young Adult Select     

TRICARE Young Adult Prime

This version of TRICARE Young Adult is available to the following individuals:

• Adult children of active duty military members stationed anywhere in the world
• Adult children of retired military members residing only in Prime service areas 

Under this plan, beneficiaries receive the same coverage as TRICARE Prime. They receive their medical care from an assigned primary care manager (PCM) who oversees their medical services at a military health care provider. 

TRICARE Young Adult Select

This version of TRICARE Young Adult is available to all adult children who qualify for the Young Adult plan. Under this plan, beneficiaries receive the same coverage as TRICARE Select, which means they can choose a health care provider from in-network or out-of-network. Prior authorization may be required when seeing an out-of-network doctor.

U.S. Family Health Plan

This health care plan is available in six areas of the U.S. It is a not-for-profit, community-based health care system that provides primary medical care to those who live in a designated Family Health Plan Area and fall into one of the following categories:

• Family members of active duty military members
• Retired military members and their families
• Family members of the following groups:
  • Army National Guard
  • Army Reserve
  • Navy Reserve
  • Marine Corps Reserve
  • Air National Guard
  • Air Force Reserve
  • U.S. Coast Guard Reserve
• Non-activated members of the above branches, as well as their families, who are eligible for care under the Transitional Assistance Management Program
• Retired National Guard/Reserve members who are at least 60 years old, as well as their families
• Survivors (dependents of deceased veterans)
• Military members who have received the Medal of Honor, and their families
• Former spouses who are eligible 

The chart below provides information about these designated areas, corresponding care facilities and contact information.

Family Health Plan Area	Health Care Provider
– Maryland – Washington D.C. – Parts of Pennsylvania – Virginia – Delaware – West Virginia	Johns Hopkins Medicine 1-800-808-7347
– Maine – New Hampshire – Vermont – Upstate and Western New York – Northern Tier of Pennsylvania	Martin’s Point Health Care 1-888-241-4556
– Massachusetts, including Cape Cod – Rhode Island – Northern Connecticut	Brighton Marine Health Center 1-800-818-8589
– New York City – Long Island – Southern Connecticut – New Jersey – Philadelphia and area suburbs	St. Vincent Catholic Medical Centers  1-800-241-4848
– Southeast Texas – Southwest Louisiana	CHRISTUS Health 1-800-678-7347
Western Washington State Most of Central and Eastern Washington State Northern Idaho Western Oregon Most of California	Pacific Medical Centers (Pacmed Clinics)  1-866-418-7346

Under this plan, beneficiaries receive medical care from a primary care provider of their choice. They may choose from the network of private physicians affiliated with one of the not-for-profit health care systems above.

Eligibility for TRICARE by Military Status

The TRICARE health coverage plans for which military members qualify depend on their military status.

Active Duty Eligibility

Active duty military personnel are eligible for the following TRICARE plans:

• TRICARE Prime
• TRICARE Prime Remote
  • This plan is for members who are stationed in the United States and are located more than one hour away from a military hospital or clinic.
• TRICARE Prime Overseas
• TRICARE Prime Remote Overseas
  • This plan is for members who are stationed overseas in Eurasia, Africa, Pacific Regions, Latin America or Canada. It is based on proximity to a military hospital or clinic. 
• TRICARE Active Duty Dental Program

Family members of active duty military personnel can also receive coverage through TRICARE. They may be spouses or children of an active duty servicemember. They are eligible for the following TRICARE plans:

• TRICARE Select
• U.S. Family Health Plan
• TRICARE For Life 
• TRICARE Select Overseas
• TRICARE Young Adult (dependent adult children only)
• TRICARE Dental

National Guard and Reserve Eligibility

TRICARE eligibility and coverage options for National Guard and Reserve members depend on their status. These types of military members fall into one of four categories:

1. Inactive
2. Activated
3. Deactivated
4. Individual Ready Reserve (IRR) Members

Inactive Members

National Guard and Reserve members are inactive when they are on duty for 30 days or less, performing annual training or performing inactive duty through weekend drills. They are only eligible for the following plans:

• TRICARE Reserve Select
• Line of Duty Care
  • Coverage for an injury, illness or disease received in the line of duty, including traveling to and from the place of duty.

Activated Members

National Guard and Reserve members are activated when they are called to service for more than 30 days. They qualify for the following TRICARE plans:

• TRICARE Prime
• TRICARE Prime Remote
• TRICARE Prime Overseas
• TRICARE Prime Remote Overseas
• TRICARE Active Duty Dental Program

Family members of activated National Guard and Reserve members qualify for the following TRICARE health plans beginning on the first day of the member’s military duties:

• TRICARE Prime
• TRICARE Prime Remote
• TRICARE Prime Overseas
• TRICARE Prime Remote Overseas
• TRICARE Select
• TRICARE Select Overseas
• U.S. Family Health Plan
• TRICARE Young Adult

Deactivated Members

National Guard and Reserve members are deactivated after leaving active duty military service. When deactivation occurs, members and their families may experience a change in their health care coverage. These changes depend on the reason for activation, which can be:

• Due to a pre-planned mission, or
• Due to supporting a contingency operation (a Secretary of State-designated military operation).

Once they finish active duty and are deactivated, they fall under a transitional period and receive 180 days of continued health care coverage through the Transitional Assistance Management Program (TAMP). This program provides health coverage while National Guard and Reserve members find a new health care plan that fits their needs. TAMP is only available to members who are called to active duty due to one of the reasons listed above. 

TAMP begins the day after active duty service ends. Once TAMP ends, members and their families can choose to purchase TRICARE Reserve Select. Learn more about TAMP in the section called TRICARE Special Programs.

Members who were activated for reasons outside of a preplanned or contingency mission do not qualify for TAMP. Instead, they can immediately purchase TRICARE Reserve Select, the Continued Health Care Benefit Program or any other health insurance plan. 

Individual Ready Reserve (IRR) Members

IRR members are trained soldiers who may be called upon to replace soldiers in active duty and Army Reserve units. They are eligible to enroll in the TRICARE Dental Program. They typically do not qualify for any other TRICARE plans.

Eligibility for Retired Service and Reserve Members

Retired military service members, retired reserve members and their families qualify for TRICARE coverage depending on the member’s service type and age. 

Retired Service Members

Retired military service members and their families qualify for the following TRICARE health coverage plans:

• TRICARE Prime
• TRICARE Select
• U.S. Family Health Plan
• TRICARE for Life (with Medicare Parts A and B)
• TRICARE Select Overseas 
• TRICARE Young Adult
  • For children of retired service members who may have aged out of other TRICARE plans.

Medically retired service members who are officially placed on the Temporary Disabled Retirement List (TDRL) are also eligible for these plans for as long as they remain on the TDRL. 

To qualify for the TDRL, beneficiaries must have:

• A physical condition, injury or disease that disqualifies them from military service, AND
• A disability rating of at least 30 percent issued from a professional in the Department of Veterans Affairs (VA).
  • A disability rating is a percentage that represents how much the  disability decreases the service member’s overall health and ability to function. The higher the percentage, the more severe the disability. The VA determines this percentage based on:
    • Evidence provided by a doctor’s report or medical test results
    • Results of a VA claim exam (also called a compensation and pension, or C&P, exam), if necessary
    • Other information from federal agencies

Retired Reserve Members – Younger Than 60

Retired Reserve members who are younger than 60 years of age can purchase TRICARE Retired Reserve, a premium paid-for health care option. 

If they have adult children who age out of coverage at 21 years of age (or 23 if attending college), they may qualify to purchase TRICARE Young Adult.

Retired Reserve Members – 60 Years or Older

Once they turn 60 years of age, retired Reserve members and their families automatically qualify for all the same coverage options as retired service members, which are:

• TRICARE Prime
• TRICARE Select
• U.S. Family Health Plan
• TRICARE for Life (with Medicare Parts A and B)
• TRICARE Select Overseas 

Dual Eligibility for TRICARE and Medicare

Some individuals may qualify for both TRICARE and Medicare, and there are rules that they must follow to remain eligible for both types of coverage.

Medicare for servicemembers has two main parts:

• Part A: hospital insurance with no premium
• Part B: medical insurance with a monthly premium

Individuals who qualify for Medicare Part A must also have Medicare Part B coverage in order to remain eligible for TRICARE, except for the following individuals:

• Active duty service members and their families 
• Beneficiaries enrolled in TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult or the U.S. Family Health Plan

All others must adhere to this rule to avoid penalties. TRICARE beneficiaries who only held Medicare Part A coverage will not have their disability claims paid by TRICARE. Any payments that were mistakenly made on behalf of a beneficiary during a time he or she did not have Part B coverage can be reclaimed by TRICARE. 

Eligibility for Survivors and Children

Survivors of Deceased Active Duty Members

Survivors (also referred to as former spouses) of deceased active duty service members receive transitional health coverage for a period of three years after the death of the service member. During this transitional period, health coverage remains the same as whatever was in place prior to the death of the service member. 

After three years, survivors become covered by TRICARE as a “retired sponsor family member” and are eligible for the following TRICARE health coverage plans:

• TRICARE Prime
• TRICARE Select
• TRICARE Select Overseas
• U.S. Family Health plan
• TRICARE For Life

Children of Deceased Active Duty Members

Children of deceased active duty service members remain covered through the active duty TRICARE plan that was in place prior to the death of the service member, until they age out at 21 years of age. Children enrolled in college do not age out of coverage until they reach 23 years of age. 

Survivors and Children of Deceased National Guard or Reserve Members 

When a National Guard or Reserve member dies while on active duty, his or her spouse and children remain covered by the TRICARE plan that was in place prior to the death. The length of time for which coverage is extended depends on the plan.

If the family member was covered under TRICARE Reserve Select on the day of the member’s death, he or she is eligible for an additional six months of coverage under the same plan. 

If the National Guard or Reserve member died while covered by the Transitional Assistance Management Program (TAMP), the family member qualifies for TAMP coverage for a period of 180 days.

