Understanding TRICARE, Dental & Other VA Health Care Benefits Nov, 2021

Understanding TRICARE, Dental & Other VA Health Care Benefits Nov, 2021

Understanding how TRICARE works is essential to determining how your coverage will impact the health of you and your family.

Active duty service members have a limited number of healthcare options and incur low fees. Their qualified family members and other TRICARE beneficiaries, on the other hand, have a variety of health plan alternatives available to them, depending on where they live and how they choose to get health care. The following information can assist you in making the best choice for your needs:

  • The fundamentals of TRICARE coverage
  • The various TRICARE Health Insurance plans and how they operate
  • TRICARE’s additional coverage and benefits

What Is TRICARE Insurance?

TRICARE is a Department of Defense (DOD) healthcare program covering about 10 million active-duty and retired military personnel and their dependents. Although many users’ costs are on the rise, they are still lower than costs for a civilian plan or program of similar benefits.

The “TRICARE” program began in the 1990s with only three plan options, thus its name. The program has changed over time to meet the needs and benefit users in practically every country. As a result, qualified members can choose from various health and dental plans based on their status, geography, and preferred medical providers.

All beneficiaries of TRICARE health insurance receive comprehensive coverage including:

What Is TRICARE Used For?

TRICARE combines the Military Health System’s healthcare resources—such as military hospitals and clinics—with a network of civilian healthcare experts, institutions, pharmacies, and suppliers to promote, protect, and restore health for individuals committed to their care.

What Does TRICARE Cover?

TRICARE offers health insurance benefits that differ depending on who is enrolled, the plan they select, and any additional requirements they may have. All of these factors can affect what’s covered by your health plan, but the following is a broad overview of military health benefits.

  • Preventative Care: TRICARE covers basic health care aimed at maintaining wellbeing while preventing major health concerns and identifying future health problems.
  • Mental Health Care: There is a range of mental health care services, including individual and family therapy, substance abuse treatment, eating disorder treatment, and psychological testing and behavior analysis.
  • Vision Care: Exams and corrective lenses, such as glasses or contacts, are covered. The vision benefits offered by TRICARE vary depending on your plan, age, and service status.
  • Pharmacy Benefits: Fill prescriptions and receive medications through military pharmacies, home delivery, and other pharmacies.
  • Dental Care: TRICARE’s dental coverage is independent from its medical coverage and requires separate enrollment.
  • Catastrophic Cap: Out-of-pocket deductibles and cost-sharing for all TRICARE plans are capped at a certain amount per year. The threshold amount varies according to the plan and the start date of the sponsor’s service.
  • Special Programs: Other medical needs could include cancer clinical trials, hospice care, chiropractic care, or durable medical equipment. All these programs and more are available through TRICARE.

Click here to see a list of TRICARE-covered services.

Disclaimer – TRICARE covers a wide range of healthcare services and needs, depending on military status, plan selection, and other criteria. Before seeking medical treatments, always verify your specific benefits to understand better what your unique plan will or will not cover.

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Who Is Eligible for TRICARE?

TRICARE has two primary types of beneficiaries, each with its own set of health benefits and plans.

  1. Sponsors – Retired, active duty, and Guard/Reserves.
  2. Family members – Dependents enrolled in the Defense Enrollment Eligibility Reporting System (DEERS).

TRICARE health insurance provides coverage to all active duty uniformed service members and their dependent family members. Many National Guard and Reserves members and former military personnel, including their families, are covered under one or more programs.

All health plans require enrollment except for TRICARE for Life, a supplemental coverage plan for retirees with Medicare Part A and B.

Not every veteran is covered. Separated service personnel usually are not eligible for TRICARE, with one major exception being Medal of Honor recipients and their families.

On the other hand, veterans are entitled to a wide range of medical care through the VA health system. The VA provides free care for service-connected diseases and injuries.

How to Enroll in TRICARE?

Registration in the Defense Enrollment Eligibility Reporting System (DEERS) is the first step to apply for TRICARE. DEERS is a worldwide database that stores data on military personnel, their families, and dependents. This system ensures you and your family receive military health benefits, no matter where you live or are stationed. To apply for TRICARE benefits, you must be a member of DEERS.

Follow these steps to apply for TRICARE benefits:

  • Become a member of the Defense Enrollment Eligibility Reporting System.
  • Determine if you are eligible for health benefits through DEERS.
  • Go to TRICARE online to choose a health insurance plan that best suits your family’s needs.

