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TRICARE Health Insurance Coverage & Benefits Plans

TRICARE Health Insurance Coverage & Benefits Plans

What is TRICARE Insurance?

TRICARE (aka: the Triple Option Benefit Plan) is the health care and health insurance program provided to members of the United States military and their dependents. Whether you are an active duty service member, a member of the National Guard or the Reserves, a veteran, or a military dependent, there’s a high likelihood that you are eligible to receive TRICARE medical insurance benefits.

TRICARE, which was formerly called the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), is the official health care program of the United States Department of Defense Military Health System. TRICARE offers civilian health benefits for military personnel, veterans, and their dependents. Think of it as the civilian care component of the Military Health System.

TRICARE benefits are provided with three main options, which you should think of as three levels of insurance coverage (the better ones cost more, but also offer additional benefits). You will want to pick your TRICARE plan based on your specific medical situation.

The three TRICARE plans are called:

  1. TRICARE Standard – Similar to the old CHAMPUS program
  2. TRICARE Extra – Similar to a Preferred Provider Organization (PPO) insurance plan
  3. TRICARE Prime – Similar to a Health Maintenance Organization (HMO) insurance plan

TRICARE plans have some significant differences (in both costs incurred and benefits offered), so if you’re looking at selecting your own medical insurance, please be sure to read the rest of this article closely before choosing which TRICARE insurance plan you want to go with.

TRICARE Standard

TRICARE Standard is a plan similar to the original CHAMPUS program that used to be provided to military personnel. TRICARE Standard is a program available to active duty military, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members (military dependents).

TRICARE Standard plans allow you to use any civilian health care practitioner as long as they are payable under TRICARE regulations. TRICARE Standard does not require an enrollment fee, but you do have to pay an annual deductible and coinsurance (copayments), along with other potential out-of-pocket (uncovered) expenses.

Depending on your unique medical situation, TRICARE Standard could be the best plan for you, but it could also be the worst!

While TRICARE Standard benefits offer you a selection of the broadest range of medical providers to choose from, you won’t have a Primary Care Manager (which some people like having) and you may have to spend significant amounts of money to meet your deductible and cover out-of-pocket expenses. Make sure that you do your research before signing up for this plan!

TRICARE Extra – Similar to a PPO Plan

TRICARE Extra is only available to TRICARE Standard members (it’s basically an upgrade from TRICARE Standard). TRICARE Extra lets you go to any civilian health care provider that you want, as long as they’re within the regional contractor’s provider network (there are limits here!). TRICARE Extra is like a PPO plan, because you can basically go to any doctor you want, without having to get a referral from your primary physician (which you would need if you’re enrolled in TRICARE Prime).

TRICARE Extra may even provide you with a money saving opportunity, though it depends on what type of health benefits you will be using. Co-Payment under TRICARE Extra are 5% less expensive than under TRICARE Standard, and there is also no enrollment fee to join this plan, except for the copayments you will be responsible for making each time you visit a medical facility.

TRICARE Prime – Similar to an HMO Plan

TRICARE Prime is available to all active military personnel and is similar to an HMO insurance plan. TRICARE Prime does not have an enrollment fee for active duty service members, or for members of their families. However, members of the TRICARE Prime benefits package must choose a primary care physician, also called a Primary Care Manager, and receive direct referrals from that physician in order to visit other specialists for ‘specialty care’. Because of the referral process, most TRICARE Prime members are treated at military-run facilities and health centers.

TRICARE Prime offers the advantage of being typically, but not always, significantly cheaper than the other TRICARE healthcare plans, with much lower fees and a lack of annual deductibles (which can be very expensive). However, the number of available treatment facilities and the choice of health care providers are limited for those individuals who enroll in TRICARE Prime, and you can’t just walk into any doctor you want whenever you feel like it.

If you don’t need much in the way of healthcare though, and especially if you don’t have any specialty care issues, this may be the best plan for you because of it’s possible cost savings.

How Much Does TRICARE Insurance Cost?

Use the following TRICARE benefits calculator tables to determine how much each of the three TRICARE medical insurance plans will cost for you and your dependents. Make sure to use the right table, depending on which category you fall into.

Calculator for Active Duty, Guard, Reserves & Their Dependents

Tricare Medical Insurance Plan Benefits Calculator Chart

Calculator for Retirees (under 65), Their Dependents & Others

Tricare Medical Insurance Benefits Cost Estimator Tables

TRICARE Vision Coverage

The level and type of TRICARE vision insurance available to military personnel depends on both the beneficiary status of the military member and the type of TRICARE insurance package (Standard, Extra or Prime) that the member is enrolled in.

Members of the TRICARE Standard plan typically do not receive substantial TRICARE eye coverage benefits. Similarly, members enrolled in TRICARE Extra are also not likely to receive comprehensive TRICARE optometry benefits. Enrollees of TRICARE Standard and Extra are, however, provided with one eye exam per year, given that they are either an active duty member of the United States Armed Forces, or a dependent of someone on active duty.

Under the “well-child” benefit, children up to the age of six who are enrolled in TRICARE Standard or Extra plans can also receive eye and vision screening by their Primary Care Managers, which is definitely helpful, but nowhere near the level of vision benefits provided by TRICARE Prime coverage.

Unlike TRICARE Standard and Extra plans, people enrolled in TRICARE Prime do receive comprehensive vision benefits, some of which can be extraordinarily useful. TRICARE Prime vision coverage offers comprehensive eye exams once every other year for members three or older. Pediatric vision screening is available from birth to approximately six months of age, and diabetic patients of all ages are eligible for annual comprehensive eye examinations.