Other Groups With Eligibility for TRICARE

TRICARE coverage is extended to a variety of other groups, namely:

• Medal of Honor recipients and their families
• Dependent parents and in-laws
• Foreign Force Members
• Victims of abuse 

Medal of Honor Recipients

Medal of Honor recipients and their families qualify for several TRICARE coverage plans based on their military status/location. Recipients who are still serving on active duty qualify for the following health care plans:

• TRICARE Prime
• TRICARE Prime Remote
• TRICARE Prime Overseas
• TRICARE Prime Remote Overseas
• TRICARE Select
• U.S. Family Health Plan
• TRICARE For Life 
• TRICARE Select Overseas
• TRICARE Young Adult (dependent adult children only)

Recipients who have separated from military service or are retired from active duty (along with their family members) qualify for the following plans:

• TRICARE Prime
• TRICARE Select
• U.S. Family Health Plan
• TRICARE for Life (with Medicare Parts A and B)
• TRICARE Select Overseas 

Dependent Parents and Parents-in-Law

Dependent parents and parents-in-law of active duty service members qualify for TRICARE Plus as long as the service member is on active duty for 30 days or longer. As TRICARE beneficiaries, they are eligible to fill their prescriptions at military pharmacies and receive care in military hospitals.

Foreign Force Members

The following Foreign Force Members and their families can receive medical care at military hospitals or from civilian TRICARE providers in the United States:

• Citizens of NATO-affiliated (North Atlantic Treaty Organization) countries
• Citizens of countries part of the NATO Status of Forces Agreement (SOFA)
• Citizens of countries part of the Partnership for Peace Agreement (PFP)
• Citizens of countries part of the Reciprocal Health Care Agreement

To qualify, they must be in the United States on military orders and registered in the Defense Enrollment Eligibility Reporting System (DEERS). To learn more about DEERS, refer to the section called What Is the Defense Enrollment Eligibility Reporting System (DEERS)?

Victims of Abuse

Victims of abuse from active duty service members may also qualify to receive health coverage. When the active duty member separates from military service, victims are eligible to receive Transitional Compensation (TC) from the Department of Defense (DoD) for a period of 12 to 36 months. These monthly payments help victims get back on their feet after leaving an abusive relationship. Additionally, victims can receive care at military base facilities and military hospitals.

Family members who qualify are covered as “active duty family members” and qualify for the following plans:

• TRICARE Select
• U.S. Family Health Plan
• TRICARE For Life 
• TRICARE Select Overseas
• TRICARE Young Adult (dependent adult children only)
• TRICARE Dental

They are also eligible for the Extended Care Health Option (ECHO) if they have a qualifying medical condition. Learn more about ECHO in the section called TRICARE Coverage Extensions.

How to Enroll in TRICARE

Enrolling in TRICARE involves determining your eligibility, choosing a health insurance plan and registering in the online system. 

How to Find the Correct TRICARE Plan 

Finding the correct TRICARE plan is the first step toward receiving benefits. There are several plans available to you, depending on the following factors:

• Your military status
• Your relationship to a military member (if you are a family member)
• Your age
• Your location

You can view a list of all the TRICARE plans for which you qualify by using the TRICARE Plan Finder tool. You will be prompted to provide a variety of personal and military service-related information. The tool uses your responses to calculate your eligibility for TRICARE.

The first step is to identify your status. If you are a military member, you are known as a “sponsor” in the TRICARE system. Sponsors can be active duty, inactive, deactivated or retired military personnel. 

If you are not a sponsor, you will need to identify your relationship to the sponsor. For purposes of finding a TRICARE plan, you must identify as one of the following:

• Spouse
• Child
• Dependent parent or parent-in-paw
• Ex-spouse
• Surviving spouse
• Surviving child

Once you determine your relationship to the sponsor (or if you are the sponsor yourself), you will need to proceed through the Plan Finder and answer questions about the following topics:

• The sponsor’s military service type
• The sponsor’s length of service
• Your age
• Information about marriage (for spouses, ex-spouses or surviving spouses)
• Information about the sponsor’s service-connected disability (if medically retired)
• Information about the sponsor’s service-related death (if applicable)

Steps to Enroll in a TRICARE Plan

Once you have determined the TRICARE plan that is right for you, find it in the sections below and follow the steps outlined to complete enrollment.

1. Choose a Primary Care Manager (PCM) if you are enrolling in any TRICARE Prime plan. You can select either a military or a network provider. 
   • You may be required to choose a military provider if you live within a military clinic’s “enrollment area,” which is a certain radius around the military clinic. Find a military clinic in your area here: https://www.tricare.mil/mtf
   • If you do not need to choose a military provider, you can choose a network provider available in your region (east or west). Refer to TRICARE Program Contact Information for a list of states within each region.
     • Find a network provider in the East Region here: https://www.goperspecta.com/VPD/HumanaMilitary/public/ProviderSearch/Main
     • Find a network provider in the West Region here: https://www.tricare-west.com/content/hnfs/home/tw/bene/provider-directory.html
2. If you do not choose a PCM at the time of enrollment, one will be assigned to you during enrollment. You can always change your PCM at a later date.

Complete the application. Fill out a single application that includes all family members you wish to be covered through TRICARE. You can apply in one of the following ways:

Application Method	How to Apply	When to Apply
Online (only available to those living in a Prime Service Area)	– Visit the milConnect website and log into your account here:  https://milconnect.dmdc.osd.mil/milconnect/. – If you do not have an account, register for one using your Common Access Card (CAC).  – Once logged in, click on the “Benefits” tab, and then click on “Beneficiary Web Enrollment (BWE).”	New enrollment or after a Qualifying Life Event (QLE). Find a list of QLEs here: https://tricare.mil/lifeevents
By Phone	– East Region: Humana Military  1 (800) 444-5445 – West Region: Health Net 1 (844) 866-9378 – Overseas : Call the regional call center in your area. Find a list of call center numbers here: https://tricare.mil/ContactUs/CallUs/OverseasResources  If enrolling in the U.S. Family Health Plan, call 1 (800) 748-7347	New enrollment, Open Season (November 9 – December 14) or after a QLE
By Mail	For TRICARE Prime and Select plans, download, complete and print one of the following enrollment forms: – East Enrollment Form: https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2876-1.pdf  – West Enrollment Form: https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2876-2.pdf  – Overseas Enrollment Form: https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2876.pdf  For TRICARE Reserve or Retired Reserve, download the Reserve Component Health Coverage Request Form, sign it and return it by mail. This form is only available to those who qualify and will be available at the end of the qualification process. Log into your milConnect account here to determine if you qualify to purchase these plans: https://milconnect.dmdc.osd.mil/milconnect/  For the U.S. Family Health Plan, download one of the enrollment forms found here and mail it to the address listed below: https://www.tricare.mil/Plans/Enroll/USFHP  Mail the East Enrollment Form to: Humana Military  P.O. Box 105838 Atlanta, GA 30348-5838 Mail the West Enrollment Form to:  Health Net, LLC P.O. Box 8458  Virginia Beach, VA 23450-8458 Mail the Overseas Enrollment Form to:  International SOS Assistance TOP Prime Enrollments P.O. Box 11520 Philadelphia, PA 19116	New enrollment, Open Season (November 9 – December 14) or after a QLE

3. Send payment for enrollment fees (if applicable). 
   • Include payment for all fees with your enrollment form. Refer to TRICARE Costs section for a list of enrollment fees based on the type of TRICARE plan.

What information will I need to enroll in a TRICARE plan?

During the TRICARE enrollment process, you will need to provide the following information about the military sponsor on the enrollment application:

• Full name
• Date of birth
• Social Security Number (SSN)
• Military status 
• Phone number and email address
• Residential and mailing address
• Military assignment (for Prime plans)

You will also need the following information about each family member you wish to enroll:

• Full name
• Date of birth
• Residential and mailing address (if different from the sponsor)
• Phone number and email address

What documents will I need to enroll in a TRICARE plan?

The documents you will need to provide to enroll in a TRICARE plan are verified during enrollment in the Defense Enrollment Eligibility Reporting System (DEERS) rather than enrollment in a health care plan. For more information about DEERS and to view a list of documents you will need to enroll family members, continue reading the next section.

What is the Defense Enrollment Eligibility Reporting System (DEERS)? 

The Defense Enrollment Eligibility Reporting System (DEERS) is an online government database for military members and their families. All beneficiaries must be enrolled in DEERS in order to receive any TRICARE benefits. Sponsors are automatically registered in DEERS, but they must manually register their family members if they plan to add them to any TRICARE plan.

To add a spouse to DEERS, sponsors will need the following information and documents:

• DD Form 1172: https://www.cac.mil/Portals/53/Documents/dd1172-2.pdf?ver=2020-04-27-093224-893 
• A valid marriage certificate
• The spouse’s birth certificate
• The spouse’s Social Security card
• A valid photo ID for the spouse

To add children, dependent parents or young adults, sponsors will need the following information and documents:

• Two valid forms of ID
• A birth certificate
• A Social Security card
• A marriage certificate (for step-children)
• Letter of full-time enrollment (for young adults enrolled in school)
• DFAS letter of approval (for dependent parents)

After Enrolling in TRICARE

Once enrolled, beneficiaries can begin scheduling appointments and receiving medical services. The first step is to find a TRICARE provider, which depends on the beneficiary’s status and particular TRICARE health plan.

How to Find a TRICARE Provider

You can also find providers in your area by calling your regional office. Find a list of regional phone numbers in the chart provided in TRICARE Program Contact Information.

Network vs. Non-Network Providers

Health care providers can be divided into two categories: network and non-network providers.

Network Providers

A network provider is a business, hospital, pharmacy or doctor that is authorized by TRICARE to provide covered health care services. To be part of the TRICARE network, they must be licensed by a state, accredited by a national organization or meet specific standards of the medical community. TRICARE certifies and authorizes these providers.

TRICARE network providers accept payment from TRICARE in full for any of the covered health care services that you receive. Network providers will never ask you to sign documents requiring you to pay more than your copayment or cost-share portion outlined in your TRICARE plan. More information about copayments and cost-shares can be found in the section called TRICARE Costs.

TRICARE network providers file medical claims on your behalf. They will also submit claims for those who are in the TRICARE Overseas Program (TOP), TOP Prime Remote, and active duty service members on temporary duty or leave. For more information about claims, refer to the TRICARE Claims.

Non-Network Providers

Non-network providers are still authorized by TRICARE to provide health care services, but they have not signed a contract with TRICARE and are not part of the network. They can be divided into the following categories:

• Participating Non-Network Providers
  • These providers accept TRICARE payment in full and file claims on your behalf, which means you are only responsible for your specific cost-share or copayment (if applicable).
• Non-Participating Non-Network Providers
  • These providers do not accept TRICARE as the full payment and typically do not file claims on your behalf, which means you will be responsible for paying the provider directly. Also, these providers can charge up to 15 percent more than the TRICARE allowable charge, which cannot be reimbursed to you.

