Understanding TRICARE

Locate a TRICARE Service Provider #

Go to the Introduction to Local Healthcare page or click here.

[Top of Page]

TRICARE and Divorce #

Not adjusting your DEERS can be quite expensive for you, in the event you do not change it in a timely manner. Here are the generalized rules regarding divorce and TRICARE:

DEERS Update Required:  When there is a divorce, the sponsor must update this information in the Defense Enrollment Eligibility Reporting System (DEERS). A copy of the divorce decree is needed to update DEERS.

TRICARE eligibility for some family members may change:

       Former Spouses:  As of 12:01 a.m. on the day of the divorce, your benefits end unless you meet the eligibility requirements of a former spouse. If you meet the former spouse requirements, you’ll continue to be eligible for TRICARE, and will use your name and health benefit number (not your former sponsor’s) to schedule appointments and file claims. If you do not meet the former spouse eligibility requirements, you can no longer get care through TRICARE. Any claims paid after your loss of eligibility will be recouped. Upon loss of eligibility, you may be eligible to purchase coverage under the Continued Health Care Benefits Program.

     –  Children: Biological and adopted children of the sponsor remain eligible for TRICARE up to age 21 (or age 23 if enrolled in college) as long as the child remains a dependent child (i.e. is not married or serving on active duty.) Stepchildren who were not adopted by the sponsor lose TRICARE eligibility once DEERS is updated with the divorce decree. Upon loss of eligibility, stepchildren may be eligible to purchase coverage under the Continued Health Care Benefits Program.

Getting Care for Children After a Divorce:  The custody agreement, sponsor’s military status and location may have an impact on how and where eligible children get care. In many cases, if your child lives between two households, or apart from the Service member parent, he or she can get health care anywhere by following the rules of their health care plan. If needed, contact your regional contractor for assistance. Read below for some common things to keep in mind when selecting a health plan option and getting care for your child after a divorce. If you need further assistance for a unique situation, or would like assistance in selecting a health plan for your child, contact your regional contractor.

When Both Parents are Service Members:  A child can only have one sponsor. When both of the divorced parents are Service members, you must decide together which parent should be the sponsor of the child’s benefits. If an agreement cannot be reached, visit an ID card office for additional guidance on how to resolve the issue. The ID card office can also update your child’s records to remove their benefits and entitlements under one of the applicable parents. Removing their benefits and entitlements will not remove them from the other parent’s DEERS record.

When One Parent is a Service Member and the One Parent is No Longer Eligible for TRICARE: Your child should have his or her own ID card when in the care of a parent or guardian who is not eligible for TRICARE or who is not the custodial parent. Contact your local ID card office for more information if your child does not have an ID card.

Shared Custody in Different TRICARE Regions:  If custody of your child is shared, and you and your former spouse live in different TRICARE regions, you should decide carefully which health plan option your child should use based on the amount of time they stay with each parent. For instance, if your child is enrolled in TRICARE Prime, is available in both locations, and custody is shared for more than 60 days at a time, you should consider transferring your child’s TRICARE Prime enrollment each time the child moves between parent’s homes. If you don’t transfer the enrollment each time, you’ll need a referral from the primary care manager for any non-emergency care. Without a referral, you will pay higher out-of-pocket costs for some services through the point-of-service option. TRICARE Standard and Extra may be the best option in this scenario because your child can get care from any TRICARE-authorized provider, network or non-network without a referral. However, some services require authorization.

Using TRICARE with Other Health Insurance:  TRICARE is always the second payer to any other health insurance (OHI) plan. After a divorce, if a child is covered by health insurance from the non-uniformed Service parent, then TRICARE can still act as a second payer after the OHI. If the child visits the uniformed Service member for extended periods of time, TRICARE is still the second payer, so make sure your child has the OHI information to get care away from home during these visits. You should review your OHI and TRICARE options carefully, to make sure you have the best coverage for your child.

Source: Financial Frontline, FMAP, National Guard, 9 October 2012

[Top of Page]

Change to TRICARE For Life Coverage for VA Non-service Connected Care #

Effective 1 October 2013, TRICARE will reimburse the VA only 20% of the allowable charge vice the past practice of paying 80% for non-service connected care received in the VA for TRICARE for Life (TFL) beneficiaries rated at less than 50% disabled. The change in policy is not the result of new law, but the enforcing of an existing one.