How Much Is TRICARE?

Active duty service members do not have to pay any fees or co-payments under TRICARE. Family members may be required to pay co-payments or a part of the cost of treatments, depending on the health plan choice they have.

Enrollment fees, co-pays, and a percentage of the cost of services may be required of retired service members and their families. Here is a breakdown of the expenses incurred by beneficiaries.

Service members on active duty
  • Neither enrollment fees nor copayments are required.
Families of active-duty personnel
  • Treatment at military facilities is free.
  • TRICARE Prime waives any fees or co-payments.
  • TRICARE Select and Extra have low cost-shares.
Retired service members and their families
  • Treatment at military facilities is free.
  • TRICARE Prime has low annual enrollment fees ($289.08 per person or $578.16 per family).
  • Co-payments to the network are kept to a minimum (ranging from $20 to $30).
  • TRICARE Standard and Select have low cost-shares.

To learn more about the costs of various health plan options, visit the TRICARE Beneficiary Costs Flyer.

What’s the Difference Between TRICARE vs. VA Health Care Benefits?

TRICARE Benefits VA Healthcare Benefits
The restrictions and costs of TRICARE services may differ based on your health plan. Your co-payment and eligibility rely upon discharge, connection to a service, or income.
Services Provided TRICARE Benefits VA Healthcare Benefits
Outpatient services
  • Ambulance services
  • Ancillary services, like a laboratory, X-ray
  • Medical or surgical care, like individual provider services
  • Mental and behavioral health
  • Home health care
  • Maternity and obstetric services
  • Emergency care in military or civilian facilities
  • Eye exams and glasses
  • Pediatric services
  • Ancillary services like laboratory, X-ray
  • Medical or surgical care like reconstructive and plastic surgery as a result of disease or trauma
  • Mental and behavioral health
  • Home health care
  • Maternity and obstetric services
  • Bereavement counseling
  • Chiropractic care
  • Substance abuse
  • Eye exams
  • Transportation services
Inpatient Services
  • Military or civilian emergency care
  • Hospitalization
  • Mental and behavioral health
  • Skilled nursing facility care
  • Substance abuse
  • Surgical care
  • Centers of excellence, such as MS, spinal cord injury, and rehabilitation for blind and mental health patients.
  • Emergency care
  • Hospitalization
  • Nursing home
  • Medical care
  • Polytrauma centers
  • Substance abuse
Prescriptions
  • Prescriptions are covered through the TRICARE pharmacy program. They can be obtained via military pharmacies, network pharmacies, or home delivery.
  • The prescription has to be written by a VA doctor. They’re only available through the VA’s national formulary in most cases.
Preventive Services
  • Health education and counseling
  • Hearing screening
  • Immunizations
  • Physical exams
  • Vision screening
  • Screening tests, such as mammograms, pap smears, cardiac screenings, prostate exams, colorectal exams, cholesterol, blood pressure, and skin cancer screenings
  • Immunizations
  • Physical exams
  • Screening tests
  • Health care assessments
  • Health education programs
Dental Care
  • Active duty service members are provided dental treatment either at dental treatment centers or through the Active Duty Dental Program.
  • Members of the TRICARE Dental Program include family members and National Guard or Reserve members.
  • TRICARE Retiree Dental Program gives retired individuals and their families access to dental care.
The dental care rules of the VA are very different from the medical care rules.
Note: Applicants who were recently discharged must apply to VA within 90 days after discharge.
 

What Care and Services Does VA Health Care Cover?

The medical benefits package for each veteran is different. Yours will include assistance and attention in the following areas:

  1. Diagnose and treat diseases and injuries
  2. Prevent future health issues
  3. Boost productivity
  4. Improve the quality of life

Most care and services are covered for all veterans. However, only select members will be eligible for additional benefits like dental treatment. The following factors determine the complete list of your covered perks:

  • Your priority group
  • Your VA primary care provider’s (main doctor, nurse, or physician’s assistant) advice
  • Medical guidelines for managing any health issues you may have

Moreover, you will satisfy the Affordable Care Act (ACA) health coverage requirement by applying for VA health care.

Beware of Tricare Downside!

Did you know Tricare does not cover multiple benefits? Learn the 5 most important benefits Tricare doesn't cover.

Problems With Veterans Health Care

If you are dissatisfied with your care provider, a VA medical facility, or any other part of your care, you may:

Call 1-877-222-VETS (1-877-222-8387) for more information.