How to Book an Appointment With a TRICARE Provider

The steps to schedule an appointment with a TRICARE provider differ based on the type of health plan you have.

TRICARE Prime

If you are enrolled in TRICARE Prime as an active duty or activated Guard or Reserve member, you must call your primary care manager (PCM) first to schedule an appointment. You cannot seek care from another type of provider without first contacting your PCM.

If the PCM cannot provide the service you require, you need a referral from him or her to receive care from another provider. Your PCM will first refer you to a military hospital or a clinic. If the service is still not available at either of these locations, your PCM will refer you to a network provider in your area. Learn more about referrals in TRICARE Referrals and Prior Authorizations.

The process is the same if you are enrolled in TRICARE Prime as a family member or other type of beneficiary. However, you do NOT need a referral for any preventive care or mental health care if you receive services from a network provider in your area.

TRICARE Select, Select Overseas, Reserve Select, Retired Reserve and Young Adult-Select

If you are enrolled in any of these plans, you typically do not need a referral to receive care. You can schedule an appointment with any TRICARE-authorized provider, including both network and non-network. Keep in mind that if you receive care from a non-network provider, you will pay more out-of-pocket. Learn more about network and non-network providers in How to Find a TRICARE Provider.

To find a doctor in your area, use the Find a Doctor Wizard provided on the TRICARE website. The tool will prompt you to enter the type of provider you wish to see, your zip code and other information to match you with providers in your area.

TRICARE For Life

If you have TRICARE for Life, you can schedule an appointment with any TRICARE-authorized provider. However, receiving care from a provider that also participates in Medicare is the lowest-cost and most convenient option. These types of providers will file claims for you and you will pay nothing out-of-pocket.

U.S. Family Health Plan

If you are enrolled in the U.S. Family Health Plan, you can schedule an appointment with any primary care physician from your specific health plan’s provider directory within the member handbook. Refer to U.S. Family Health Plan for participating plan centers and corresponding contact information by area.

Scheduling an Appointment Online

If you are a service member with a TRICARE Online (TOL) account, you can schedule an appointment at a military hospital or clinic online.

You must log in with your Department of Defense (DoD) account. If you do not have an account, you can register for one on the same website with your full name, date of birth and one of the following items of information:

• Department of Defense (DoD) Number
• Social Security Number
• Temporary Identification Number
• Foreign Identification Number
• Tax Identification Number

Once logged in, you can make new appointments, cancel or schedule existing ones and view medical documents. 

TRICARE Coverage Options

TRICARE provides other types of coverage aside from basic health care. Coverage options vary depending on the type of plan. TRICARE plans can provide the following types of coverage:

• Prescription medication coverage
• Dental coverage
• Vision coverage
• Mental health coverage

Prescription Medication Coverage

TRICARE has prescription and pharmacy benefits for many enrollees. In each TRICARE plan, only drugs that are deemed necessary to treat a medical issue are covered. Most medications that are approved by the United States Food and Drug Administration (FDA) can be obtained with TRICARE. 

TRICARE Formulary

You can use the TRICARE Formulary to check if your prescription medications will be covered by TRICARE. The formulary is a list of generic and brand-name drugs that are covered by TRICARE and has information about quantity limits and prior authorizations. 

There are four categories of drugs within the TRICARE Formulary:

1. Generic Formulary – The drugs on this list are generic prescriptions of brand-name versions and are covered in the TRICARE formulary.
2. Brand-Name Formulary – The drugs on this list are provided by brand-name drugmakers and are covered in the formulary.
3. Non-Formulary – The drugs on this list are not included in the formulary but are covered with a higher copayment.
4. Non-Covered – The drugs on this list are not included in the formulary and are not covered at all by TRICARE. 

TRICARE will not pay for any medications that are considered experimental or alternative to FDA-qualified medical practice. The following types of drugs are also excluded: 

• Drugs used to treat non-covered conditions
• Homeopathic and herbal medicine
• Weight loss drugs
• Drugs for cosmetic purposes
• Multivitamins (except prenatal drugs with prescriptions)
• Fluoride preparations
• Over-the-counter (OTC) drugs, except:
  • Insulin and diabetic supplies
  • The following OTC drugs with a prescription:
    • Cetirizine tablets
    • Fexofenadine tablets
    • Loratadine tablets
    • Omeprazole (generic version of Prilosec OTC)
  • The following OTC drugs without a prescription:
    • Levonorgestrel (Plan B One-Step Emergency Contraceptive) 
  • Smoking cessation products covered by the Smoking Cessation benefit

Some prescriptions require prior authorization to ensure medical necessity, safety or effectiveness before they can be successfully filled. These are:

• Drugs with age limits
• Drugs recommended by the Department of Defense Pharmacy and Therapeutics (DoD P&T) Committee
• Drugs that are prescribed at a dosage higher than the established limit
• Brand-name drugs that have generic substitutes

TRICARE Pharmacy Options

You can get your TRICARE prescriptions in the following ways:

• Military Pharmacy – This is the least expensive option with no out-of-pocket expenses to the insured.
• TRICARE Network Pharmacy – This option is considered convenient, as the network comprises more than 60,000 locations throughout the world.
• Non-Network (Civilian) Pharmacy – This is the most expensive option for beneficiaries, given out-of-pocket costs for non-network providers.
• TRICARE Pharmacy Home Delivery – This can be effective and reliable when a military pharmacy is not accessible. 

Using a Military Pharmacy

If you are an active duty military member, you and your covered family members can get your prescriptions filled at military pharmacies around the world. These are usually located in military hospitals or clinics, but can also be found in free-standing pharmacies on military bases. You aren’t required to use these pharmacies exclusively, but they are the lowest-cost option. 

As an active duty service member, you can receive low-cost or free prescription medications up to a 90-day supply. Most prescriptions you will receive are generic versions of brand-name medications. Military pharmacies fill prescriptions from military and civilian providers. 

Using a TRICARE Network Pharmacy 

TRICARE network pharmacies are located around the U.S. and U.S. territories (excluding American Samoa). They are available at national chains, grocery stores and independent pharmacies.

You can fill multiple prescriptions and pay a single copayment for every 30-day supply of medication. All that you need to provide is a written or electronic prescription and a uniformed services ID card.

Enter your ZIP code to be matched with a list of participating pharmacies in your area.

When you fill your prescriptions at network pharmacies, you are eligible to use the Express Rx mobile app to quickly refill prescriptions from your phone.

You may not be able to fill the following prescriptions at a TRICARE network pharmacy:

• Some non-formulary drugs (refer to TRICARE Formulary to learn more about the drug formulary)
• Certain maintenance drugs used to treat chronic conditions
  • Check if your maintenance drug can be filled at a network pharmacy by calling Express Scripts at (877) 363-1303
  • This limitation only applies to beneficiaries who are not active duty service members

Using a Non-Network Pharmacy

A non-network pharmacy (also known as a civilian pharmacy) is one that is not in the TRICARE network. If you fill prescriptions at a non-network pharmacy, you will pay full price for your medications and need to file your own claims.

If you are in the United States or a U.S. Territory, you can only use a non-network pharmacy as a last resort. If you are overseas, you fill prescriptions at overseas pharmacies, which are non-network. You will pay full price for your prescriptions, but may file a claim for reimbursement.

Using TRICARE Pharmacy Home Delivery

The TRICARE Home Delivery Pharmacy method is the second least expensive option behind filling prescriptions at military pharmacies. It allows you to receive your regularly-prescribed medications at your door without needing to visit a pharmacy. Once you are enrolled, you will start receiving prescriptions in 90-day quantities.

TRICARE Home Delivery ships prescriptions to any address in the U.S. or U.S. territories, including army post office (APO) and fleet post office (FPO) addresses. If you live overseas, you must use your APO or FPO address to receive prescriptions through the home delivery program. If you are assigned to an embassy and do not have an APO or FPO address, you must use the embassy address. You cannot receive prescriptions at a private foreign address, and you cannot receive refrigerated drugs at an APO or FPO address. Home delivery is not available in Germany.

Maintenance medication can only be filled by non active duty beneficiaries through military pharmacies or through the home delivery option. Home delivery is the least expensive way to receive these types of medications.

Maintenance medications are prescriptions that are taken regularly in order to maintain long-term or chronic illnesses and diseases. When you use the automatic option provided through TRICARE Home Delivery, maintenance medications are shipped on a scheduled basis as needed in order to avoid a lapse in coverage. 

How to Enroll in TRICARE Pharmacy Home Delivery

There are three ways to enroll in TRICARE Pharmacy Home Delivery. 

Online

During registration, you will need to provide the following information:

• Full name
• Date of birth
• DoD Benefits Number (DBN) or Sponsor ID 
• Username
• Password
• Email address

Once registration is complete, you can log into your Express Scripts account to order new prescriptions, refill current prescriptions and check order statuses. 

By Mail

To enroll by mail, you must complete a Home Delivery Order Form.

After you complete the form, attach your official prescription and any applicable copayment and send it to:

By Phone

To enroll by phone, call Express Scripts at:

You will need to provide your prescription and personal details to complete the process.

TRICARE Pharmacy Costs

You have a few different options when it comes to filling prescriptions. The costs vary depending on the drug type as well as how you choose to fill it. Prescription drugs fall into four categories:

• Generic formulary drugs – cheapest option
• Brand-name formulary drugs – a bit more expensive
• Non-formulary drugs – higher out of pocket costs
• Non-covered drugs – highest out of pocket costs (100% of the drug’s cost)

To see which drug category your prescription falls into, you can search the TRICARE drug formulary here: https://www.express-scripts.com/frontend/open-enrollment/tricare/fst/#/ 

As mentioned, there are three ways that TRICARE allows you to fill your prescriptions:

• Using military pharmacies – free as long as it carries the drug you need
• Getting home delivery – if the drug is permitted to be shipped via home delivery, it usually costs a small fee
• Network pharmacies – this option may be best for those who need prescriptions immediately and cannot travel to a military pharmacy or wait for home delivery. Search for a network pharmacy near you: https://militaryrx.express-scripts.com/find-pharmacy 

Non-network pharmacies may be an option, but not in call cases. For instance, all overseas pharmacies are non-network pharmacies. However, if it is your only option, TRICARE may work with you. You’ll pay full price for any prescription drugs filled at a non-network pharmacy. You’ll also need to file a claim for reimbursement, which are subject to deductibles or out-of-network cost-shares, and copayments.

