Meeting Your Changing Needs: TRICARE Premium-Based Plans

8/18/2020

If you’re eligible for TRICARE, your health plan options may include premium-based plans. Plan availability depends on who you are and where you live. Take the time to learn which plans you may qualify for, so you can make the best decisions for yourself and your family.

 

What are premium-based plans?

A premium is the amount you pay for a health care plan you purchased. In addition to enrollment-based plans like TRICARE Prime and TRICARE Select, TRICARE offers coverage options that you can purchase. These premium-based plans include:

Who is eligible for these premium-based plans? Qualified members of the Selected Reserve or Retired Reserve who aren’t in an activatedCalled or ordered to active duty service for more than 30 days in a row. status and those who have eligibility changes, such as children aging out of regular TRICARE coverage. Premium-based plans offer continuous open enrollment throughout the year. As described in the TRICARE Plans Overview, that means you can purchase a premium-based plan at any time. TRICARE Open Season enrollment rules don’t apply to these plans.

 

Here’s a closer look at the four TRICARE premium-based health plans.

 

TRICARE Reserve Select

If you’re a Selected Reserve member, you and your family members may be eligible to purchase TRS. Your coverage and costs for care are similar to TRICARE Select for active duty family members. To qualify for TRS, you must not be on active duty orders for more than 30 days, covered by the Transitional Assistance Management Program, or eligible for or enrolled in the Federal Employees Health Benefits Program through your employer. This doesn’t apply if you’re eligible through your spouse’s employer. (All of this criteria also applies to the TRICARE Retired Reserve plan.) Read more about TRS features, or download the TRICARE Choices for National Guard and Reserve Handbook.

 

TRICARE Retired Reserve

TRR is for qualified Retired Reserve members and their family members until the sponsor turns age 60. Your coverage is similar to TRICARE Select coverage for retirees. Read the article on TRR to learn more about the plan’s key features. You can also download the TRICARE Retiring from National Guard or Reserve Brochure to learn more about your health care options after retirement.

 

TRICARE Young Adult

Did you know about 30% of young adults are uninsured? The Center for Consumer Information and Insurance Oversight reports that “young adults have the highest uninsured rate of any age group.” TYA is available for purchase by certain family members under the age of 26 who have lost or will lose TRICARE eligibility due to age. Qualified adult children can purchase TYA after regular TRICARE coverage ends at either:

  • Age 21
  • Age 23 (if enrolled in college fulltime or at college graduation, whichever comes first)

If you qualify for TYA, you can enroll in either TYA Prime or TYA Select, depending on your location and sponsor status. Coverage, provider choice, and costs for TYA are the same as for TRICARE Prime and TRICARE Select. There’s no family option with TYA.

 

Continued Health Care Benefit Program

If you need health care as you make a transition to civilian life, the CHCBP gives health coverage for 18 to 36 months. This is temporary coverage for when you lose TRICARE coverage. But certain former spouses who haven’t remarried before age 55 may qualify for an unlimited duration of CHCBP coverage. If you qualify, you may purchase CHCBP coverage within 60 days of loss of TRICARE coverage. Coverage is like TRICARE Select, and you can choose an individual or family plan.

 

What are the costs for premium-based plans?

You’ll pay monthly or quarterly payments (called premiums) for premium-based plans. You also pay a yearly deductible, and applicable copayments or cost-shares for covered services. TRICARE costs depend on a sponsor’s initial enlistment or appointment. You’ll fall into one of two groups. Your group designation determines your costs. However, if you’re in Group AIf you or your sponsor’s initial enlistment or appointment occurred before January 1, 2018, you are in Group A. and enrolled in TRS, TRR, TYA, or the CHCBP, you follow Group BIf you or your sponsor’s initial enlistment or appointment occurs on or after January 1, 2018, are in Group B. DS deductibles and applicable copayments or cost-shares. For current plan costs, use the TRICARE Compare Cost Tool. You can also download the TRICARE Costs and Fees Sheet.

 

A big part of taking command of your health is knowing your coverage options. Learn more about premium-based health plans and your TRICARE benefits.

At the time of posting, this information is current. For the most recent information, contact your TRICARE contractor or local military hospital or clinic.

Last Updated 9/1/2020