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Who and What is Covered?

Who and What is Covered ?

Who and What is Covered? Want to find out whether or not you are covered by the TRICARE health care plans? Read on to find more.

Who and What is Covered?

TRICARE is the military’s health coverage insurance program. As a military person, you are automatically entitled to the benefits that accompany TRICARE and are included under the coverage. This program is implemented and is available for acquisition for all seven service branches of the United States militia: Navy, Marine Corps, Air Force, Army, Coast Guard, Public Health Service and the National Oceanic and Atmospheric Administration. To utilize and access the benefits of TRICARE, it is essential to be enrolled and registered validly and officially, in the Defense Enrollment Eligibility Reporting System, which is colloquially referred in military vernacular by its simple acronym, ‘DEERS’. After dutiful registration in DEERS, you are deemed to be eligible to receive military health care gains.

However, it is not only military personnel that are covered under TRICARE. It extends beyond them and provides medical coverage for the immediate family members of the military. The beneficiaries of TRICARE are broadly split into two ways; those serving or have served in military ranks previously are known as sponsors, who sponsor their immediate families to come under the TRICARE umbrella. The families therefore form the other type of major beneficiary of TRICARE.  While families are generally taken to be just the spouse and children, TRICARE offers coverage for more than that.

Family Coverage Under TRICARE:

Typical family coverage under TRICARE includes marital affiliates, biological or adopted children, sponsor dependent parents and parents in law. However, instances and circumstances of family eligibility differ. TRICARE eligible family members include:

  1. Marital partners (wife/husband) and single, unwed children of active duty service military affiliates.
  2. Marital dependents and unmarried offspring of retired uniformed service members.
  3. Military Individuals who have been conferred the Medal of Honor and their immediate family members
  4. Former spouses who have remained single and children who are yet single of deceased, retired or active duty uniformed individuals.
  5. Marital dependents and unwed, underage progeny of members of the Reserves and National Guard who are under order and command to serve in active duty for more than thirty days at a stretch or individuals in reserve and the National Guard who are killed while serving in combat duty.
  6. The wives/husbands and their respective single as yet underage children of reservists and members of the National Guard who are killed under any kind of circumstance or condition pertaining to active combat..
  7. Financially and functionally dependent parents and parents in law can also be afforded care coverage under TRICARE under excruciating circumstances.
  8. Unwed, single offspring who are under or have attained the age of twenty-one. This also includes stepchildren who have been legally adopted by the military person in question. TRICARE remains in place even if the spouse gets divorced or remarries. However, if the stepchild was never adopted and if the marriage breaks down due to divorce, TRICARE privileges will be revoked. This does not mean that TRICARE coverage was not there whilst the stepchild’s parents were married.
  9. Children over the age of 21 may be covered if they are excruciatingly handicapped or have disabilities that hinder proper functioning and if the condition was present before his or her 21st birthday.
  10. Children of military sponsors may also be covered under TRICARE till the age of 23, if they are still in school or an institute of higher learning on a full-time basis. It also needs to be proven that the child in question is at least partially (50%) responsible on his or her parents.
  11. Children who are lawfully placed in the guardianship of an active or retired service member.
  12. The offspring of incumbent or past military service members who are illegitimate may also qualify as legible candidates for TRICARE coverage, but certain conditions may apply and consulting a Health Benefits Advisor may be helpful.
  13. In addition, some family individuals of incumbent service members may be eligible for medical coverage if their military sponsor is under court ordered separation and is martialed for spousal and child abuse.
  14. Spouses and children of the North Atlantic Treaty Organization (NATO) and Partners For Peace (PFP) country ambassadors who are under official authority, allowed to travel and stay with the NATO and PFP country spokespersons. They are eligible for out- patient benefits only as long as they are currently living in or temporarily staying in (travelling through) the United States of America.
  15. Other family members registered in the Defense Enrollment Eligibility Reporting System (DEERS).
  16. Former marital partners of uniformed service men (including active, retired and former), but they need to meet certain requirements:
  • They must not remarry; if they do so TRICARE privileges will be revoked in any case, even though the new marriages are dissolved as a consequence of death or divorce.
  • They should not have an existing or additional health insurance plan such as that covered by the employer.
  • They should not have been married at all in the past to any of the NATO or PFP nation members.
  • It is essential that the person has been married to the same member or former member for at least two decades.

