Department of Defense — not VA

TRICARE: the plans and who qualifies

TRICARE is the military health plan, run by the Defense Department. VA health care is a separate system, run by VA. Mixing the two up sends you to the wrong door — and it decides whether CHAMPVA is even on the table for your Family.

Veterans Crisis Line — dial 988, then press 1. Text 838255. Chat at veteranscrisisline.net. TTY 711 then 988, or 1-800-799-4889. 24 hours a day, 7 days a week. You do not have to be enrolled in VA benefits or health care to connect.

The one distinction to hold onto. TRICARE comes from the Defense Department and covers service members, retirees, Guard and Reserve, their Families, survivors and certain former spouses. CHAMPVA comes from VA and covers certain Family members of disabled or deceased veterans. They do not overlap, and the rule runs one direction: check TRICARE first. If you are eligible for or enrolled in TRICARE, you cannot get CHAMPVA. CHAMPVA is the coverage for Family members who are not TRICARE-eligible.

Rough routing, then read the panel. Active duty Family living near a base → Prime · Retiree who wants civilian doctors → Select · Drilling reservist → Reserve Select · Retiree with Medicare → For Life · Adult child age 24 → Young Adult. Every one of those has a qualifier under it. Read the panel before you enroll.

Plan

TRICARE Prime

Managed care, HMO-style. Lowest out-of-pocket cost of the main plans.

You are assigned a Primary Care Manager (PCM) — the doctor or clinic that runs your care. It may be a military or a civilian network provider. You may request a specific one.
Referrals are usually required to see a specialist.
Covers primary care, specialists, emergency care, hospital visits, mental health, prescriptions and preventive care.

Prime is not available everywhere. It is sold only in designated Prime Service Areas, generally near a military hospital or clinic. If you do not live in one, Prime is not an option for you — use TRICARE Select. Check the Plan Finder at tricare.mil.

Skip the referral and you pay for it. Get specialty care without a referral and you fall under the point-of-service option — a separate deductible and a much higher cost-share. Get the referral first. Active duty service members must always use the referral process.

★ Cheapest plan, tightest rules.

Plan

TRICARE Select

PPO-style. More freedom, higher out-of-pocket cost.

No Primary Care Manager to go through.
No referral needed for most specialists.
You choose your providers from a wider field.
Costs you more out of pocket than Prime.

Active duty cannot use Select. Active duty service members, including activated Guard and Reserve, must use Prime.

Not every doctor accepts TRICARE, and moving to another state can change which providers are available to you. Confirm the provider takes TRICARE before the appointment, not after.

★ Your pick of doctor, your bigger bill.

Costliest mistake

Medicare Part B and your TRICARE

This is the one that ends coverage. Read it even if you are nowhere near 65.

If you are eligible for TRICARE and for Medicare Part A, in most cases you must also have Medicare Part B or you lose TRICARE entirely. Sign up no later than 2 months before you turn 65.

The exception. Active duty service members and active duty Family members may delay Part B without a late-enrollment penalty while the sponsor is on active duty. Do not buy Part B early if that is you.

This is not only a 65 event. Medicare eligibility through disability, end-stage renal disease, ALS or mesothelioma triggers the same Part B requirement at any age.

tricare.mil/Plans/Eligibility/MedicareEligible

★ No Part B, no TRICARE.

Plan

TRICARE For Life

Not just for retirees over 65. Read the breadth of this one.

For any TRICARE-eligible beneficiary who has Medicare Part A and Part B — regardless of age or where you live.
That includes retirees, spouses, survivors, certain former spouses, and beneficiaries under 65 who became Medicare-eligible through disability, end-stage renal disease, ALS or mesothelioma.
Medicare pays first. TRICARE usually pays second.

There is nothing to enroll in and no enrollment fee. For Life starts automatically once you have Part A and Part B. There is no For Life card — your Medicare card and your military ID are the proof. The step people miss is not enrolling in For Life; it is enrolling in Part B.

Overseas the order flips. Outside the United States and its territories, TRICARE pays first, because Medicare provides no overseas coverage — and you still must keep Part B to stay TRICARE-eligible. And if you have coverage through a current employer, that plan pays first, Medicare second, TRICARE last.

★ Automatic, once Part B is in place.

Plan

TRICARE Young Adult

A plan your adult child buys. Two versions, two prices.

Regular TRICARE for a dependent child ends at 21 — or at 23 if the child is enrolled full-time at an approved school and the sponsor provides more than half their support.
Young Adult then covers ages 21 to under 26, by monthly premium.
The child must be unmarried, aged out of regular TRICARE, not otherwise eligible for TRICARE, and not eligible to enroll in an employer-sponsored health plan based on their own employment.

Young Adult is two separate plans. TYA-Prime assigns a PCM, requires referrals, and is sold only in Prime Service Areas. TYA-Select lets you use any authorized provider with no referrals. The premiums differ. You must qualify for and purchase one of them.

Do not buy premiums you do not owe yet. A 22-year-old full-time student may still be on regular TRICARE to age 23.

★ Know which version before you pay.

Plan

TRICARE Reserve Select

Premium-based coverage for the Selected Reserve and their Families. Nationwide network.

For Selected Reserve members, including National Guard, and their Families.
You must be not on active duty orders for more than 30 days. Shorter orders do not disqualify you.
Individual Ready Reserve members do not qualify.

Federal employment can bar you. You cannot buy Reserve Select if you are eligible for or enrolled in the Federal Employees Health Benefits (FEHB) program.

There is still a door. If your spouse is a Selected Reserve member who does qualify, you can be covered under their Reserve Select enrollment. Check the spouse's eligibility before you give up on it.

