Tricare 2024: A Guide to Enrollment, Options, and Changes

Tricare, the health insurance program for the US military family, is undergoing some changes in 2024, alongside plans for a major overhaul in 2025. Here’s a breakdown of what you need to know to ensure your family has the best health coverage this year.

Who is Tricare For?

Managed by the Pentagon’s Defense Health Agency, the Tricare umbrella extends to a broad range of beneficiaries that offers both security and support.

Here’s who can benefit from Tricare programs:

Active Duty Service Members and Families: Active duty personnel automatically receive Tricare coverage. Spouses and children registered in the Defense Enrollment Eligibility Reporting System (DEERS) are also eligible.

Military Retirees and Families: Retirees with qualifying service time and their families can continue their Tricare coverage under specific plans.

National Guard & Reserve Members (and Families): National Guard and Reserve members with qualifying service may be eligible for Tricare coverage, especially when activated or deployed. Coverage may also extend to their families under certain conditions.

Other Eligible Beneficiaries: This category encompasses former spouses in specific situations, survivors of fallen service members, and Medal of Honor recipients with their immediate families.

Keeping your family’s Tricare information accurate is crucial. While service members can add or remove family members through their local ID card office, it’s important for them to double-check that all details for their dependents are correct. This ensures everyone in the family is properly enrolled and can access Tricare benefits without any issues.

Tricare Enrollment: Keeping Your Family Covered

Tricare offers a safety net for military families, but navigating enrollment and plan changes can be tricky. This section clarifies the process and highlights key points to remember:

1 | Enrollment and Open Season

New Entrants and Status Changes: If you’re joining the military or your status changes (e.g., active duty to retired), ensure you and your eligible family members are enrolled in the Tricare plan of your choice.

Don’t wait for open season! Missing enrollment means you might only receive care at a military facility (if space is available), and civilian care wouldn’t be covered by Tricare.

Open Season: This one-month window typically occurs around the Monday of the second full week in November. During this period, you can switch from Tricare Prime to Tricare Select or vice versa or change your enrollment within either program.

If you’re happy with your current plan, no action is required.

Exceptions to Switching Plans: Generally, Tricare restricts plan changes outside of open season. However, qualifying life events like birth/adoption of a child, marriage, retirement, or a move.

More information about DEERS can be found here.

2 | Tricare Beneficiary Groups

Group A vs. Group B: The law established two categories for Tricare beneficiaries. Group A includes sponsors who entered the military before January 1, 2018, and their dependents. Group B consists of sponsors who entered the military on or after January 1, 2018, and their dependents.

These groups have different enrollment fees and out-of-pocket costs associated with their plans.

3 | Separate Dental and Vision Coverage

Tricare Dental Program: This program caters specifically to families of active duty service members, National Guard and Reserve members (active and inactive). It requires separate enrollment from your Tricare health plan.

FEDVIP: Most retirees and their families qualify for dental and vision coverage under the Federal Employees Dental and Vision Insurance Program (FEDVIP), managed by the Office of Personnel Management. Similar to Tricare Dental, FEDVIP requires separate enrollment.

For more details about the Dental Plan, check here.

Tricare Program Options

Tricare offers a variety of health plan options to fit your needs. Here are the two main ones:

Tricare Prime: Similar to an HMO (health maintenance organization) plan, Tricare Prime emphasizes preventive care and coordination with a primary care manager (PCM). You’ll generally have lower out-of-pocket costs but must use network providers for most services.

Tricare Select: This plan functions more like a preferred provider organization, or PPO plan. You have more flexibility to choose any authorized provider, but out-of-network care typically comes with higher costs.

There are also several other Tricare programs catering to specific situations, such as:

Tricare Reserve Select: Caters to qualified members of the Selected Reserve (National Guard and Reserves) who aren’t on active duty but maintain drilling status. It functions similarly to a traditional Tricare Select plan, offering the flexibility to choose any authorized provider in the network.

However, unlike active duty families on Tricare Select, there are enrollment fees, and beneficiaries are responsible for co-pays and deductibles, making it a self-pay option for qualified reservists seeking civilian healthcare coverage during their inactive periods.

Tricare Retired Reserve: It is a premium-based health plan specifically for “gray area” retirees. These are qualified National Guard and Reserve retirees who haven’t yet reached the age for drawing retirement benefits (usually 60) but meet service time requirements.

Unlike traditional Tricare options for retirees, Tricare Retired Reserve requires monthly payments. It offers Tricare Select benefits, meaning beneficiaries can choose any authorized provider but face out-of-pocket costs like co-pays and deductibles. It bridges the gap for these retirees by providing civilian healthcare coverage until they become eligible for other Tricare programs.

Tricare Prime Remote/Overseas: For those stationed far from the military treatment facility (MTF).

Tricare Prime Remote is a managed care option for active duty service members and their families who live and work more than 50 miles (or one hour’s drive) from the nearest MTF. This program ensures continued access to quality healthcare for geographically isolated military families, even when far from a base.

Meanwhile, Tricare Prime Overseas is a managed care program designed for active duty service members and their command-sponsored families stationed overseas in locations with readily available military hospitals or clinics. This program offers stability and familiarity for active-duty families stationed abroad by keeping them connected to the military healthcare system.

Tricare for Life: Combines Tricare with Medicare for eligible retirees. It acts as a “wraparound” that pays for some of the costs Medicare doesn’t cover, potentially lowering retirees’ out-of-pocket expenses and simplifying healthcare billing.

Tricare Young Adult: Extends coverage for unmarried dependents up to age 26. It requires enrollment in either Tricare Prime or Tricare Select with premiums involved but offers a valuable option for young adults to maintain health insurance during a potentially transitional time in their lives.

US Family Health Plan (USFHP): This Tricare Prime option is limited to specific regions, including the six states discussed below. It allows beneficiaries to choose a primary care doctor from a network of private physicians affiliated with USFHP for all their healthcare needs, including prescriptions.

Unlike standard Tricare Prime, USFHP doesn’t utilize military hospitals or clinics and has its own network of civilian providers.

Need help deciding what plan option to choose? Find your TRICARE Plan here.

Changes in 2024

Be aware of some cost increases implemented in 2024. These include higher co-pays, annual enrollment fees (for retirees in some plans), and deductibles. (See premium rate changes for TRICARE premium-based plans, including Reserve Select, Retired Reserve, Young Adult, and the Continued Health Care Benefit Program, here.)

Pharmacy costs may also increase for beneficiaries using retail or mail-order pharmacies. However, the good news is that telehealth is now a permanent benefit, though it comes with cost-shares and co-pays similar to in-person visits.

Looking Ahead to 2025

While the biggest changes won’t hit until next year, it’s worth noting that new regional contractors will take over Tricare management in 2025.

This major shift, taking place on January 1st, 2025, includes the TriWest Healthcare Alliance taking over the management of Tricare’s West Region while Humana Government Business retains the East Region. This will involve transferring 1.5 million beneficiaries from six eastern states (Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin) to the newly expanded West Region.

The contractors will notify affected beneficiaries about any necessary actions.

You might be interested in knowing which health insurance is better, Veteran Affairs’ Health Care or TRICARE. Watch the video below.

By understanding your eligibility, program options, and recent changes, you can ensure your family receives the best possible healthcare coverage through Tricare in 2024.

Remember to stay updated on developments for the 2025 transition.