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Is Tricare considered health insurance?

Keep in mind...
  • TRICARE is a health insurance program for soldiers in the United States armed services and their families
  • There are several different types of TRICARE plans
  • Most TRICARE plans meet the minimum essential coverage guidelines outlined in the Affordable Care Act
  • Some of the most common TRICARE plans include TRICARE Prime andTRICARE Standard
  • TRICARE for life is a program for those also enrolled in Medicare

TRICARE meets the requirements for minimum essential coverage under the Affordable Care Act guidelines. You do not need to enroll in additional coverage and you will not have to pay the individual mandate penalty fine.

Other military programs such as the Veterans Health Care Program, the VA Civilian Health and Medical Program, and the Spina bifida health care benefits program are all considered minimum essential coverage as defined by the ACA, as well.

Explore private health insurance for non-TRICARE qualifying family members by entering your zip code above and comparing free quotes!

Who is eligible for TRICARE?

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TRICARE is specifically for those in the United States military and their family members. This includes active duty soldiers, those in the National Guard, and various others registered in the Defense Enrollment Eligibility Reporting System.

There are two different types of beneficiaries known as sponsors and family members. Sponsors are the active duty or reserve military members. There are some plans that are only available to sponsors and the benefits included can vary depending on the type of plan and the enrolled beneficiary.

What is TRICARE Prime?

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TRICARE Prime is available for those who are located in a Prime service area. You can check your zip code online to see if you live in an eligible area. You are required to sign up for TRICARE Prime, you will not automatically be enrolled in this program.

With this program, you will get a primary care doctor who manages most of your healthcare needs. Your primary care provider is typically required to write you a referral before you can see a specialist. They will also file your health insurance claims for you so you do not need to worry about doing it yourself.

Active duty and reserve members, as well as their families, are eligible to enroll in TRICARE Prime.

If you are an active duty soldier, you will not have to pay any out-of-pocket costs. There might be co-payments and monthly premiums for other types of beneficiaries.

There are three different ways to enroll in the TRICARE Prime program. You can mail in your application, call the contractor in your region, or enroll online through the TRICARE website.

What is TRICARE Standard?

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TRICARE Standard plans allow you to have more flexibility in your choice of providers. However, you may have to pay more out-of-pocket costs.

Another difference is that you do not have to sign up for TRICARE standard. If you are already registered in the Defense Enrollment Eligibility Reporting System, your coverage will be automatic. However, active duty soldiers do not use this type of coverage, it is only for family members and non-activated reserve members.

With TRICARE Standard, you are not required to have a primary care provider or get referrals before seeing a specialist. You might still need prior authorization in some cases, depending on the medical service you need. To use your TRICARE coverage, you can just schedule an appointment with any provider that is authorized by the TRICARE system.

In order to see a provider, you do not need any type of health insurance card. Your military ID is sufficient enough for proof of coverage. The amount you pay will vary depending on your status, but you will typically have to pay a yearly deductible and for a percentage of the service.

What is TRICARE For Life?

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TRICARE For Life is supplemental coverage for those who are enrolled in Medicare Parts A and B. You do not need to enroll in this plan, you will be automatically enrolled if you are eligible for TRICARE and Medicare Part A and paying Part B premiums.

In the United States, Medicare will pay for your medical services first and TRICARE will pay after. If you are outside of the United States, TRICARE will be the primary insurance plan. You can see any provider that accepts Medicare and TRICARE.

Although you will have to pay your Part B premiums, you should not have to pay any additional out of pocket costs if the service is covered by the two insurance companies.

Is TRICARE considered health insurance?

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TRICARE plans are considered health insurance based on the regulations in the Affordable Care Act. There are several different types of TRICARE plans and eligibility, coverage benefits, and cost varies depending on the plan type and the beneficiary’s military status.

See how TRICARE compares to private health insurance by comparing free quotes with your zip code in the box below!

References:
  1. https://www.healthcare.gov/veterans/
  2. https://www.tricare.mil/Plans/Eligibility
  3. https://www.tricare.mil/Plans/HealthPlans/Prime
  4. https://www.tricare.mil/Plans/HealthPlans/TSE

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