MENTAL HEALTH AND SUBSTANCE ABUSE HELP FOR VETERANS

If you or someone you know requires immediate assistance, call the Veterans Crisis Line. Counselors are available 24/7 via the following options:

  • Online chat
  • Call at 1-800-273-8255
  • Send a text to the number 838255.

Caregivers of veterans can contact the VA Caregiver Support Line at 1-855-260-3274 for assistance.

Are All Veterans Eligible for VA Health Care?

Military, navy, or air force veterans who did not receive a dishonorable discharge may qualify for VA health care benefits. You must have served 24 consecutive months or the entire period you were called to active duty, except under certain conditions detailed below.

The minimum duty requirement may not apply if any of the following statements are true.

  1. You were dismissed because of a disability that was caused by—or worsened as a result of—your active-duty service.
  2. You were released due to a hardship or “early out”.
  3. You served in the military before September 7, 1980.

You must have been summoned to active service by a federal order and fulfilled the entire period you were called or ordered to active duty if you are a current or former Reserves or National Guard member. You are not eligible for VA health care if you were on active duty for training.

What Are the Standard Medical Benefits?

VA offers all enrolled veterans a standard improved health care package called the VA Medical Benefits Package. The plan emphasizes primary care within the VA healthcare system and offers a wide range of outpatient and inpatient services.

There is no monthly fee for using VA services, although veterans may be required to pay co-payments. Co-pays may be covered if a veteran has health insurance. For the first five years after their release from active duty, the VA will provide free medical care for any disease their service may have caused during a period of hostility.

The VA health care system offers outpatient and inpatient services, including but not limited to:

PREVENTIVE CARE SERVICES

  • Vaccinations
  • Routine vision care and testing
  • Regular checkups
  • Monitoring, maintaining, and educating about drug use
  • Substance abuse prevention and mental health services
  • Preventing musculoskeletal deformities or degenerative disabilities
  • Genealogical counseling regarding genetically determined diseases
  • Regular re-examination of members of high-risk groups for specific conditions and functional decline of sensory organs and services to treat these conditions
  • Health Education Programs

AMBULATORY (OUTPATIENT) DIAGNOSTIC AND TREATMENT SERVICES

  • Primary and specialty care
  • Medical assistance in an emergency
  • Surgical procedures (including reconstructive/plastic procedures as a result of sickness or trauma)
  • Mental Well-Being
  • Abuse of Substances
  • Long-lasting medical equipment
  • Prosthetic and orthotic devices, such as eyeglasses and hearing aids (for qualifying veterans)

DIAGNOSTIC AND TREATMENT SERVICES AT HOSPITALS (INPATIENT)

  • Medical
  • Surgical procedures (including reconstructive/plastic procedures)
  • Mental Well-Being
  • Abuse of Substances

PRESCRIPTION DRUGS

Under the VA national formulary system, prescription drugs, including over-the-counter medications, medical supplies, and surgical supplies, are available to patients following a doctor’s prescription.

LONG-TERM CARE STANDARD BENEFITS

  • Programs at VA Community Living Centers (VA Nursing Homes)
  • Domiciliary Care
  • Medical Foster Homes
  • State Veterans Homes
  • Additional Services
  • Respite Care
    • Geriatric Assessment
    • Extended Care and Geriatrics
    • Adult Day Health Care
    • Home Healthcare
    • Home Telehealth
    • Palliative/Hospice Care

TRICARE Insurance and VA Health Care FAQ

Here are the most frequently asked questions about TRICARE insurance other VA health care benefits.

DOES THE VA PROVIDE GENDER-SPECIFIC SERVICES FOR WOMEN?

The Veterans Health Administration offers a range of gender-specific primary health care services to women veterans, such as contraceptives, screenings for breasts and cervical cancer, and menopause support services, through Women’s Health Clinics and mixed-gender primary care clinics.

DOES THE VA PROVIDE INFERTILITY SERVICES TO VETERANS?

Infertility services may include genetic counseling, sperm tests, ultrasound techniques, surgery, vasectomy reversal, tubal ligation reversal, and medication for those who qualify.

There may also be some relief for procedures involving assisted reproductive technology, such as IVF treatments, up to three cycles.

DOES THE VA PROVIDE DENTAL CARE?

The requirements for dental care eligibility differ significantly from those for medical treatment. The extent of dental services is often limited with exceptions including a veteran who is a former prisoner of war (POW), has a 100% service-connected disability, or has a service-connected dental ailment.