Express Scripts is a nationwide pharmacy service and handles most TRICARE prescriptions. The service offers multiple payment options, including online payments.

Dental Coverage

In addition to health care coverage, TRICARE offers several dental plan options for military members, active Guard or Reserve members and their families.

There are three TRICARE dental coverage options available to those who meet the eligibility requirements for each plan. These are:

• Active Duty Dental Program
• TRICARE Dental Program
• Federal Employees Dental and Vision Insurance Program (FEDVIP)

Active Duty Dental Program

Active duty service members receive their dental care at military dental clinics with no out-of-pocket costs. However, the Active Duty Dental Program may also cover you for civilian dental care services you may need. You may seek civilian dental care when:

• You receive a referral from a military dental clinic for services unavailable at the military clinic.
• You live in a remote area far from military clinics.

Aside from active duty personnel, the following groups of beneficiaries may also be eligible for the Active Duty Dental Program:

• National Guard/Reserve members:
  • On active duty orders 
  • With delayed-effective-date orders
  • Enrolled in the Transitional Assistance Management Program (TAMP)
• Service members needing care due to illness or injury in the line of duty
• Foreign force members stationed in the U.S.

The Active Duty Dental Program provider is United Concordia.

Active duty members do not have any out-of-pocket costs under the Active Duty Dental Program.

TRICARE Dental Program

The TRICARE Dental Program is a dental insurance program that provides a host of services that protect and improve oral health. The following groups of individuals may purchase the TRICARE Dental Program insurance plan:

• Family members of active duty sponsors
• Family members of National Guard or Reserve members
• National Guard and Reserve members not on active-duty or not covered by TAMP

The TRICARE Dental Program is available in all areas of the world. The program covers the following dental services:

• Exams, cleanings, fluorides, sealants, and X-rays
• Fillings
• Root canal procedures
• Gum surgery
• Other oral surgery, including extractions
• Crowns 
• Dentures
• Orthodontics and braces

TRICARE Dental Program for Survivors

The TRICARE Dental Program also provides specific benefits for survivors after the death of a sponsor. It provides the exact same benefit coverage as the standard TRICARE Dental Program. Survivors are exempt from paying any premiums for this benefit. 

Spouses are eligible for the TRICARE Dental Program Survivors Benefit for a period of three years beginning on the date of the sponsor’s death, after which they are eligible to enroll in FEDVIP. Refer to Federal Employees Dental and Vision Insurance Program for more information. Children are eligible until age 21 (23 if they are enrolled full time in a college or university). 

How to Enroll in the TRICARE Dental Program

There are three ways to enroll in the TRICARE Dental Program.

Online

• Navigate to the milConnect website here: https://milconnect.dmdc.osd.mil/milconnect/ 
• Click the “Sign In” button at the top of the page
  • If you do not already have a milConnect account, you can register for one by clicking “New User? Start Here.” You must have a DoD Self-Service Logon, Common Access Card (CAC), DFAS (MyPay) Account or a Premium (Level 2) account. 
• Select the “Dental” tab to enroll in a dental plan.

By Phone

Use one of the following numbers to enroll in the TRICARE Dental Program by phone:

• If residing in the contiguous United States, call (844) 653-4061.
• If residing outside the contiguous United States, call (844) 653-4060 or (717) 888-7400.

By Mail

1. Download, print and complete the TRICARE Dental Program Enrollment/Change Authorization form here: https://www.uccitdp.com/branded/tdp/docs/member-tdp-enrollment-form101816bfillable.pdf 
2. Attach payment for your first monthly premium.
3. Mail all documents to:
   United Concordia
   TRICARE Dental Program
   P.O. Box 645547
   Pittsburgh, PA 15264-5253

TRICARE Dental Program Costs

When you purchase the TRICARE Dental Program insurance plan, you will need to pay monthly premiums for coverage. A premium is a fixed amount charged to you (the beneficiary) each month. Premium amounts depend on military status and the number of beneficiaries enrolled in the program. 

The 2023-2024 TRICARE Dental Program monthly premiums are listed below.

• When the sponsor is on active duty:
  • Single beneficiary (not the sponsor): $12.36
  • Family (more than one beneficiary): $32.13
• When the sponsor is Selected Reserve and Individual Ready Reserve (IRR) Mobilized:
  • Sponsor only: $12.36
  • Single beneficiary (not the sponsor): $30.89
  • Family (more than one beneficiary): $80.33
  • Sponsor and family: $92.69
• IRR Non-Mobilized:
  • Sponsor only: $30.89
  • Single beneficiary (not the sponsor): $30.89
  • Family (more than one beneficiary): $80.33
  • Sponsor and family: $111.22

In addition to monthly premiums, you must share the cost of dental services. Cost-shares are based on a percentage of the cost of services. They are calculated based on the sponsor’s pay grade and location. Sponsors residing in the U.S., the District of Columbia, Guam, Puerto Rico or the U.S. Virgin Islands live in the contiguous U.S. CONUS service area. Those who live outside of these regions live in the OCONUS service area.

 The following table outlines the current cost-shares for TRICARE dental care.

Type of Service	Pay Grades E1 – E4 (CONUS)	Pay Grades E5 & Above (CONUS)	OCONUS
Diagnostic	0%	0%	0%
Preventive	0%	0%	0%
Sealants	20%	20%	0%
Consultation/Office Visit	20%	20%	0%
Post-Surgical Services	20%	20%	0%
Basic Restorative	20%	20%	0%
Endodontic	30%	40%	0%
Periodontic	30%	40%	0%
Oral Surgery	30%	40%	0%
General Anesthesia	40%	40%	0%
Intravenous Sedation	50%	50%	0%
Miscellaneous Services (occlusal guard, athletic mouth guard)	50%	50%	0%
Other Restorative	50%	50%	50%
Implant Services	50%	50%	50%
Prosthodontic	50%	50%	50%
Orthodontic	50%	50%	50%

Federal Employees Dental and Vision Insurance Program (FEDVIP)

The Federal Employees Dental and Vision Insurance Program (FEDVIP) is another type of voluntary dental and vision insurance program open to the following groups of individuals:

• Retired uniform, National Guard and Reserve members
• Family members of retirees (including National Guard and Reserves)
• Medal of Honor recipients and their families
• Survivors

You must enroll during the FEDVIP enrollment season, which typically runs from November to December. However, newly eligible beneficiaries and those with Qualifying Life Events (QLEs) may be permitted to enroll anytime. The following are acceptable QLEs:

• Getting married
• Losing other dental coverage
• Having military pay restored
• Acquiring or losing a family member
• Returning from or to active duty
• Moving
• Transferring positions

Vision Coverage

TRICARE provides coverage for vision services to military personnel and their families. Specific vision benefits depend on military status, age and plan type. Read the sections below to learn more about vision coverage eligibility guidelines, coverage options and costs.

TRICARE Vision Coverage Eligibility Guidelines 

To receive TRICARE vision coverage, you must already be enrolled in a TRICARE health plan. Vision coverage is considered an add-on package to an existing TRICARE health care insurance plan. Vision plans are open to anyone who is eligible for TRICARE health plans. To learn more about TRICARE eligibility, refer to Basic TRICARE Eligibility.

What vision services does TRICARE cover? 

TRICARE covers a variety of eye care services that vary in availability and cost.

Eye Exams

TRICARE vision benefits include routine eye exams to monitor eye health. The availability and frequency of these exams depends on military status and plan type. 

Eye Exams for Active Duty, Activated Guard and Activated Reserve Members

These types of military personnel receive routine eye exams at military hospitals and network providers as needed to maintain military fitness. 

Eye Exams for Family Members of Active Duty Personnel

Family members of active-duty personnel and activated Guard or Reserve members receive one yearly eye exam at a network provider. 

Eye Exams for Guard and Reserve Members and Their Families

These members and their family members can receive one routine eye exam per year if they are enrolled in TRICARE Reserve Select.

Eye Exams for Retirees and Their Families

Only retirees and their families enrolled in TRICARE Prime or Young Adult Prime are covered for one eye exam every two years. They are not covered for eye exams in the following plans:

• TRICARE Select
• TRICARE Select Overseas
• TRICARE Young Adult – Select
• TRICARE For Life 

Eye Exams for Children 

Children up to age 6 can receive well-child eye exams regardless of the TRICARE plan in which they are enrolled.These exams consist of screenings for common childhood eye conditions, like lazy eye (amblyopia) and crossed eyes (strabismus).

Corrective Lenses and Eyeglasses

TRICARE also provides coverage for corrective lenses and eyeglasses. Coverage options and costs depend on the sponsor’s military status. Active duty and activated Guard or Reserve members are covered in full for corrective lenses. They may select one standard-issue (military-approved) pair of eyeglasses, one pair of their choice and one pair of prescription sunglasses.

Non-active members of the National Guard and Reserves can receive one standard-issue pair of eyeglasses from their unit, which orders them from the Naval Ophthalmic Support and Training Activity Command. 

Retired service members can order their own pair of standard-issue eyeglasses from the Naval Ophthalmic Support and Training Activity Command.

All other TRICARE beneficiaries can only receive glasses or lenses to treat the following eye conditions:

• Infantile glaucoma
• Keratoconus
• Dry eyes
• Irregularities in the shape of the eye (other than astigmatism)
• Loss of function in the lenses of the eyes as a result of surgery or congenital condition
• “Pinhole” glasses prescribed for use after surgery for detached retina

TRICARE Vision Plan Costs

TRICARE vision costs vary depending on your military status. Active duty personnel are exempt from copayments. However, family members and non-active members of the National Guard or the Reserves are required to pay a share of costs for corrective lenses or eyeglasses. 

TRICARE does not cover prescription changes in full, so you may need to pay each time it changes. Also, lost or damaged glasses or lenses are not covered by TRICARE. You are responsible for paying for your own adjustments, cleanings or repairs. 

Contact your plan provider for information on specific costs.

Mental Health Coverage

TRICARE offers comprehensive mental health care coverage in each of its health plans. The program partners with qualified mental health care professionals — including therapists and counselors — as well as physicians and clinicians who operate either in in-patient facilities as well as out-patient settings. 

TRICARE Mental Health Coverage Eligibility Guidelines

Mental health care and services are available to anyone who is enrolled in a TRICARE health plan. They must meet the basic TRICARE eligibility requirements, which you can find in Basic TRICARE Eligibility. 

What mental health services does TRICARE cover?