TRICARE Prime eye coverage also allows treatment to be received from TRICARE eye doctors operating under all eligible TRICARE vision providers. People with the Prime version of the TRICARE vision plan may also receive services from opticians who are not registered TRICARE optometry providers, if those members have received a direct referral from their Primary Care Manager, and received authorization from their Health Care Finder.

TRICARE Dental Insurance Coverage

The TRICARE Dental Program is a voluntary dental insurance program that can be utilized by eligible Active Duty family members, Select Reserve and Individual Ready Reserve members. Family members of the Select Reserve and Individual Ready Reserve may also be eligible to receive TRICARE dental benefits.

TRICARE Dental Coverage:

  • Participants in TDP can receive 100% coverage for emergency, diagnostic and preventative dental treatments. The only exception to full-coverage for emergency, diagnostic and preventative treatments is sealants. Sealants are covered 80% by the TRICARE dental plan with the member responsible for paying 20% of the cost out of pocket.
  • Other cost share services include: filings, roots canals, orthodontics, crowns, extractions and periodontics.
  • The maximum annual coverage benefit for routine dental care is $1200.
  • The lifetime maximum coverage for orthodontic services is $1500.
  • Additional services available to eligible TRICARE members includes dental implants, dental prosthetics and various restorative services.

TRICARE Retiree Dental Program

The TRICARE retiree dental program is a premium-based benefits package.

This TRICARE dental plan is available to all uniformed service retirees and certain family members. Delta Dental Plan of California administers the TRICARE dental for retirees program, with coverage including a wide variety of treatments. Coverage is worldwide and premiums are paid by the enrollee, though the cost of those premiums can vary between states. As a TRICARE dental retiree member, you can visit any dentist within your service area for treatment. Members can visit dentists out of their service area as well, but complete payment by TRICARE for dental fees incurred outside of your service area are not guaranteed.

TRICARE Retiree Dental Plan Benefits Cost Calculator :

TRICARE Retiree Dental Plan Benefits Cost Calculator Chart

TRICARE Supplemental Insurance Plans

Various civilian insurance companies provide TRICARE supplemental plans which may allow those using TRICARE benefits packages to pay less out of pocket for uncovered medical procedures. These plans function as supplemental insurance, covering the gap between what your TRICARE benefits cover, and what you’re supposed to be paying for copay, or out of pocket.

There are a wide variety of TRICARE supplemental insurance providers around the country, which consist of both military associations and even private insurance companies that primarily cater to civilians.

Benefits, cost, and coverage varies between providers, so you should make sure to thoroughly research each of the potential TRICARE supplemental plans available, try to predict what kind of medical procedures and costs you’ll be responsible in the future, and choose the TRICARE supplemental insurance plan that best reduces your out of pocket costs.

Which TRICARE Region do I belong to?

As of 2004, TRICARE has been divided into 3 main regions that members can find TRICARE providers from. These main regions are known as TRICARE South, TRICARE North and TRICARE West. When you enroll in a TRICARE program, you will be assigned a region, and will need to choose your medical providers from within that region.

TRICARE South

TRICARE South provides TRICARE coverage to the following states and regions:

  • Alabama
  • Arkansas
  • Florida
  • Georgia
  • Louisiana
  • Mississippi
  • Oklahoma
  • South Carolina
  • Tennessee (excluding Ft. Campbell area)
  • Texas (excluding el Paso area)

TRICARE North

TRICARE North provides healthcare to the following states and regions:

  • Connecticut
  • Delaware
  • District of Columbia
  • Illinois
  • Indiana
  • Kentucky
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • New Hampshire
  • New Jersey
  • New York
  • North Carolina
  • Ohio
  • Pennsylvania
  • Rhode Island
  • Vermont
  • Virginia
  • West Virginia
  • Wisconsin
  • Iowa – Rock Island Arsenal area
  • Missouri – St. Louis area
  • Tennessee – Ft. Campbell area

TRICARE West

TRICARE West provides TRICARE benefits to the following states and regions:

  • Alaska
  • Arizona
  • California
  • Colorado
  • Hawaii
  • Idaho
  • Iowa (excluding Rock Island Arsenal area)
  • Kansas
  • Minnesota
  • Missouri (excluding the St. Louis area)
  • Montana
  • Nebraska
  • Nevada
  • New Mexico
  • North Dakota
  • Oregon
  • South Dakota
  • Texas (southwestern corner including El Paso)
  • Utah
  • Washington
  • Wyoming
  • Oregon

How Do I Sign Up For a TRICARE Insurance Plan?

As long as you are registered in the Defense Enrollment Eligibility Reporting System you are automatically enrolled in TRICARE Standard or TRICARE Extra. However, TRICARE Prime requires an application which can be completed either online or by mail (find the TRICARE Prime application form here).

Potential participants in the TRICARE Dental Program and the TRICARE Retiree Dental Program also requires an application process which can be completed either entirely online or by mail (find the TRICARE dental forms here).

As you can see, TRICARE Insurance is an invaluable and extremely useful health benefit system available to certain military members. Make sure you find out what benefits are available to you and how you can gain effective access to them. To fully understand your benefits and how to apply for them you may want to contact your local TRICARE Support Center or your Beneficiary Counseling and Assistance Coordinator.