TRICARE Eligibility – Things You Need to Know


TRICARE Eligibility – Things You Need to Know

Everyone cannot, of course, sign up for TRICARE health care plans. Here, you can find out whether or not you can be considered Eligibility for one.

TRICARE is a medical and health coverage arrangement built to provide medical care and ensure the well-being of persons serving in the United States armed forces. It is available for all seven uniformed services: Navy, Marine Corps, Air Force, Army, Coast Guard, Public Health Service and the National Oceanic and Atmospheric Administration. To use and access the benefits of TRICARE, you must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) as being eligible to receive military health care gains. Active duty members of the military are automatically included and are eligible for TRICARE. TRICARE is not for everybody; certainly not for civilians and also not for every person closely or remotely related to the military. It is primarily for military people. However, it also extends beyond that.

People who fall under the eligibility term and conditions of TRICARE:

Individuals and persons who can avail the incentives of TRICARE are grouped broadly into two major categories:

Sponsors: These include individuals who are actively involved in and serving the U.S Armed forces, the members of the U.S Navy, Air Force personnel, Marine Corps and other members of the seven functional branches of the military. They are mandated and entitled to enroll in and benefit from one of the TRICARE health plans that are offered and which best cover their needs. Sponsors also include retired and Guard/Reserve members.

Family Members: These include the closest and dearest relatives and immediate families of the military sponsors. This particular roster includes marital partners (wives/husbands), naturally born or adopted (biologically unrelated) children, step children, parental figures who are financially dependent and dependent parents-in-law. For a child to become qualified for TRICARE, he or she must be unmarried and under the age of 21. Children of military personnel can also be eligible for TRICARE if they are under the age of 23 and are studying full-time in an educational institute of learning and if at least half of all their expenses are paid for by their military sponsors, which are predominantly their parents.

In order to get answers to any eligibility questions or any other queries you might have, it is advisable to refer to your military service personnel office for more detailed and specific information. However, the eligibility criteria for TRICARE medical coverage remains pretty clear on what and whom it encompasses. Finding out if you are in fact eligible for TRICARE is pretty straightforward. Aside from the plethora of information available, there are other avenues that can be explored. The internet is a limitless resource. Specific and content centric websites include: TRICARE dot Mil and Military dot Com . The first step towards eligibility and enrolment is to get registered and provide up to date information in DEERS. Family members of sponsors must be enrolled in DEERs to qualify for TRICARE.

People eligible for TRICARE are split broadly into two categories- sponsors and family members. However, it should be kept in mind that there is more specific criteria to be met, before becoming truly eligible for TRICARE.

TRICARE health Program is for:

1. Uniformed service members (retired and active duty) and National Guard/Reserve members including the U.S Army, Navy, Air Force, Marine Corps, Coast Guard, Commissioned Corps of the U.S Public Health Service and the Commissioned Corps of the National Oceanic and Atmospheric Association.

2. Military Survivors

3. Marital partners (wife/husband) and single, unwed children of active duty service military affiliates.

4. Marital dependents and unmarried offspring of retired uniformed service members

5. Military Individuals who have been conferred the Medal of Honor and their immediate family members

6.Former spouses who have remained single and children who are yet single of deceased, retired or activ  duty uniformed individuals.

7. Marital dependents and unwed, underage progeny of members of the Reserves and National Guard who are under order and command to serve in active duty for more than thirty days at a stretch or of individuals in reserve and the National Guard who are killed while serving in combat duty.

8. The wives/husbands and their respective single and as yet underage children of reservists and members of the National Guard who are killed under any kind of circumstance or condition pertaining to active combat.

9. Unwed, single offspring who have attained the age or are under twenty-one. This also includes stepchildren who have been legally adopted by the military person in question. TRICARE remains in place even if the spouse got divorced or remarried. However, if the stepchild was never adopted and if the marriage breaks down due to divorce, TRICARE privileges will be revoked. This does not mean that TRICARE was not there whilst the stepchild’s parents were married.
Children over the age of 21 may be covered if they are excruciatingly handicapped or have disabilities that hinder proper functioning and if the condition was present before his or her 21st birthday.

12. Children of military sponsors may also be covered under TRICARE till the age of 23, if they are still in school or an institute of higher learning on a full-time basis. It also needs to be proven that the child in question is at least partially (50%) responsible on his or her parents.

13. Children who are lawfully placed in the guardianship of an active or retired service member.

14. The offspring of incumbent or past military service members who are illegitimate may also qualify as legible candidates for TRICARE coverage, but certain conditions may apply and consulting a Health Benefits Advisor may be helpful.

15. In addition, some family individuals of incumbent service members may be eligible for medical coverage if their military sponsor is under court ordered separation and is martialed for spousal and child abuse.

16. Spouses and children of the North Atlantic Treaty Organization (NATO) and Partners for Peace (PFP) country ambassadors who are under official authority, allowed to travel and stay with the NATO and PFP country spokespersons. They are eligible for out- patient benefits only for as long as they are currently living in or temporarily staying in (travelling through) the United States of America
Others registered in the Defense Enrollment Eligibility Reporting System (DEERS).

17. Ex marital partners of uniformed service men, including active, retired and former.

However, they need to meet certain requirements:

  • They must not be remarried; if they do so, TRICARE privileges will be revoked in any case, even though the new marriages are dissolved as a consequence of death or divorce.
  • They should not have an existing or additional health insurance plan such as that covered by the employer.
  • They should not have been married at all in the past to any of the NATO or PFP nation members.
  • It is essential that the person is married to the same member or former member for at least two decades.
1 Comment
  • Howard R White
    Posted at 22:14h, 02 December Reply

    Am I to assume that a veteran of four years in the US Navy does not qualify for the DEERS program?

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