TRICARE provides a wide array of mental health services, treatments and medications to improve mental and behavioral health. The program covers medically and psychologically necessary mental health and substance use disorder care, including both inpatient and outpatient care.

The following mental health services are covered by TRICARE:

TRICARE Mental Health Costs

The cost of receiving mental health care through a TRICARE plan depends on many factors, such as plan type, length of service and military status. Most costs are associated with prescription medications and out-of-network services.

Active duty service members are exempt from paying any out-of-pocket costs for coverage, including mental health care. Family members of active-duty personnel pay for services only when using a TRICARE Select plan or getting care without a referral. For an explanation of costs per plan type and treatment, refer to TRICARE Costs.

TRICARE Costs

TRICARE requires certain types of beneficiaries to pay fees for health care coverage and services they receive. The total costs of services vary depending on the military sponsor’s status. The following types of fees may be assessed:

• Copayment: An out-of-pocket expense that a beneficiary pays to the health care provider at the time of receiving a medical service or medication. 
• Monthly premium: A fixed amount charged to the beneficiary each month to remain covered in the health plan. 
• Annual enrollment fee: A fixed amount charged to the beneficiary each year he or she wishes to receive TRICARE coverage.
• Deductible: The total amount of money a beneficiary pays out-of-pocket per year before TRICARE pays for services.

When a beneficiary needs to stay in a hospital or other medical facility, he or she is receiving inpatient care, which requires per diem fees.

The sections below outline the costs of health care categorized by type of TRICARE plan. All costs are updated for the 2024 coverage year.

TRICARE Prime

Active duty members and family members of active duty service members enrolled in any Prime plan pay nothing out-of-pocket unless they receive medical care without a referral. All other TRICARE Prime enrollees, such as retirees and their family members, are subject to annual enrollment fees and copayments.

Annual Enrollment Fees 

Annual enrollment fees depend on military status and date of entry. Beneficiaries fall into one of two groups: 

• Group A: Joined uniform service before January 1, 2018.
• Group B: Joined uniform service on or after January 1, 2018.

Annual TRICARE Prime enrollment fees for active duty members and families with active duty sponsors:

• Group A: $0
• Group B: $0

Annual TRICARE Prime enrollment fees for retired service members, their families and others:

• Group A: $363 per individual, $726 per family
• Group B: $438.96 per individual, $879 per family

Deductibles

There is no annual deductible for TRICARE Prime plans.

Copayments

The copayments shown in the table below are for network services. Receiving care from non-network providers in Prime plans is known as point-of-service and requires point-of-service fees instead of copayments. Learn more about point-of-service in TRICARE Point-of-Service Option.

Service	Active Duty Group A	Active Duty Group B	Retirees, Their Families & Others Group A	Retirees, Their Families & Others Group B
Outpatient – Primary (including mental health)	$0	$0	$25	$25
Outpatient – Specialist (including mental health)	$0	$0	$37	$37
Urgent Care	$0	$0	$37	$37
Emergency Services	$0	$0	$75	$75
Ambulance – Outpatient Network	$0	$0	$20	$20
Ambulance – Outpatient Non-Network	$0	$0	$20	$20
Ambulance – Inpatient	$0	$0	25% of allowable charge	25% of allowable charge
Inpatient Admission (including mental health stays)	$0	$0	$188/stay	$188/stay
Durable Medical Equipment and Supplies	$0	$0	20%	20%
Maternity Care – Inpatient Admission	$0	$0	$188/stay	$188/stay
Maternity Care – Delivery / Birthing Center	$0	$0	$75	$75
Maternity – Home Primary Care	$0	$0	$25	$25
Maternity – Home Specialist Care	$0	$0	$37	$37
Skilled Nursing	$0	$0	$37/day	$37/day

TRICARE Select 

TRICARE Select has certain fees for service for all beneficiaries except active duty personnel.

Annual Enrollment Fees

Annual enrollment fees depend on military status and date of entry. Beneficiaries fall into one of two groups: 

• Group A: Joined uniform service before January 1, 2018.
• Group B: Joined uniform service on or after January 1, 2018.

Deductibles

Deductibles depend on pay grade (for active duty sponsors), date of entry and sponsor status. 

Deductibles for beneficiaries with active duty family members:

Group A	Group B
Pay Grades E1-E4: $50 per individual, $100 per family E5 and above: $150 per individual, $300 per family	Pay Grades E1-E4: $62 per individual, $125 per family E5 and above: $188 per individual, $377 per family

Deductibles for retired service members, their families and others:

Group A	Group B
$150 per individual, $300 per family	Network: $188 per individual, $377 per family Non-network: $377 per individual, $754 per family

Copayments 

Service	Active Duty Group A	Active Duty Group B	Retirees, Their Families & Others Group A	Retirees, Their Families & Others Group B
Outpatient – Primary (including mental health)	Network: $27 Non-network: 20%	Network: $18 Non-network: 20%	Network: $36 Non-network: 25%	Network: $31 Non-network: 25%
Outpatient – Specialist (including mental health)	Network: $38 Non-network: 20%	Network: $31 Non-network: 20%	Network: $50 Non-network: 25%	Network $50 Non-network 25%
Urgent Care Center	Network: $27 Non-network: 20%	Network: $25 Non-network: 20%	Network: $36 Non-network: 25%	Network: $50 Non-network: 25%
Emergency Services	Network: $104 Non-network: 20%	Network: $50 Non-network: 20%	Network: $139 Non-network: 25%	Network: $100 Non-network: 25%
Ambulatory Surgery	$25	Network: $31 Non-network: 20%	Network: 20% Non-network: 25%	Network: $119 Non-network: 25%
Ambulance – Outpatient Network	$79	$18	$106	$75
Ambulance – Outpatient Non-Network	20%	20%	25%	25%
Ambulance – Inpatient	20%	20%	25%	25%
Inpatient Admission (including mental health stays)	Network: $22.30/day ($25 minimum) Out-of-Network: $22.30/day ($25 minimum)	Network: $75/admission Out-of-Network: 20%	Network: $250/day or up to 25% of hospital charges (whichever is less) + 20% separately billed charges Out-of-Network: $1,221 /day or up to 25% of hospital charges (whichever is less) + 25% separately billed charges	Network: $219/admission Out-of-Network: 25%
Durable Medical Equipment and Supplies	Network: 15% Non-network: 20%	Network: 10% Non-network: 20%	Network: 20% Non-network: 25%	Network: 20% Non-network: 25%
Maternity Care – Inpatient Admission	Network: $22.30/day ($25 minimum) Out-of-Network: $22.30/day ($25 minimum)	Network: $75/admission Out-of-Network: 20%	Network: $250/day or 25% + 20% of billed separate charges Non-network: $1,221/day or 25% + 25% of billed separate charges	Network: $219/admission Non-network: 25%
Maternity Care – Delivery / Birthing Center	Network: $27 Out-of-Network: $27	Network: $31 Out-of-Network: 20%	Network: 20% Out-of-Network: 25%	Network: $119 Out-of-Network: 25%
Maternity – Home Primary Care	Network: $27 Non-network: 20%	Network: $18 Non-network: 20%	Network: $36 Non-network: 25%	Network: $31 Non-network: 25%
Maternity – Home Specialist Care	Network: $38 Non-network: 20%	Network: $31 Non-network: 20%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%
Skilled Nursing	Network: $22.30/day ($25 minimum) Out-of-Network: $22.30/day ($25 minimum)	Network: $31/day Out-of-Network: $62/day	Network: $250/day or 25% + 20% of billed separate charges Non-network: 25%	Network: $62 Non-network: Lesser of $377/day or 20%

TRICARE Reserve Select 

TRICARE Reserve Select has monthly premiums, deductibles and copayments for services.

Monthly Premiums 

• Military member only: $51.95 per month
• Military member and family: $256.87 per month 

Deductibles

Deductibles depend on pay grade.

• Pay Grades E1-E4: $62 per individual, $125 per family
• Pay Grades E5 and above: $188 per individual, $377 per family

Copayments   

Service	Copayment for All Beneficiaries
Outpatient – Primary	Network: $18 Non-network: 20%
Outpatient – Specialist	Network: $31 Non-network: 20%
Urgent Care	Network: $25 Non-network: 20%
Emergency Services	Network: $50 Non-network: 20%
Ambulance	Network: $18 Non-network: 20% Inpatient: 20%
Inpatient Admission (including mental health stays)	Network: $75/admission Non-network: 20%
Outpatient Mental Health Specialist	Network: $31 Non-network: 20%
Durable Medical Equipment and Supplies	Network: 10% Non-network: 20%
Home and Hospice Care	$0
Inpatient Maternity	Network: $75/admission Non-network: 20%
Maternity Birthing Center	Network: $31 Non-network: 20%
Maternity Home Primary	Network: $18 Non-network: 20%
Maternity Home Specialist	Network: $31 Non-network: 20%
Skilled Nursing	Network: $31/day Non-network: $62/day

TRICARE Retired Reserve 

TRICARE Retired Reserve has monthly premiums, annual deductibles and copayments for services.

Monthly Premiums

• Military member only: $585.25 per month
• Military member and family: $1,406.22 per month 

Deductibles

Deductibles depend on whether services are rendered at network or non-network providers:

• Network: $188 per individual, $377 maximum per family
• Non-network: $377 per individual, $754 maximum per family

Copayments   

Service	Copayments for All Beneficiaries
Outpatient – Primary	Network: $31 Non-network: 25%
Outpatient – Specialist	Network: $50 Non-network: 25%
Urgent Care	Network: $50 Non-network: 25%
Emergency Services	Network: $100 Non-network: 25%
Ambulance	Network: $75 Non-network: 25% Inpatient: 25%
Inpatient Mental Health	Network: $219/admission Non-network: 25%
Outpatient Mental Health Primary	Network: $31 Non-network: 25%
Outpatient Mental Health Specialist	Network: $50 Non-network: 25%
Durable Medical Equipment and Supplies	Network: 20% Non-network: 25%
Home and Hospice Care	$0
Inpatient Maternity	Network: $219/admission Non-network: 25%
Maternity Birthing Center	Network: $119 Non-network: 25%
Maternity Home Primary	Network: $31 Non-network: 25%
Maternity Home Specialist	Network: $50 Non-network: 25%
Skilled Nursing	Network: $62/day Non-network: Lesser of $377/day or 20%

TRICARE for Life 

Beneficiaries enrolled in TRICARE for Life must receive medical services from providers who also accept Medicare. If they see doctors who do not accept Medicare, they are responsible for paying out-of-pocket costs. They are also required to pay Medicare Part B premiums in order to maintain TRICARE eligibility.