Eligibility is determined by various factors, including your military service history, present health, and living situation. VA assigns you to a benefits class based on these variables.

DOES THE VA PROVIDE HEARING AIDS AND EYEGLASSES?

All enrolled veterans are entitled to audiology and eye care treatments, including preventive care and routine vision testing. For naturally occurring visual or hearing impairments, the VA does not give hearing aids or eyeglasses.

If you’re receiving VA care and have a service-connected disability rating of 10% or above, or if you were a former POW, the answer is yes. Hearing aids and spectacles will only be offered in exceptional cases and not for joint hearing or vision loss.

DOES THE VA PROVIDE LONG-TERM CARE?

Long-term care services include the following:

  • Nursing and medical assistance, available 24 hours a day, seven days a week
  • Physical therapy
  • Assistance with routine duties (like bathing, dressing, making meals, and taking medicine)
  • Assistance with pain management and comfort care
  • Support for caregivers who may require specialized assistance or a break to work, travel, or run errands

This care is available in various venues, some administered by the VA and others run by the state or community organizations.

See our guide to long-term services and support for additional information.

DOES THE VA PROVIDE SUPPORT TO CAREGIVERS OF DISABLED VETERANS?

Caregivers of critically injured veterans are eligible for several VA benefits. The new Comprehensive Assistance for Family Caregivers Program benefits qualifying veterans who suffered or exacerbated a significant injury while serving in the military on or before May 7, 1975, or on or after September 11, 2001.

Related:Tricare Standard

Parents, spouses, children, step-family members, extended family members, or anyone else who lives with the veteran but is not a family member can act as caregivers.

DOES THE VA PAY FOR MEDICAL CARE IN THE COMMUNITY?

Veterans can get general healthcare at a Veterans Medical Center (VAMC), but they may need outside help sooner.

The Veterans Choice Program allows you to see civilian doctors in your community for VA-related health care. This program addressed the VA’s delays in providing medical care to veterans, allowing them to receive treatment sooner.

DOES THE VA PAY FOR HEALTH CARE FOR VETERANS ABROAD?

Through the Foreign Medical Program (FMP), the VA provides limited health care coverage to veterans who live or travel outside of the US. Under present law, the VA can only provide hospital care and medical services to a qualified veteran outside the US if the VA “determines that such care and services are needed to treat the veteran’s service-connected disability or as part of a rehabilitation program.”

DOES THE VA PAY FOR EMERGENCY CARE AT NON-VA FACILITIES?

In a medical emergency, VA advises all Veterans to seek medical help as soon as possible. Before requesting an ambulance or deciding to go to the emergency room, veterans don’t need to check with the VA. Veteran emergency care claims will never be denied because the VA was not notified before the patient sought care.

In general, if the care is related to a veteran’s service-connected condition, VA will pay for emergency medical care at a local ER. The VA may also cover a veteran’s non-service-connected medical condition.

DOES THE VA PAY FOR URGENT CARE?

Eligible veterans can get urgent care at VA medical facilities or in-network urgent care clinics near their homes.

Use the VA’s urgent care benefit to treat non-life-threatening injuries and illnesses like colds, strep throat, strained muscles, and skin and ear infections.

BEWARE OF TRICARE DOWNSIDE

Did you know Tricare does not cover multiple benefits? Learn the 5 most important benefits Tricare doesn’t cover.

TRICARE Dental Insurance

Active-duty personnel’s family members as well as non-active members of the National Guard and Reserve, retirees, and all their families are eligible for the TRICARE Dental Plan. TDP is a supplemental dental insurance policy available to TRICARE members. It is available in the Continental United States (CONUS) as well as internationally (OCONUS).

ELIGIBILITY

To be eligible for TDP, your sponsor must have served in the military for at least 12 months at the time of enrollment. Up to 21 years old, spouses and children are qualified family members (or age 23 if full-time students).

TRICARE’s Options

There are different TRICARE plans based on whether a service member has access to both network and non-network doctors as well as their proximity to a military base. The primary TRICARE plans are briefly described below:

WHAT IS TRICARE SELECT?

TRICARE Select lets you manage your preferred provider network. It took the place of TRICARE Standard and Extra in 2018.

You can enroll in TRICARE Select in one of two ways:

  • During Open Season (for new enrollments only)
  • During Qualifying Life Event (for new registration or changes to current plans).