What is covered?

TRICARE is medical insurance, meaning that it will only cover the medical aspects of your life. This insurance will only benefit you medically in case of any type of emergency or procedure that is required. Normally, TRICARE benefits will depend upon and vary according to the type of plan that is in intended usage. TRICARE covers hospitalization and outpatient visits as well as procedures involved in preventive care and maternity care. Immunizations as well as mental / behavioral health care are also included under the coverage program. Furthermore, TRICARE covers most inpatient and outpatient care that is medically necessary and proven. It also includes a yearly physical exam as well as any kind of surgery, be it robotically assisted, preexisting conditions, pharmaceutical prescriptions and other types of medical emergencies, including but not limited to cosmetic surgery as a result of disfigurement due to burns and so on.  Pharmacy services ensure that you are provided with the prescription drugs you need, when you need them in a timely and cost effective manner. TRICARE covers most prescription drugs approved by the U.S. Food and Drug Administration (FDA). However, it will not cover over the counter drugs.

You have the right to receive all the hospital care that is necessary for the proper diagnosis and treatment of your illness or injury. According to Federal law, your discharge date must be determined solely by your medical needs, not by Diagnosis Related Groups (DRGs) or by TRICARE payments. You have the right to be fully informed about decisions affecting your TRICARE coverage and payment of your visit to or stay in the hospital and any post-hospital services.

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68 comments

  1. Joesph E Tibor Sr /SSGT/USMC Retired

    Will preexisting medical issues for my wife, Married ( 06/06/2015 )be covered under my Champus coverage. She does have a retired dependent ID card .

  2. I am curious about the item number 7 in the Who and What is Covered section of this website. I am the sponsor and a 21 year retired USAF Member. I along with my wife and daughter (college) are covered through TriCare Prime. I have a situation in which my mother-in-law, who is in dire need of care, is not being taken care of medically. I would like to find out what I would have to do to be eligible for item number 7. (Financially and functionally dependent parents and parents in law can also be afforded care coverage under TRICARE under excruciating circumstances.) She has already been diagnosed with dementia and I fear that if she stays on her own, she will wind up hurt due to her leaving her current residence. I would be the sole provider for my mother-in-law.

    Please provide guidance and regulations that will allow me to determine if she would become eligible for insurance through Tri-Care.

    Thank you,
    Donald Edington

  3. Christine Hofrichter

    I will be officially retire on 1 March 2016 from the Naval Reserve with Pay because I am turning 60. Will I be eligible to enroll in Tricare Prime?

  4. I see a Pain Management doctor every 4 month’s for pain management issues. I need to know what I need to do to get my approval for the next 6 month’s to 1 year so that I can continue to see my doctor as I have been since 2007. So, How do I get Tricare to approve my doctors visits for the next 6 mos – 1 year as required by my Tricare Prime Insurance? I have a scheduled appointment to see my doctor on 15 Oct 2015. I cannot see her until Tricare approves my next 2 visits. Please advise as to how I can speed-up my approval as I clearly get approved every time My doctor requires Tricare to approve such visits since Sep 2007. Thank you for any advice or assistance you can give me.

  5. My wife had an eye exam today and I was wondering if part of the office call is covered by Tricare. Please
    let me know. If it is covered where do I send the paid receipt?

    Thank you for your time and consideration.

    Sincerely;

    John K. Endsley Navy Retired

  6. I just got married and want to know how to add my wife to my policy.

  7. George Louis Miranda

    Wondering if you have a program called silver slippers?

  8. I have had a double chin all my life? I’ve lost weight and now I have hanging skin on my neck and stomach. Does Tricare standard cover the surgery to remove or fix it?

