Medical Care for Service Members

The Military Health System (MHS) is one of America’s largest and most complex healthcare institutions and the world’s preeminent military healthcare delivery operation. The MHS has a simple three-part directive: save lives on the battlefield, combat infectious disease worldwide, and provide healthcare to America’s active-duty and reserve-duty personnel and their families.

Within MHS lies TRICARE, the Defense Health Agency’s primary healthcare delivery mechanism for uniformed service members, retirees, and their dependents around the world. Here we focus on members of the armed services—both active duty and reserve—how they receive healthcare, where they receive it, and what it costs.

History of Modern Military Healthcare

Prior to 1956, military healthcare consisted primarily of keeping soldiers, sailors, Marines, and airmen alive during combat and combat-ready during peacetime. During that period, Title 10 Legislation required medical treatment for active-duty military and treatment on a space-available basis for dependents and retirees.

In 1956, Congress passed the Dependents Medical Care Act, which re-emphasized priority care at military treatment facilities (MTFs) for active-duty service members and officially extended treatment to retirees, dependents, and survivors on a space-available basis. The Military Medical Benefits Amendments were adopted in 1966, establishing the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), the precursor of today’s TRICARE system.

Following a number of benefit improvements, including the establishment of a dental program for dependents, CHAMPUS became TRICARE in 1994. At that time, TRICARE consisted of three health plan options (Prime, Standard, and Extra), provided automatic enrollment for active-duty military, included required treatment for Prime enrollees, and on a space-available basis for non-enrollees.

Today’s TRICARE provides 11 health plans for an expanded list of eligible care recipients, including active-duty service members and their families, members of the National Guard/Reserve and their families, survivors, former military spouses, Medal of Honor recipients and their families, and others registered in the Defense Enrollment Eligibility Reporting System (DEERS).

TRICARE

As the current worldwide U.S. military healthcare program, TRICARE provides exclusive medical, pharmacy, and dental coverage to uniformed service members, retirees, and their families. TRICARE’s healthcare plans provide two basic types of care.

• Direct care at an MTF
• Purchased care at a civilian provider contracted by the Department of Defense (DOD)

Currently, according to the Defense Health Agency (DHA), approximately 60% of healthcare services are purchased with 40% provided by MTFs. The amount of purchased care is expected to rise in the future.

Eligibility

There are two classes of people eligible for TRICARE coverage: sponsors (uniformed service members) and family members. Sponsors include active-duty uniformed service members of the:

• Army
• Navy
• Marines
• Air Force
• Coast Guard

Also included are members of the National Guard and Reserve, including:

• Army National Guard
• Army Reserve
• Navy Reserve
• Marine Corps Reserve
• Air National Guard
• Air Force Reserve
• U.S. Coast Guard Reserve

Beneficiaries are family members of any of the above who are registered in DEERS.

In addition to those named above, others eligible for TRICARE coverage include surviving family members of a deceased sponsor, former spouses, Medal of Honor recipients and their families, and others registered in DEERS.

Coverage Provided

Your benefits and coverage vary depending on whether you are an active-duty service member or a member of the National Guard/Reserve.

Active-duty service members

You and your family members are eligible for TRICARE. As an active-duty service member, you must enroll in TRICARE Prime. Depending on your duty station, your coverage will be provided by one of the following:

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

Your family members can enroll in one of the plans above with you, or they may qualify for one of the following plans:

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

As an active-duty service member, you will get most of your dental care at a military dental clinic. If you require care outside of a military clinic, it is available through the Active Duty Dental Program or overseas through International SOS. Family members may purchase the TRICARE Dental Program.

When you end your term of active-duty service (separate), you retain TRICARE coverage for 90 days to allow time for transition to other healthcare coverage. In certain cases, you and your family may qualify for temporary healthcare coverage of 180 days or more.

National Guard/Reserve members

As a member of the National Guard or Reserve, you and your family members may be eligible for enrollment in TRICARE. Your benefits, if you are eligible, depend on your status.

Line of duty (LOD) care—If you incur an injury or suffer illness in the line of duty, such as performing ADT, IDT, weekend drill, or other training, you may qualify for LOD care. Your treatment, including dental care, will be specific to your illness or injury.

Inactive status—Inactive status means you are on orders for inactive duty, including weekend training, annual training, or active service of 30 days or less. During this period you are eligible for TRICARE Reserve Select, a premium-based healthcare plan you purchase, or LOD care, if applicable.

When activated—When you’re 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 as active-duty service members, including TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Overseas Remote, and the Active Duty Dental Program.

When deactivated—When you leave active duty or deactivate, your healthcare options depend on whether you were activated in support of a contingency operation.

• If your activation was not in support of a contingency operation, your TRICARE coverage begins on the first day of your orders and ends when you leave active duty. At that time, you can purchase either TRICARE Reserve Select, if you qualify, or the Continued Health Care Benefit Program, if you do not.
• If you’re activated in support of a contingency operation, your TRICARE coverage begins on the first day of your orders and continues for 180 days after you deactivate under the Transitional Assistance Management Program (TAMP). When TAMP ends, you may purchase TRICARE Reserve Select or the Continued Health Care Benefit Program.
• If your activation in support of a contingency operation has delayed effective date orders, you become eligible for active-duty benefits up to 180 days before the first day of your orders. When you leave active duty, you will have TAMP coverage for 180 days, following which you can choose Reserve Select coverage or the Continued Health Care Benefit Program.

To verify your eligibility, go online to the milConnect site and log in using your Common Access Card (CAC), DFAS (myPay) Account, or DOD Self-Service Logon (DS Logon) Premium (Level 2) account.

Medical Retirement

If you become disabled and are medically retired, you can sign up for TRICARE as a retired member of the military. Your family may also qualify for retiree family member healthcare coverage under TRICARE. You have 90 days from the date of your medical retirement to enroll in a TRICARE health plan.

Cost

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

Active-duty service members

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 annual deductible fees for active-duty service members (ADSMs). Active-duty family members (ADFMs) who are enrolled in any of the programs listed above pay no fees unless they use:

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

National Guard/Reserve members

When on active duty for 30 days or more in a row, you and your family are eligible for the same benefits active-duty service members are (see above). Otherwise, you will be inactive or active for less than 30 days and eligible for a TRICARE Reserve Select premium-based plan. For 2022, your monthly individual premium is $46.70. If you wish to enroll yourself and your family, the monthly premium is $229.99.