Both active-duty and non-active-duty family members are eligible for TRICARE Select. This plan allows participants to get care from any TRICARE-authorized provider, whether or not they are in the network.

There is no deductible, but a $1,000 catastrophic cap varies depending on the sponsor.

WHAT IS TRICARE EXTRA?

TRICARE Extra offers you more flexibility than TRICARE Prime, but it can cost you more. If you are eligible for TRICARE benefits, you do not need to enroll in advance to use TRICARE Extra. You are immediately registered the first time you utilize any benefits and present your military or dependent ID card to the provider.

This program allows you to go to any TRICARE network provider (TNP) and obtain medical care by presenting your military or dependent ID card. You do not have to file your claims under the TRICARE Extra program.

TRICARE extra is not available to active duty service members or those stationed overseas.

WHAT IS TRICARE PRIME?

TRICARE Prime is a healthcare program for active-duty military personnel and their families offered in Prime service zones in the United States. It covers general preventative and eye care.

A primary care manager (PCM), a military or network provider, is responsible for your care. Patients who require care that the PCM does not offer can be referred to specialists.

There are no out-of-pocket costs, network copays, point-of-service fees, or registration fees for active-duty members.

Out-of-pocket charges and copays may apply to family members on the plan.

WHAT IS TRICARE RESERVE SELECT (TRS)?

TRICARE Reserve Select is accessible in all 50 states and the District of Columbia. Members of the National Guard and Reserve can purchase it as a premium-based plan.

The annual deductible varies, and both network and non-network authorized doctors offer care. Specialists do not require referrals, but some treatments may require prior authorization.

If the care is performed in-network, claims are filed; however, the patient must submit claims if the provider is not in-network. Fees vary depending on the type of provider seen, but providers in the TRICARE network have lower out-of-pocket costs.

WHAT IS TRICARE RESERVE RETIRED (TRR)?

The TRICARE Retired Reserve plan is a premium-based plan available worldwide.

A retiree and their family members who are eligible for non-regular retirement (under the age of 60) and are not enrolled or suitable for the Federal Employees Health Benefits Program will be offered enrollment.

TRICARE-authorized providers, either network or non-network, provide care. If space is available, beneficiaries can request an appointment at a military clinic or hospital.

Monthly premiums, a yearly deductible, and a percentage of covered services are paid by the beneficiaries.

WHAT IS TRICARE FOR LIFE (TFL)?

TRICARE for Life is a Medicare program for retired military personnel and their families. It is available worldwide and provides supplementary health insurance to TRICARE beneficiaries with Medicare Part A and Part B.

Authorized doctors and experts at military clinics and hospitals provide care if space is available.

There are no enrollment fees and little out-of-pocket costs if participants pay their Medicare Part B payment. The maximum out-of-pocket cost varies, but beneficiaries with both Medicare and TRICARE coverage pay nothing out of pocket.

WHAT IS TRICARE YOUNG ADULT (TYA)?

Adult children who are no longer eligible for other TRICARE plans are eligible for TRICARE Young Adult coverage.

To qualify for the program, applicants must be between the ages of 21 and 26. Beneficiaries can choose between Prime and Select.

The cost of a plan is determined by whether it is Prime or Select, the sponsor’s military status, and the location of care for the beneficiary.

Monthly premiums, as well as payments for covered services, are included in the costs.

WHAT IS TRICARE SUPPLEMENT?

A TRICARE Supplement Plan works in conjunction with your TRICARE health insurance to assist in covering costs that TRICARE does not cover. (CHAMPVA works similarly for people not eligible for TRICARE coverage.)

Additionally, this plan provides you with extra benefits, such as the opportunity to seek treatment at any TRICARE-authorized civilian institution or provider.

Supplemental health insurance pays you after TRICARE pays half of the cost, as opposed to regular health insurance, which pays first. It reimburses you for medical expenses you spent out of pocket on civilian providers.

There are rules specific to each supplemental insurance plan. Before acquiring a supplemental insurance plan, carefully assess you and your family’s healthcare needs.

How Do TRICARE and Medicare Work Together?

TRICARE For Life (TFL) is a free health insurance program for eligible U.S. military retirees and their dependents separate from Medicare.

The Medicare program in the United States provides health insurance to the elderly and the disabled. Dual-eligible individuals should be aware of their coverage options.

The TRICARE For Life program can work with Original Medicare (Parts A & B), Medicare Advantage plans, or Part D prescription drug plans.