  9. Does Tricare standard cover either breast reductions or bariatric surgery if proven that its needed?

  10. I am a widow of a 21yr Navy Serviceman..I have Tricare medical for life. Am I eligible to sign up for Tricare Dental? Thank you for your assistance

  11. I need proof of Tricare coverage, how do I obtain that proof

  12. Hello,

    I recently filled my prescription medications at a CVS. Along with the medicines I also received bills/receipt. How do I know if CVS already claimed the bills at Tricare, and so what I had to pay at that moment is what’s left after tricare coverage? Not sure if I still need to send the bill to Tricare or that it is already handled.

  13. I am retired Air Force and am wanting to get my teeth pulled and get false teeth. Please advise.

  14. I need to know if this insurance would help pay for bartitic surgery that the dr. would recommend ..

  15. My 91-year-old father is covered by Tricare. His physician gave him a prescription for a lift chair, which tilts and raises him more easily to his feet as he rises. Is this a covered expense?

  16. How can i contact tricare by phone?

  17. HOW DOES ONE GET SIGNED UP IN D.E.E.R.S.

  18. I’m a reserve retiree. Am I eligible for any insurance ?

  19. I’m 56 and a reserve retiree. Am I eligible for any insurance ?

  20. John H Champagne ETCS Retired

    My spouse needs a Hip replacement . Is this covered after Medicare pays it’s share?

  21. I am trying to find a list of marriage counselor’s in my area, Marion, IL 62959

  22. My husband is a retired disabled navy vet. He needs to have cataract surgery. Will tricameral cover this?

  23. how do I find the doctors, hospitals and pharmacies in my area
    What is the cost for an office visit? regular doctor? specialist?
    what is the deductible per year?
    what % of bill is to be paid after deductible is met?
    I have Tricare for life

    Thank you for your assistance.

  24. If a sponsor has given up their rights as a parent in the court of law and the child currently has Tricare are they still eligible for Tricare and benefits if the sponsor is still in the military ?

    • Children
      – A sponsor’s biological and adopted children stay eligible for TRICARE until they age out.
      – To be TRICARE eligible, your child must be a dependent. This means they aren’t married or serving on active duty.
      – After your child ages out, they can choose to purchase TRICARE Young Adult until they turn 26.
      – A sponsor’s stepchildren who weren’t adopted by the sponsor will lose TRICARE eligibility once the sponsor updates DEERS with the divorce decree.

      For more information, visit: http://www.tricare.mil/LifeEvents/Divorce

  25. I just want clarification on one issue. We have a daughter who is almost 20 yrs old. She is not going to school at all and still lives with us. We pay all of her expenses. My husband is retired from the Navy. Is she covered in anyway or is totally on her own?

  26. Do you cover C Pack Machine for sleeping at night.

  27. Marzella L Blackmon

    Does tricare standard pay for blood work to check for high blood pressure

  • I have Tricare and will be going to Mexico in Dec. I have an appointment with a Travel Clinic to receive immunizations necessary- is this covered under Tricare?

    • Vaccines Needed for Travel Outside of the United States
      For travel outside of the United States, immunizations aren’t covered, except for those required by dependents of active duty service members who are traveling outside of the United States with their sponsor on permanent change of duty station orders (or other official travel).

      See here: http://www.tricare.mil/immunizations for more information on immunizations.

  • does Tricare cover a check up on my wife for things such as dislocated hips and ribs?

  • I am a retired Army /Army National Guard veteran, Do I am my family qualify for Tricare? If so how can I get enrolled? My daughter is 17 yrs old…Keith Curd

  • does tricare prime pay any on out of network doctors?

  • Ronald Fernandez De Los Santos

    What is the procedure now for getting referrals for outside dermatology for my wife & son?

  • Does Tricare cover an EMG

  • I have a hear condition, and need tests from a kardiologist…Iso this covered. Also a nodule in my thyroud,, I need a specialist. I still covered without a rereversal. I have medicare and tricare for life. What do I need to do.

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