Annual Enrollment Fees

There are no annual enrollment fees for TRICARE for Life.

Deductibles

Annual deductibles for retired, medically retired or survivor sponsor status:

• $150 per individual, $300 per family

Annual deductibles for active duty sponsor status:

• Pay grades E1-E4: $50 per individual and $100 per family 
• Pay grades E5 & above: $150 per individual and $300 per family

Copayments   

Service	Active Duty Group A	Active Duty Group B	Retired Group A	Retired Group B	Survivor / Medically Retired Group A	Survivor / Medically Retired Group B
Outpatient – Primary or Specialist	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%
Urgent Care	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%
Emergency Services	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%
Ambulance	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%
Inpatient Mental Health	$0 (If covered by both Medicare and TRICARE) $21.30/day if not ($25 minimum) Overseas: 25%	$0 (If covered by both Medicare and TRICARE) $21.30/day if not ($25 minimum) Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: $250 or up to 25% of hospital charges (whichever is less) +20% separately billed charges	$0 (If covered by both Medicare and TRICARE) Network: $250 or up to 25% of hospital charges (whichever is less) +20% separately billed charges	$0 (If covered by both Medicare and TRICARE) Network: $250 or up to 25% of hospital charges (whichever is less) +20% separately billed charges	$0 (If covered by both Medicare and TRICARE) Network: $250 or up to 25% of hospital charges (whichever is less) +20% separately billed charges
Outpatient Mental Health Primary or Specialist	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%
Durable Medical Equipment and Supplies	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%
Home and Hospice Care	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Maternity	$0 (If covered by both Medicare and TRICARE) $21.30/day if not ($25 minimum) Overseas: 25%	$0 (If covered by both Medicare and TRICARE) $21.30/day if not ($25 minimum) Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: $250 + 20% Non-network: $1,053 + 25% Overseas: $1,053 + 25%	$0 (If covered by both Medicare and TRICARE) Network: $250 + 20% Non-network: $1,053 + 25% Overseas: $1,053 + 25%	$0 (If covered by both Medicare and TRICARE) Network: $250 + 20% Non-network: $1,053 + 25% Overseas: $1,053 + 25%	$0 (If covered by both Medicare and TRICARE) Network: $250 + 20% Non-network: $1,053 + 25% Overseas: $1,053 + 25%
Maternity Home Primary	$0 (If covered by both Medicare and TRICARE) $20.75/day if not ($25 minimum) Overseas: 25%	$0 (If covered by both Medicare and TRICARE) $20.75/day if not ($25 minimum) Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%
Maternity Home Specialist	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 15% Non-network: 20% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%	$0 (If covered by both Medicare and TRICARE) Network: 20% Non-network: 25% Overseas: 25%
Newborn Care	$0 (If covered by both Medicare and TRICARE) 25% if not	$0 (If covered by both Medicare and TRICARE) 25% if not	$0 (If covered by both Medicare and TRICARE) Network: $250 or 25% + 20% of billed separate charges Non-network: $1,053 or 25% + 25% of billed separate charges Overseas: $1,053 or 25% + 25% of billed separate charges	$0 (If covered by both Medicare and TRICARE) Network: $250 or 25% + 20% of billed separate charges Non-network: $1,053 or 25% + 25% of billed separate charges Overseas: $1,053 or 25% + 25% of billed separate charges	$0 (If covered by both Medicare and TRICARE) Network: $250 or 25% + 20% of billed separate charges Non-network: $1,053 or 25% + 25% of billed separate charges Overseas: $1,053 or 25% + 25% of billed separate charges	$0 (If covered by both Medicare and TRICARE) Network: $250 or 25% + 20% of billed separate charges Non-network: $1,053 or 25% + 25% of billed separate charges Overseas: $1,053 or 25% + 25% of billed separate charges
Skilled Nursing	N/A	N/A	$0	$0	$0	$0

TRICARE Young Adult Prime 

TRICARE Young Adult Prime charges monthly premiums and copayments depending on the sponsor’s military status.

Monthly Premiums

Monthly premiums for all beneficiaries, regardless of sponsor status are $637 per month.

Deductibles

There are no annual deductibles for TRICARE Young Adult Prime.

Copayments

Service	Active Duty – Group A and Group B	Retired – Group A and Group B	Survivor / Medically Retired – Group A and Group B
Outpatient – Primary	$0	$25	$25
Outpatient – Specialist	$0	$37	$37
Urgent Care	$0	$37	$37
Emergency Services	$0	$75	$75
Ambulance	$0	Outpatient Network: $20 Outpatient Non-Network: $20 Inpatient: 25% of allowable charge	Outpatient Network: $20 Outpatient Non-Network: $20 Inpatient: 25% of allowable charge
Inpatient Mental Health	$0	$188/admission	$188/admission
Outpatient Mental Health Primary	$0	$25	$22
Outpatient Mental Health Specialist	$0	$37	$33
Durable Medical Equipment and Supplies	$0	20%	20%
Home and Hospice Care	$0	$0	$0
Inpatient Maternity	$0	$188/admission	$188/admission
Birthing Center Maternity	$0	$75	$75
Maternity Home Primary	$0	$25	$25
Maternity Home Specialist	$0	$37	$37
Newborn Care	$0	$0	$0
Skilled Nursing	$0	$37/day	$37/day

TRICARE Young Adult Select

TRICARE Young Adult Select charges monthly premiums, deductibles and copayments depending on the sponsor’s military status.

Monthly Premiums

Monthly premiums for all beneficiaries, regardless of sponsor status are $311 per month.

Deductibles

Deductibles depend on: 

• pay grade (for active duty sponsors),
• sponsor status,
• and whether care was rendered at network or non-network providers.

Annual deductibles for retired, medically retired or survivor sponsor status:

• Network: $168 per individual, $336 maximum per family
• Non-network: $336 per individual, $672 maximum per family

Annual deductibles for active duty sponsor status:

• Pay grades E1-E4: $62 per individual and $125 per family
• Pay grades E5 & above: $188 per individual and $377 per family

Copayments

Service	Active Duty Group A	Active Duty Group B	Retired Group A	Retired Group B	Survivor / Medically Retired Group A	Survivor / Medically Retired Group B
Outpatient – Primary	Network: $18 Non-network: 20%	Network: $18 Non-network: 20%	Network: $31 Non-network: 25%	Network: $31 Non-network: 25%	Network: $31 Non-network: 25%	Network: $31 Non-network: 25%
Outpatient – Specialist	Network: $31 Non-network: 20%	Network: $31 Non-network: 20%	Network: $50 Non-network: 25%	Network $50 Non-network: 25%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%
Urgent Care	Network: $25 Non-network: 20%	Network: $25 Non-network: 20%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%
Emergency Services	Network: $50 Non-network: 20%	Network: $50 Non-network: 20%	Network: $100 Non-network: 25%	Network: $1000 Non-network: 25%	Network: $100 Non-network: 25%	Network: $100 Non-network: 25%
Ambulance	Network: $18 Non-network: 20%	Network: $18 Non-network: 20%	Network: $75 Non-network: 25%	Network: $75 Non-network: 25%	Network: $75 Non-network: 25%	Network: $75 Non-network: 25%
Inpatient Mental Health	Network: $75/admission Non-network: 20%	Network: $75/admission Non-network: 20%	Network: $219/admission Non-network: 25%	Network: $219/admission Non-network: 25%	Network: $219/admission Non-network: 25%	Network: $219/admission Non-network: 25%
Outpatient Mental Health Primary	Network: $18 Non-network: 20%	Network: $18 Non-network: 20%	Network: $31 Non-network: 25%	Network: $31 Non-network: 25%	Network: $31 Non-network: 25%	Network: $31 Non-network: 25%
Outpatient Mental Health Specialist	Network: $31 Non-network: 20%	Network: $31 Non-network: 20%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%
Durable Medical Equipment and Supplies	Network: 10% Non-network: 20%	Network: 10% Non-network: 20%	Network: 20% Non-network: 25%	Network: 20% Non-network: 25%	Network: 20% Non-network: 25%	Network: 20% Non-network: 25%
Home and Hospice Care	$0	$0	$0	$0	$0	$0
Inpatient Maternity	Network: $75/admission Non-network: 20%	Network: $75/admission Non-network: 20%	Network: $219/admission Non-network: 25%	Network: $219/admission Non-network: 25%	Network: $219/admission Non-network: 25%	Network: $219/admission Non-network: 25%
Birthing Center Maternity	Network: $31 Non-network: 20%	Network: $31 Non-network: 20%	Network: $119 Non-network: 25%	Network: $119 Non-network: 25%	Network: $119 Non-network: 25%	Network: $119 Non-network: 25%
Maternity Home Primary	Network: $18 Non-network: 20%	Network: $18 Non-network: 20%	Network: $31 Non-network: 25%	Network: $31 Non-network: 25%	Network: $31 Non-network: 25%	Network: $31 Non-network: 25%
Maternity Home Specialist	Network: $31 Non-network: 20%	Network: $31 Non-network: 20%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%	Network: $50 Non-network: 25%
Newborn Care	Network: $0 Non-network: 20%	Network: $0 Non-network: 20%	Network: $0 Non-network: 25%	Network: $0 Non-network: 25%	Network: $0 Non-network: 25%	Network: $0 Non-network: 25%
Skilled Nursing	Network: $31/day Non-network: $62/day	Network: $31/day Non-network: $62/day	Network: $62/day Non-network: Lesser of $377/day or 20%	Network: $62/day Non-network: Lesser of $377/day or 20%	Network: $62/day Non-network: Lesser of $377/day or 20%	Network: $62/day Non-network: Lesser of $377/day or 20%

U.S. Family Health Plan

Active duty family members do not pay enrollment fees or out-of-pocket costs for any type of care received under the U.S. Family Health Plan provider. Beneficiaries of all other TRICARE health care plans are subject to enrollment fees and copayments.

Annual Enrollment Fees

Annual enrollment fees depend on the sponsor’s military status and date of entry. Beneficiaries fall into one of two groups: 

• Group A: Joined uniform service before January 1, 2018.
• Group B: Joined uniform service on or after January 1, 2018.

Annual enrollment fees for beneficiaries with active duty sponsor status:

• Group A: $0
• Group B: $0

Annual enrollment fees for retired service members, their families and others:

• Group A: $363 per individual, $726 per family
• Group B: $438.96 per individual, $879 per family

Deductibles

There are no deductibles for the U.S. Family Health Plan.