Those rated at 50% or higher service-connected disability for compensation are unaffected because the VA is required to provide free healthcare of both service and non-service connected injuries and illnesses to them.  Veterans not enrolled in Medicare, such as those using TRICARE Prime or TRICARE Standard/Extra,  are also unaffected.

Accordingly, as part of the intake process at VA facilities TFL beneficiaries will be asked if they’re using their VA or TFL benefit or if they have other health insurance (OHI).  When electing to use their TFL benefit at the VA, they will also be informed they must pay the remained bill after TRICARE pays its portion of the TRICARE-allowable charge. They may be asked to sign a form indicating they understand their responsibility

By law, VA facilities cannot be Medicare-certified because Medicare can not reimburse care provided by a Government facility.  Therefore, they are considered non-Medicare providers.  The result is TRICARE can pay only up to 20 percent of the TRICARE allowable charge to them as non-Medicare providers and TFL users are responsible for covering the balance (80% of the cost).

Therefore, if the condition for which you are being treated  is not rated as service-connected and you do not have a 50% or higher service-connected disability, use a community healthcare facility (a Medicare-certified provider) instead of the VA to prevent being billed for the balance — especially if you are not using private insurance to make up the difference.

Sources for more information: http://www.tricare.mil/tfl or call Wisconsin Physician Services, a customer service contractor, at 1-866-773-0404 or use its www.tricare4u.com.

[Top of Page]

TRICARE Nurse Advice Line (NAL) #

This program began 25  April 2014 and may be new to you.

With the 24/7 Nurse Advice Line, reached by selecting Option #1 at 1-800-TRICARE (1-800-874-2273), most TRICARE beneficiaries can now access a team of registered nurses by telephone for advice about immediate health care needs. The Nurse Advice Line, is available at no cost to beneficiaries.  Its purpose is to help callers make informed decisions about self-care at home or when to see a health care provider.

Nurse Advice Line nurses ask a series of questions about a caller’s specific concerns to advise when and how to seek care for an urgent problem or give instruction on self-care at home.

For those using TRICARE Prime, the NAL can also make appointments at military hospitals and clinics for beneficiaries enrolled in those facilities.

Eligibility: TRICARE beneficiaries using TRICARE Prime, TPR, TPRADFM, TRICARE Standard and TRICARE Extra, TRS, TRR, TYA, and TFL can call the Nurse Advice Line. The Nurse Advice Line verifies a caller’s eligibility in DEERS.

Mental Health issues: Nurse Advice Line nurses have experience in answering questions and providing advice on how and when to seek help for mental health concerns.

Pediatric issues: If your child is ill, the Nurse Advice Line routes your call to a nurse who has special pediatric training. For quality and safety purposes, you will be asked to have your child present for the call so the nurse can perform an accurate assessment. If you want a follow-up call, the Nurse Advice Line calls you back to check on your child.

How to handle disagreement over the advice given: If you feel you need to be seen sooner than the Nurse Advice Line recommends, you may seek care at a military treatment facility (emergency department or clinic) or a TRICARE-authorized network urgent care provider.  You will need to contact your PCM for appropriate authorization  [Editor’s Note: applies to those using TRICARE Prime or Prime Remote.  Note urgent care is not the same thing as emergency care.

Additional Program Notes for those using TRICARE Prime programs:  If you need additional services such as prescription authorizations or refills, pharmacy locator services, referrals for other services, revisions to Defense Enrollment Eligibility Reporting System (DEERS) information, benefits and claims assistance, or ancillary services (e.g., labs, radiology), please contact your primary care manager (PCM) or health benefits advisor at your military hospital or clinic.

For more information, click here.

[Top of Page]

TRICARE For Life Cost Matrix #

For those who have reached the age of 65, TRICARE For Life applies.  It uses Medicare as the primary payer.  For the 2022 TRICARE For Life Cost Matrix, click here.

[Top of Page]


Last Updated: 14 June 2022 (link updates)

Powered by BetterDocs