Medical Care for Military Family Members

Enlisting in the military is a big decision, and an important consideration is healthcare. Within the U.S. Military Health System (MHS) lies TRICARE, the Defense Health Agency’s primary healthcare delivery mechanism. This is the medical system used by active-duty and reserve-duty military, National Guard, and their families for medical treatment. About 40% of the time, that treatment takes place on base at a military treatment facility (MTF). More often, 60% of the time and growing, care is provided at facilities with which the government contracts or purchases care.

Working in the military brings with it specific financial challenges. This article focuses on medical care received by military family members—including eligibility, coverage provided, and the cost of care.

TRICARE

TRICARE provides exclusive medical, pharmacy, and dental coverage to uniformed service members, retirees, and their families. Within TRICARE’s healthcare plans, there are two basic types of care:

1. Direct care at an MTF
2. Purchased care at a civilian provider contracted by the U.S. Department of Defense (DoD)

All TRICARE plans provide minimum essential coverage that meets Affordable Care Act requirements. You don’t need IRS Form 1095-B to file your tax return.

Eligibility

There are two classes of people eligible for TRICARE coverage: sponsors (service members) and beneficiaries (dependents). Sponsors include active-duty service members as well as activated or inactivated members of the National Guard and Reserve. Beneficiaries (dependents) are family members of any of the above who are registered in DEERS.

Others—including surviving family members of a deceased sponsor, former spouses, Medal of Honor recipients, their families, and additional DEERS registrants—are also eligible for TRICARE coverage. Eligibility does not mean you are eligible for all 11 TRICARE plans. Specific plan eligibility depends on your sponsor’s status and duty station.

The table below illustrates which military family members are eligible for which TRICARE plans. Entries marked with an asterisk (*) have special considerations that are spelled out on the TRICARE website.

Source: TRICARE

Coverage Provided

As a military dependent, your benefits and coverage vary according to whether your sponsor is an active-duty service member, a member of the National Guard/Reserves, or a retired service member of any sort. Benefits and coverage also depend on location and duty status, if applicable.

Active-Duty Service Member Dependents

As an active-duty dependent, you have a choice of any TRICARE plan for which your sponsor qualifies. Your enrollment is not automatic, however. Your sponsor must enroll you in TRICARE and DEERS. Depending on your sponsor’s duty station, your coverage may be provided by one of the following:

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

You may also qualify for one of the following:

• TRICARE Select
• U.S. Family Health Plan
• TRICARE for Life (with Medicare)
• TRICARE Select Overseas
• TRICARE Young Adult

Dependents may also purchase the TRICARE Dental Program.

When your sponsor separates from the military, the service member and family members may qualify for the Transitional Assistance Management Program (TAMP), which provides 180 days of premium-free healthcare benefits. After TAMP coverage ends, the former service member and family can enroll in the premium-based Continued Health Care Benefit Program (CHCBP) for up to 18 months of coverage. The service member who does not qualify for TAMP coverage can also enroll in CHCBP for 18 months of coverage.

National Guard/Reserve Member Dependents

Dependents of members of the National Guard or Reserve may be eligible for enrollment in TRICARE. Benefits, if you are eligible, depend on your sponsor’s status.

Line of duty (LOD) care

If your sponsor incurs an injury or suffers illness in the line of duty, such as performing active duty for training (ADT), inactive-duty training (IDT), weekend drill, or other training, they may qualify for LOD care. Treatment, including dental care, will be specific to the illness or injury. LOD care does not qualify family members for health insurance.

Inactive status

Inactive status means your sponsor is on orders for inactive duty, including weekend training, annual training, or active service of 30 days or less. During this period, dependents are eligible for TRICARE Reserve Select, a premium-based healthcare plan.

When activated

When your sponsor is called or ordered to active-duty service for more than 30 days in a row, you become eligible for the same health and dental benefits that active-duty service member dependents get, including TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Overseas Remote, elective plans, and the Active Duty Dental Program. (See Active Duty above.)

When deactivated

When your sponsor deactivates, your healthcare options depend on whether they were activated in support of a contingency operation.

• If activation was not in support of a contingency operation, TRICARE coverage begins on the first day of your sponsor’s orders and ends when they leave active duty. At that time, your sponsor can purchase TRICARE Reserve Select, if you qualify, or the CHCBP, if you do not.
• If your sponsor was activated in support of a contingency operation, your TRICARE coverage begins on the first day of their orders and continues for 180 days after they deactivate under the TAMP. When TAMP ends, your sponsor may purchase TRICARE Reserve Select or the CHCBP.
• If your sponsor’s activation in support of a contingency operation had delayed effective date orders, you become eligible for active-duty dependent benefits up to 180 days before the first day of your sponsor’s orders. When they leave active duty, you will have TAMP coverage for 180 days, following which your family can choose Reserve Select coverage or the CHCBP.

To verify your eligibility for coverage, your sponsor should go to the milConnect site and log in using their Common Access Card (CAC), Defense Finance and Accounting Service (DFAS) myPay Account, or DoD Self-Service Logon (DS Logon) Premium (Level 2) account.

Cost

As with benefits and coverage, your costs under TRICARE depend on whether your sponsor is an active-duty service member or a member of the National Guard/Reserves. Costs also vary for dependents of members of the National Guard and Reserves depending on their enrollment status.

Active-Duty Service Member Dependents

Active-duty members of the military and their families generally receive medical care at no cost through TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas, U.S. Family Health Plan (USFHP), or TRICARE Young Adult (TYA) Prime.

Specifically, there are no annual enrollment or deductible fees for active-duty service members (ADSMs). ADSMs who are enrolled in any of the programs listed above pay no fees unless they use one of the following:

• A network pharmacy or TRICARE Pharmacy Home Delivery
• A TRICARE Prime plan and they get care without a referral
• TRICARE Select

National Guard/Reserve Member Dependents

When your sponsor is activated (on active duty for 30 days or more in a row), you are eligible for the same benefits as active-duty service member dependents (see above). Otherwise, when your sponsor is on inactive status or active for fewer than 30 days, you are eligible for a TRICARE Reserve Select premium-based plan. For 2022, the sponsor plus family monthly premium is $229.99. Copayments and cost shares vary by the service provided.