Copayments

Service	Active Duty Group A	Active Duty Group B	Retirees, Their Families & Others Group A	Retirees, Their Families & Others Group B
Outpatient – Primary (including mental health)	$0	$0	$25	$25
Outpatient – Specialist (including mental health)	$0	$0	$37	$37
Urgent Care	$0	$0	$37	$37
Emergency Services	$0	$0	$75	$75
Ambulatory Surgery	$0	$0	$75	$75
Ambulance	$0	$0	$20	$20
Inpatient Admission (including mental health stays)	$0	$0	$188/stay	$188/stay
Durable Medical Equipment and Supplies	$0	$0	20%	20%
Maternity Care – Inpatient Admission	$0	$0	$188/stay	$188/stay
Maternity – Home Primary Care	$0	$0	$25	$25
Maternity – Home Specialist Care	$0	$0	$37	$37
Skilled Nursing	$0	$0	$37/day	$37/day

TRICARE Point-of-Service Option

When you are enrolled in a Prime plan and receive medical care from a TRICARE-authorized provider without a referral from your primary care manager (PCM), you are using the point-of-service (POS) option. Using this option allows you to:

• Get routine care.
• See any TRICARE-authorized provider, network or non-network.
• Seek treatment without a referral.

However, you must pay more out of pocket.

The POS does not apply if you:

• Have a non-Prime health care plan
• Are an active duty service member
• Have a referral from your PCM
• Have other health insurance
• Have a newborn or adopted child
  • Babies and children are covered under TRICARE Prime for 90 days after birth or adoption. POS may apply after this 90-day period.
• Receive the following types of care:
  • Emergency care
  • Urgent care
  • Preventive care from a network provider in your region

Point-of-Service Fees

When you use the POS option, you will pay POS fees instead of your regular copayments. You will also be responsible for paying any other fees charged by non-network providers.

TRICARE Coverage Exclusions

TRICARE plans only cover services, prescriptions and medical procedures deemed medically necessary for the treatment of covered illnesses, pregnancies or well-child care. If a service is “unnecessary,” it means that a doctor or other health care professional does not believe it to be medically helpful for treatment.

The following services are excluded from TRICARE coverage:

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TRICARE Coverage Extensions

TRICARE beneficiaries interested in receiving more extensive care for mental or physical conditions have supplemental coverage options. The Extended Health Care Option (ECHO) is open to qualifying members for no additional enrollment fees. 

To be eligible for ECHO, beneficiaries must meet the following criteria:

• Be formally diagnosed with a moderate or severe intellectual, physical or psychological condition
• The diagnosis must be entered in DEERS
• The beneficiary seeking ECHO coverage must currently be enrolled in the Exceptional Family Member Program (EFMP)
  • EFMP is a plan designed for individuals with special medical or educational needs. 
• They must register for ECHO with case managers in their region
  • Refer to TRICARE Program Contact Information for a list of contact information for each region.

ECHO is available to the following groups of beneficiaries:

• Family members of active duty personnel
• Family members of activated Guard or Reserve members
• Family members covered under the Transitional Assistance Management Program (TAMP)
• Children or spouses of former service members who are victims of abuse
• Transitional survivors (family members of deceased active duty sponsors)

The service coverage limit is $36,000 per calendar year, which runs from January 1 to December 31. ECHO has monthly cost-shares for services, the amounts of which are determined by the sponsor’s pay grade. The cost-shares are assessed per sponsor, not assessed per beneficiary. Beneficiaries only pay the cost-share if they receive services during that particular month.

The chart below outlines ECHO cost shares as of 2024.

Sponsor Pay Grade	Monthly Cost-Share Amount
E-1 through E-5	$25
E-6	$30
E-7 and O-1	$35
E-8 and O-2	$40
E-9, WO/WO-1, CWO-2, and O-3	$45
CWO-3, CWO-4, and O-4	$50
CWO-5 and O-5	$65
O-6	$75
O-7	$100
O-8	$150
0-9	$200
O-10	$250

TRICARE Referrals and Prior Authorizations

Sometimes, you need to get specialty care that your general physician or primary care manager (PCM) cannot provide. Depending on your TRICARE plan, you may be required to get a referral or prior authorization from your PCM before receiving a treatment or service from a specialty provider. 

If you need to see a specialty provider, your TRICARE PCM will work with your regional contractor for referrals and prior authorizations as needed. 

When do I need a TRICARE referral?

There are many instances in which you may need a referral. These requirements vary depending on who you are.

If you are an active duty service member, you need a referral for: 

• All medical services that your PCM does not provide.
• All civilian care, including preventive and mental health services.

If you are any other type of beneficiary enrolled in a Prime plan, you need a referral for:

• All medical services that your PCM does not provide EXCEPT for:
  • Preventive services from a network provider in your region.
  • Outpatient mental health services from a network provider in your region.

If you are enrolled in a TRICARE plan other than Prime, you only need a referral for:

• Applied behavioral analysis
  • This is a type of therapy that aims to increase language and communication skills, improve attention, focus, social skills, memory, and academics and decrease problem behaviors.

How to Get a TRICARE Referral

Your PCM will work with your regional contractor to find a provider that offers the services you need in your region. Then, the regional contractor will refer you to a military hospital or clinic that performs those particular services before any other kind of facility. 

The military hospital or clinic has the right to refuse the referral. If this happens, you will get a referral to a network provider in your region.

When do I need TRICARE prior authorization?

You need approval for some services and treatments, even if they do not require a referral. Your regional contractor will review your health care service request to determine if TRICARE will cover it. If it does, you will receive a pre-approval notice ensuring that the service will be covered by TRICARE.

If you are an active duty service member, you need prior authorization for: 

• All specialty care
• Maternity care
• Physical therapy
• Mental health
• Family counseling
• Smoking cessation programs

If you are any other type of beneficiary enrolled in a Prime plan, you need prior authorization for all specialty care.

If you are enrolled in TRICARE Select, TRICARE Select Overseas, TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE For Life or TRICARE Young Adult-Select, you need prior authorization for:

• Adjunctive dental services
• Applied behavior analysis
• Home health services
• Hospice care
• Transplants (all solid organ and stem cell)
• All services covered under the Extended Care Health Option (ECHO)
  • For more information about ECHO, refer to TRICARE Coverage Extensions.

How to Get Prior Authorization

If you are enrolled in a TRICARE Prime plan, your PCM will work with the regional contractor to get prior authorization. If you are enrolled in another type of TRICARE plan and are interested in getting prior authorization, you must contact your regional contractor. Find regional contact information in TRICARE Program Contact Information.

My TRICARE prior authorization is approved. What now?

Once your TRICARE prior authorization is approved, your regional contractor will send you and your provider an authorized letter. Then, you can schedule your appointment with a provider listed in the authorized letter within the designated time frame. If you need to find another provider, you must contact your regional contractor. Find regional contact information in TRICARE Program Contact Information.

How can I view my TRICARE referrals and prior authorizations?

You can view or check the status of your TRICARE referrals and prior authorizations online. You will need to visit the website of your regional contractor:

• East Region – www.humanamilitary.com 
• West Region – www.hnfs.com
• Overseas Region – www.tricare-overseas.com 

TRICARE Claims

A claim is a bill for a medical service. It contains information about the type of services provided, the total cost of these services and how the bill will be paid. TRICARE network providers file medical claims on your behalf. 

You will need to file a claim on your own if:

• You are traveling
• You see a non-network provider
• You are enrolled in TRICARE For Life and see a Medicare non-network provider

If you need to file your own claim, do it as soon as possible. If you receive medical care in the U.S., you have one year from the date of service to file a claim. If you receive medical care overseas, you have three years to file a claim. Most claims are supposed to be processed within 30 days of when you submit them.

How to File a TRICARE Claim

To file a TRICARE claim, follow the steps outlined below.

1. Complete the TRICARE Claim Form.
   • Download the form here: https://www.tricare.mil/FormsClaims/Claims/MedicalClaims
2. Attach the provider’s bill, ensuring it contains the following important information:
   • Your (or the sponsor’s) Social Security Number or Department of Defense Benefits Number (DBN)
   • Provider’s name and address
   • Date of medical service(s)
   • Description of medical service(s)
   • Total charge of service(s)
   • Diagnosis
3. Mail the claim to the proper claim address based on your region.
   • See the below regional claims addresses:

How can I check my TRICARE claim status?

You can check the status of a TRICARE claim online through the claim processor’s website according to your region.

• East Region – https://infocenter.humana-military.com/beneficiary/service/Account/Login
• West Region – www.tricare-west.com/content/hnfs/home/tw/bene/claims.html 
• Overseas – https://www.tricare-overseas.com/beneficiaries/claims  

Once you register in your region, you can look up your out-of-pocket expenses and your deductibles. You can also update any other health insurance you have in addition to TRICARE, such as Medicare, and view a detailed explanation of your benefits. 

What happens if my TRICARE claim is denied?

Your TRICARE claim can be denied if you did not fill out the form correctly or you failed to provide necessary information. TRICARE provides a list of filing tips you can follow when completing the Claim Form.

If your TRICARE claim is denied, you must contact the claim processor in your region. 

• If your pharmacy claim was denied, contact Express Scripts by calling 1 (877) 363-1303 in the U.S. or 1 (866) 275-4732  if you are overseas.
• If your medical claim was denied and you are in the East Region, call East Region Claims at 1 (800) 444-5445.
• If your medical claim was denied and you are in the West Region, call West Region Claims at 1 (844) 866-9378.

If your medical claim was denied and you are overseas, call the regional call center in your area. Find a list of overseas contact information in TRICARE Program Contact Information.

Appealing a Decision

If you believe your appeal was wrongly denied, you can file an appeal. The appeal process differs based on the reason or type of denial. There are four types of appeals:

• Factual Appeal
  • File a factual appeal if TRICARE refuses to pay for medical services or supplies.
• Medical Necessity Appeal
  • File a medical necessity appeal if TRICARE denies prior authorization for a service because it is not deemed medically necessary. 
• Pharmacy Appeal
  • File a pharmacy appeal if you disagree with a decision regarding pharmacy benefits.
• Medicare-TRICARE Appeal
  • File this type of appeal if Medicare denies services or supplies. This type of appeal must be done through the Medicare program and is not completed through TRICARE. Learn more here: https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal 

Appeal Addresses

The chart below contains the mailing addresses to which appeal requests should be sent based on the region. Continue reading the following sections for information on how to submit the appeal request. 

