Active Duty Family Member? Find TRICARE Coverage Options to Match Your Needs
Are you an active duty family member (ADFM) thinking about changing your TRICARE health plan? If so, you can do so now. The TRICARE Open Season—your chance to enroll or make changes to your health plan for next year—runs until Dec. 14. Looking for dental or vision coverage? This is also the time to find options for you and your family.
“Active duty family members aren’t limited to a TRICARE Prime plan,” said Mark Ellis, chief of the Policy and Programs Section of the TRICARE Health Plan with the Defense Health Agency. “They may instead enroll in TRICARE Select. Additionally, they may purchase certain premium-based plans for dental or vision coverage, as well as health care coverage for certain young adult children.”
Here’s a quick recap of what options are available for ADFMs.
TRICARE Prime is a managed care option, similar to a health maintenance organization program, or HMO, which offers comprehensive health care coverage. As described in the TRICARE Plans Overview, you’ll have a primary care manager (PCM) who manages most of your routine health care. You’ll need referrals to see a specialist or receive any care that your PCM doesn’t provide.
There are different TRICARE Prime plansTRICARE Prime plans include: TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas and TRICARE Young Adult-Prime for ADFMs. Your eligibility depends on your sponsor’s status and where you live:
- TRICARE Prime is available to those who live in a Prime Service Area in the U.S.
- TRICARE Prime Remote is for certain stateside ADFMs in remote areas.
- US Family Health Plan is available in six areas in the U.S.
- TRICARE Overseas Program Prime and TRICARE Overseas Program Prime Remote are options only available overseas for certain eligible beneficiaries.
TRICARE Prime plans have minimal out-of-pocket costs and no enrollment fees for ADFMs. You can learn more about costs on the TRICARE Prime Costs page.
TRICARE Select is a self-managed option, like a preferred provider organization, or PPO. You manage your own health care without a PCM and choose which TRICARE-authorized providers you see. You don’t need referrals for most services, but your TRICARE regional contractor must authorize some services. TRICARE Select is available anywhere in the U.S. If you live overseas, you may enroll in TRICARE Overseas Program Select.
ADFMs aren’t required to pay enrollment fees with TRICARE Select. But you may have higher out-of-pocket costs if you see a non-network provider. You can learn more about TRICARE Select costs by using the Compare Costs Tool.
Premium-based health plan for young adult dependents
Do you have a child who’s turning age 21 soon? If so, you may want to consider purchasing TRICARE Young Adult (TYA) coverage. Young adults who are age 21 (or age 23 if a fulltime student) lose regular TRICARE coverage, but may be eligible to purchase TYA coverage. TYA is a premium-based plan available for purchase by qualified dependent children under age 26. Remember, TRICARE Open Season enrollment rules don’t apply to premium-based plans. You can purchase TYA coverage at any time.
TRICARE Dental Program
Does your sponsor have at least 12 months of military service commitment? If so, you may be eligible for dental coverage through the TRICARE Dental Program (TDP). TDP is a voluntary dental plan administered by United Concordia Companies, Inc. If eligible, you can purchase coverage at any time. It’s available stateside and overseas. With TDP, you can go to any licensed and authorized dentist. But choosing a network dentist can save you money. Find more on how to enroll in TDP and what TDP covers from the TRICARE Dental Program Brochure and TRICARE Dental Program Handbook.
If you need additional vision coverage, purchasing a Federal Employees Dental and Vision Insurance Program (FEDVIP) plan may be an option. FEDVIP is voluntary and offers comprehensive vision coverage through the U.S. Office of Personnel Management. The FEDVIP plans vary in coverage and premium amounts. You have until Dec. 14 this year to enroll or change 2021 FEDVIP coverage. Otherwise, you’ll have to wait until next year’s open season or when you experience a FEDVIP qualifying life event. Visit the BENEFEDS website to learn more.
As you begin to make health coverage decisions, use TRICARE resources. The TRICARE Costs and Fees Sheet and Compare Costs Tool breaks down the costs for each plan. And the TRICARE Plans Overview and Dental Options Fact Sheet helps you understand how each plan works. Be sure to contact your TRICARE contractor if you have questions about your coverage. Take command of your health and explore your coverage options to make the best decision for you and your family.
Last Updated 10/14/2021