Health Care Reform
With the Fiscal Year 2017 National Defense Authorization Act , Congress set out to reform many aspects of the Military Health System. Changes included TRICARE Select replacing TRICARE Standard/Extra, referral-free urgent care for TRICARE Prime beneficiaries, a new out-of-pocket cost structure, and many changes to Military Treatment Facility administration.
Congress legislated sweeping changes, but it is up to the Defense Health Agency (DHA) to implement the reforms. The devil is in the details and, as DHA creates new policies, NMFA has fought to ensure the reforms meet military family needs. We have also monitored and demanded accountability for the regional contractor transitions and the shift from three CONUS regions to two. Specifically:
- We successfully fought to ensure the new TRICARE Prime urgent care policy includes unlimited referral-free urgent care visits for Prime beneficiaries.
- We raised concerns about new TRICARE copays and continue to fight for copay reductions, particularly for physical/speech/occupational therapy and mental health visits.
- After uncovering a problem with DHA’s copay calculation methodology, we achieved TRICARE Select copay reductions for primary and specialty care outpatient visits, urgent care, and emergency room visits.
- We have advocated for TRICARE Annual Open Enrollment and Qualifying Life Events policies that address the unique aspects of the military health system and continue to fight for policies that allow families to leave the MTF when they are dissatisfied with MTF access or quality of care.
- We have highlighted problems with the TRICARE enrollment process for those transitioning from active duty to retired status.
- New TRICARE Co-Pays Leave Military Families in Sticker Shock * March 2018
- TRICARE “Access Improvements” May Limit Access – Here’s How You Can Help * November 2017
- New TRICARE Enrollment Requirements May Lock You In With No Escape Hatch * October 2017
- New Name, New Costs. New TRICARE? * September 2017
- New TRICARE Change Could Force You to Stay with PRIME * July 2017
- NMFA Continues to Monitor Mental Health Networks During TRICARE Contract Transition * May 2017
TRICARE is the Department of Defense worldwide health care program for active duty service members, active duty family members, National Guard and Reserve members along with their eligible family members, military retirees and their eligible family members, survivors of deceased service members and their eligible family members, and certain former spouses of active duty and retired service members. TRICARE has several health plan options to meet the needs of its beneficiary population. TRICARE includes health care, dental and pharmacy services. This section provides information that will allow you to make an educated decision on which TRICARE options are right for you and your family.
This site does not provide medical advice:
The content on the National Military Family Association website is for your personal, educational, and informational use only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition or treatment and not consider this site a substitute for medical advice. We do not endorse or recommend any specific medical advice, procedure, treatment, therapy, pharmaceutical, product, service, or company.
TRICARE Beneficiary Category
The best way to start navigating TRICARE is by identifying your beneficiary category. Your eligibility for TRICARE health care programs, and often the cost you pay for health care services, are determined by your beneficiary category.
TRICARE beneficiaries can be divided into two main categories:
- Sponsors include active duty service members, retired service members, and National Guard and Reserve members
- Family Members are spouses and children registered in the Defense Eligibility Enrollment Reporting System (DEERS)
The Affordable Care Act (ACA) requires individuals to maintain a minimum level of health insurance, known as “minimum essential coverage” (MEC). If you are a TRICARE beneficiary, you have MEC.
The TRICARE health care programs include:
TRICARE Prime Remote (TPR)
Where will I receive health care?
TRICARE beneficiaries receive medical care at Military Treatment Facilities (MTFs) or through a network of doctors and hospitals in the Managed Care Support network. Learn More>>
Mental Health Care
Military life comes with challenges that sometimes require us to seek help for ourselves or our family members. Find information on counseling options and contact numbers to access your benefit. Learn More>>
TRICARE offers 3 dental programs for service members and military families: the TRICARE Dental Program, the TRICARE Retiree Dental Program, and the TRICARE Active Duty Dental Program. Learn More>>
The TRICARE pharmacy program offers prescription drugs to eligible beneficiaries through Military Treatment Facilities, a network of pharmacies, and via mail order. Learn More>>