Contractor	Appeal Address
Defense Health Agency	Defense Health Agency Appeals, Hearings and Claims Collection Division 16401 E. Centretech Parkway Aurora, CO 80011-9066
East Region	Prior Authorization Appeals Humana Military Appeals PO Box 740044 Louisville, KY 40201-9973
West Region	Health Net Federal Services, LLC Claims Appeals PO Box 8008 Virginia Beach, VA 23450-8008
Overseas	International SOS Assistance, Inc. Reconsideration/Grievances Department PO Box 11570 Philadelphia, PA 19116 USA
TRICARE For Life	WPS-TRICARE For Life Attn: Appeals PO Box 7490 Madison, WI 53707-7490
Pharmacy	Express Scripts, Inc. PO Box 60903 Phoenix, AZ 85082-0903

Filing a Factual Appeal

To file a factual appeal, send a letter to your regional contractor explaining that you do not agree with the TRICARE decision. Appeal addresses can be found in the Appeal Addresses section directly above. You have 90 days from the date your claim is denied. In your letter, you must include:

• A copy of the denial letter or explanation of benefits (EOB)
• Any supporting documents that may help your case
  • If you do not have all supporting documents, send the appeal and state that you will send supplemental documents when they become available.

The contractor will review the appeal and notify you of a decision. If the amount for which you are filing is less than $50, the decision is final. If it is for more than $50 and your appeal is denied, you may request a formal review with the Defense Health Agency (DHA) within 60 days. 

How to Request a Formal Review

Request a formal review with the DHA by sending a letter and a copy of your denial notice to the address found in the chart for your region in the Appeal Addresses section.

The DHA will review the appeal and submit a final decision. If the disputed amount is for less than $300, the decision is final. If it is for more than $300, the next step is to request an Independent Hearing with the Defense Health Agency within 60 days. 

How to Request an Independent Hearing

Request an independent hearing by sending a letter and a copy of the formal review decision to the address for your region found in the chart in the Appeal Addresses section. This in-person hearing will take place at a location agreed-upon by both you and the hearing officer. This decision is final.

Filing a Medical Necessity Appeal

To file an appeal of a denial of medically necessary services, send a letter to your regional contractor explaining that you do not agree with the TRICARE decision. Appeal addresses can be found in the Appeal Addresses section. You have 90 days from the date you receive your denial letter. In your letter, you must include:

• A copy of the denial or explanation of benefits (EOB)
• Any supporting documents that may help your case
  • If you do not have all supporting documents, send the appeal and state that you will send supplemental documents when they become available.

Upon reviewing your claim, the contractor will send you a decision. If you disagree, you may request a reconsideration from the TRICARE Quality Monitoring Contractor within 90 days. 

How to Request a Reconsideration

Send a request for reconsideration to the address that is listed in the decision notice. Attach a copy of your appeal. The Quality Monitoring Contractor will review your request and make a decision, which may be further reviewed if the disputed amount is for more than $300. 

How to Request an Independent Hearing 

If you disagree with the Quality Monitoring Contractor, send a letter and a copy of the reconsideration decision to the address for your region found in the chart in the Appeal Addresses section. This in-person hearing will take place at a location agreed-upon by both you and the hearing officer. This decision is final.

Filing a Pharmacy Appeal

If Express Scripts denies your pharmacy claim or prior authorization for pharmacy benefits, you can file an appeal. You must send a letter within 90 days expressing your disagreement. Be sure to include a copy of the claim decision and any supporting documents. Send the letter to the Express Scripts address found in the chart in the Appeal Addresses section.

If Express Scripts denies your appeal, you may request a second level appeal. The appeal decision letter from Express Scripts will provide further instructions.

Supplemental Insurance

Supplemental insurance plans are offered by private companies and military associations to help lower out-of-pocket insurance costs.These plans do not take the place of a health insurance plan; but provide additional coverage on top of an already existing health care plan. 

Supplemental plans pay after TRICARE pays its portion and reimburse beneficiaries for out-of-pocket expenses. These plans will not completely eliminate additional costs. In some cases, the cost of purchasing a supplemental plan may cost more than receiving care through a TRICARE health plan.

What do supplemental insurance plans pay for? 

Supplemental insurance plans differ in what they cover. Most pay some of the out-of-pocket costs that regular TRICARE insurance does not. These may include:

• Daily inpatient charges 
• Out-of-pocket costs for eligible services
• Copayments 

What do supplemental insurance plans not cover? 

Supplemental insurance plans can reduce a beneficiary’s out-of-pocket expenses, but they will not typically cover TRICARE costs, including:

• TRICARE plan enrollment fees 
• TRICARE deductibles
• Charges for pre-existing conditions 

TRICARE Special Programs

TRICARE offers a variety of special programs for qualified beneficiaries enrolled in a TRICARE health plan. Program details and eligibility requirements vary depending on the type of program. Continue reading the sections below to learn more about these programs.

TRICARE Plus

TRICARE Plus offers free primary care at participating military hospitals or clinics. Program participants can only receive care at the specific military hospital or clinic at which they enrolled. Specialty care is not included in this program.

To qualify for TRICARE Plus, enrollees must:

• Meet the eligibility requirements for TRICARE
• Not be enrolled in any TRICARE Prime plan
• Not be enrolled in the U.S. Family Health Plan

To enroll, interested beneficiaries should contact their nearest military hospital or clinic to see if they participate in the TRICARE Plus program.

Transitional Assistance Management Program (TAMP)

The Transitional Assistance Management Program (TAMP) provides 180 days of premium-free TRICARE health coverage for qualifying TRICARE beneficiaries. It is available to sponsors and eligible family members who are no longer receiving any TRICARE benefits due to one of the following reasons:

• An active duty sponsor involuntarily separated from military service under honorable conditions, including:
  • Members who receive a voluntary separation incentive (VSI)
  • Members who receive voluntary separation pay (VSP) and are not entitled to retired or retainer pay upon separation
• A member of the National Guard separated from military service for more than 30 days in a row for preplanned missions or in support of a contingency operation.
• A sponsor separated from active duty following involuntary retention (stop-loss) in support of a contingency operation.
• A sponsor separated from active duty after a voluntary agreement to remain on active duty for less than a year in support of a contingency operation.
• A sponsor receives a sole survivorship discharge.
• A sponsor separates from active duty to become a Selected Reserve or Reserve Component member on the immediate day following active duty release.

The 180-day TAMP period begins on the first day of separation. Qualified beneficiaries can use the following TRICARE plans:

• TRICARE Prime
• TRICARE Select 
• U.S. Family Health Plan 
• TRICARE Prime Overseas 
• TRICARE Select Overseas 

Chiropractic Health Care Program

The Chiropractic Health Care Program provides chiropractic care to active duty service members, including activated members of the Reserve and the National Guard, at certain military hospitals and clinics. Qualified enrollees receive treatment for pain in the back, neck and arm or leg joints.  

The following individuals cannot participate in this program:

• Retirees
• Family members
• Survivors
• Unmarried former spouses of military members

To receive care through this program, the beneficiary’s PCM determines if it is necessary. Then, the PCM will examine him or her to rule out any medical conditions that would otherwise prevent chiropractic care. If care is necessary, enrollees will receive a referral to see a chiropractor. 

Combat-Related Special Compensation (CRSC) Travel Benefit

The Combat-Related Special Compensation (CRSC) Travel Benefit is designed to help beneficiaries who need to travel more than 100 miles to receive specialty care for a combat-related health condition. Qualified recipients can be disabled or non-disabled retired military service members whose disabilities are combat-related. Upon verification of the condition, they are eligible to receive tax-free monthly stipends.

To qualify, beneficiaries must meet the following conditions:

• Receive a CRSC determination letter that identifies their combat-related condition
• Receive retirement pay
• Live in the U.S.
• Enroll in a TRICARE Select or TRICARE For Life plan
• Receive a referral from their provider for specialty care related to the combat-related condition

Continued Health Care Benefit Program

The Continued Health Care Benefit Program (CHCBP) extends health care benefits after TRICARE ends for a period of 18 or 36 months. This is a premium-based, temporary health care plan that gives beneficiaries time to transition from military benefits to civilian healthcare. Qualified beneficiaries have 60 days from the date they lose TRICARE coverage to enroll in CHCBP.

To qualify, the service member’s separation must be under “other than adverse conditions,” which is a separation that is other than “honorable” or “general”. The duration of CHCBP benefits depends on the sponsor’s military status. Below is the length of coverage for each category when loss of coverage occurs.

• Active duty service member released from active duty: 18 months
• Full-time member of the National Guard separated from full-time status: 18 months
• TAMP participant: 18 months
• Selected members of the Reserve who are covered by TRICARE Reserve Select: 18 months
• Retired members of the Reserve covered by TRICARE Retired Reserve: 18 months
• Dependent spouse, child or unmarried former spouse: 36 months

Autism Care Demonstration Initiative

Through the Autism Care Demonstration Initiative, all TRICARE beneficiaries who are diagnosed with Autism Spectrum Disorder (ASD) are eligible to receive applied behavioral analysis (ABA) health care services from a Board Certified Behavior Analyst (BCBA). The BCBA, otherwise known as an “ABA Supervisor,” plans, delivers and supervises an ABA program for the member.

Receiving care through the Autism Care Demonstration Initiative is a three-step process. 

Step 1: Diagnosis

Beneficiaries need an official ASD diagnosis from one of the following types of providers:

• A primary care physician who practices family, internal or pediatric medicine
• A Board Certified or Board Eligible physician in one of the following disciplines:
  • Licensed Clinical Psychology, doctoral level
  • Doctors of Nursing Practice in one of the following specialties:
    • Developmental-Behavioral Pediatrics
    • Neurodevelopmental Pediatrics
    • Pediatric Neurology
    • Adult or Child Psychiatry

Step 2: Referrals and Prior Authorization

All beneficiaries need referrals, no matter what type of TRICARE plan they have. The diagnosing provider will submit a referral for ABA services to the beneficiary’s regional contractor. When approved, the beneficiary will receive an authorization letter to cover six months of ABA services from an authorized ABA supervisor, after which the supervisor must request continuation of services every six months. 

Step 3: Scheduling Appointments

Beneficiaries must schedule an appointment with the provider listed in the authorization letter. If they wish to see a different provider, they must contact their regional contractor. A list of contact information for these contractors can be found in TRICARE Program Contact Information.