★ Drilling reservist, civilian life, real coverage.

Plan

TRICARE Retired Reserve

The bridge from Guard or Reserve retirement to age 60.

Premium-based, for retired Guard and Reserve members under age 60 who qualify for a non-regular retirement.
It bridges the gap until you are eligible for retiree TRICARE at 60.
Same FEHB bar: not available if you are eligible for or enrolled in FEHB. That bar does not apply to survivor coverage.

At 60 the clock starts. You have 90 days from your 60th birthday to enroll in a retiree plan. Miss it and you may request retroactive enrollment effective from your 60th birthday — but the enrollment fees are backdated to that date, so you pay for the months you were not using.

tricare.mil/LifeEvents/Retiring/GuardReserve

★ Cover the years before 60.

Dental

TRICARE Dental Program

Separate from your health plan. You enroll in it on purpose.

For active duty Family members, Guard and Reserve Families, and non-activated Guard and Reserve members themselves, plus some survivors.
Active duty service members are not eligible — you get active duty dental care instead.
Pays 100% for most preventive and diagnostic services. Restorative and specialty care carry cost-shares. Orthodontics is covered subject to limits, and overseas requires a Non-Availability and Referral Form.

Two 12-month rules. You must enroll for a minimum of 12 months, and your sponsor must have at least 12 months remaining on their service commitment when you enroll. That is a spending commitment — know it going in.

United Concordia administers the Dental Program — that is who you call to find a dentist or check a claim (uccitdp.com).

★ Enroll on purpose, for a year.

Dental

Retirees and survivors: dental

Retirees generally do not use the TRICARE Dental Program. They use FEDVIP.

FEDVIP is the federal dental and vision program, run by the Office of Personnel Management.
You enroll through BENEFEDS (benefeds.gov), during Federal Benefits Open Season or after a qualifying life event.

Survivors, this is better than most people are told. If the sponsor died on active duty, TRICARE pays 100% of the monthly Dental Program premium under the survivor benefit. Surviving spouses keep it for three years and then move to FEDVIP. Surviving children continue until they otherwise lose TRICARE eligibility.

tricare.mil/CoveredServices/Dental/RetireeSurvivorBenefit

★ Ask for the survivor dental benefit by name.

VA, not DoD

CHAMPVA

VA's health coverage for certain Family members. It is not TRICARE and not VA health care.

CHAMPVA covers the Family, not the veteran. The veteran uses VA health care. This is the coverage for the spouse or the children.

You may qualify if you are:

The spouse or child of a veteran rated permanently and totally disabled from a service-connected disability;
The surviving spouse or child of a veteran who died from a service-connected disability;
The surviving spouse or child of a veteran who was rated permanently and totally disabled at the time of death; or
The surviving spouse or child of a service member who died in the line of duty, not due to misconduct.

Check TRICARE first. If you are eligible for or enrolled in TRICARE, you cannot receive CHAMPVA. It does not run the other way — being told you are "a CHAMPVA person" is not a reason to skip checking your TRICARE eligibility.

Children are covered to age 18, or to 23 if enrolled in high school, college or another educational institution — indefinitely if permanently unable to support themselves from a disability that began before 18.
A surviving spouse who remarries before age 55 loses CHAMPVA on the date of remarriage, but may requalify the first day of the month after that marriage ends. Remarrying at 55 or older does not end CHAMPVA.

How to apply: VA Form 10-10d. Start at va.gov CHAMPVA.

★ VA's program. Different door.

Deadlines

The windows that close

Most TRICARE losses I see are deadlines, not denials.

A Qualifying Life Event — retirement, marriage, birth, a move, a child aging out — opens a 90-day window to enroll or change plans.
Retiring from active duty: you must make an enrollment decision within 90 days of retirement or you lose TRICARE coverage and are limited to space-available care at a military facility.
Guard or Reserve retiree turning 60: 90 days from your birthday.
Open Season runs each fall — Monday of the second full week of November to Monday of the second full week of December.

Update DEERS. DEERS is the Defense Enrollment Eligibility Reporting System — the roster that says who you are and who your Family is. If DEERS is wrong, your coverage is wrong. Update it at milConnect or call the DMDC/DEERS Support Office at 800-538-9552 (TDD/TTY 866-363-2883).

★ 90 days. Put it on the calendar.

Who to call

The right company for your region

TRICARE is run region by region. Calling the wrong contractor wastes the window.

East Region — Humana Military: 800-444-5445 · humanamilitary.com
West Region — TriWest Healthcare Alliance: 888-874-9378 (888-TRIWEST)
Prime Demonstration in Atlanta and Tampa is administered by CareSource Military & Veterans
Find your region: tricare.mil/About/Regions
Plans, costs and the Plan Finder: tricare.mil
Manage benefits, view documents, update your record: milConnect
Dental: United Concordia (uccitdp.com) · Retiree dental and vision: BENEFEDS (benefeds.gov)

I do not print dollar figures here. Premiums, deductibles, cost-shares and enrollment fees change. Pull the current numbers from tricare.mil before you decide.

★ Right region, first call.

Ask about these

Plans this page does not cover

This is the main lineup, not the whole lineup. If none of the above fits, ask about these by name.

US Family Health Plan — a Prime option in certain areas
TRICARE Prime Overseas and TRICARE Select Overseas
The TRICARE Pharmacy Program, which is its own benefit
The Autism Care Demonstration and ECHO, for Family members with special needs

If a contractor tells you that you do not qualify for anything, ask which of these you were screened against. Name them out loud.

★ You cannot ask for what you never heard of.