Its purpose is to lower your out-of-pocket medical expenses, such as prescription medication costs and some Medicare copayments and deductibles. It also assists in paying medical expenses incurred while traveling outside of the United States.

You can get care from any Medicare-approved provider if you have both Medicare and TFL. You can also seek care from a non-participating provider, but Medicare will only pay for Medicare-approved services. You can also seek medical attention at any military hospital if there is space available.

5 Important Benefits TRICARE Does NOT Cover

Catering to nearly 9.4 million service members, veterans and family members, TRICARE is a worldwide health care program initiated by the Defense Health Agency. It provides healthcare facilities under several plans, depending upon the location and position of the applicant.

However, while this revolutionary program is appreciated by most, there are a few things that are excluded from TRICARE.

Here are five important benefits TRICARE does not cover:

#1 – Life Insurance

Life insurance offers financial protection to the family of a policyholder after his or her death.

For people who work and have a spouse or children who depend on their income, life insurance is critical.  It can replace your lost income in the event of your death, pay off credit cards, auto loans, mortgage, and more.

The idea is to leave your family in a financially sound position instead of in financial ruins if you were to die unexpectedly.

Life insurance usually consists of two types – term life insurance and whole life insurance.

Term life insurance is a type of life insurance coverage that pays a certain amount to the family of the policyholder if they die during the stated time. Whole life insurance, on the other hand, provides coverage throughout the life of the policyholder.

These coverage options are not included under TRICARE plans. However, the Department of Veterans Affairs (VA) has a different plan for this. Active military members are directly enrolled under Servicemembers’ Group Life Insurance, while veterans and family members can enroll themselves under VGLI and FSGLI.

#2 – Long-Term Care Insurance

As the cost of health care increases in the U.S., the problem of paying for long-term care is becoming a large issue, far too burdensome for many families.

Here are a few stats from Morningstar:

  • 37% of individuals age 65 today will incur some out-of-pocket long-term care costs in their lifetimes.
  • 9% of individuals age 65 today will incur a cost of over $250,000 out-of-pocket for long-term care
  • $321,780: Estimated lifetime cost to care for someone with dementia
  • $105,850: Median annual nursing-home cost for a private room
  • 41 million family members must provide unpaid caregiving in the U.S.

Long-term care insurance pays the cost, or a portion of the cost to receive care in-home or in a facility, such as a nursing home. This coverage covers the cost of nursing home care, adult daycare, and home health care.

TRICARE does not provide this insurance, nor does it offer long-term care facilities. However, you can purchase long-term care (LTC) insurance from several other sources.

While this can be a little expensive, it will provide complete home care coverage. Some policies might also cover the cost of a therapist, nurse, companion, or housekeeper.

#3 – Disability Insurance

According to the Health Insurance Association of America, 30% of all people age 35 – 65 will suffer a disability for at least 90 days, and about 1 in 7 can expect to become disabled for 5 years or more.

Translation: If you are no longer in the service, there’s still a huge chance of becoming disabled and losing income due to lost work.

Disability insurance steps in and covers lost wages due to disability.

Note that there is a separate coverage option that covers the interest of veterans suffering from a service-related disability, commonly known as Service-Disabled Veterans Life Insurance, (S-DVLI).

While this insurance is not offered by TRICARE, you can become an eligible applicant if you meet the eligibility criteria defined by the department.

Eligible members can receive up to $100,000 of coverage and supplementary coverage of $30,000.

#4 – Final Expense Insurance

Also known as funeral insurance or burial insurance, final expense insurance is a small death benefit that helps you cover the cost of your funeral. This policy is not provided by TRICARE.

To benefit from these types of policies, contact an insurance provider. This policy can provide maximum coverage of $50,000.

#5 – Cosmetic or Plastic Surgery

Performed on almost all parts of the body, a cosmetic surgery is an alteration of body parts to enhance beauty and alter appearance. Because this is not deemed necessary for survival, this surgery is not included under the TRICARE plans.

TRICARE Regional Offices

Although your Tricare benefit remains the same regardless of your location, each region has a customer service contact. A contractor is assigned to each province to oversee health care for its residents.

Additional health care services are provided through regional contractors, excluding TRICARE For Life (in the United States and U.S. Territories) and the U.S. Family Health Plan.

They are responsible for the following in each region:

  • Networks of providers
  • Call centers for customer support that are available 24/7
  • Enrollment, referrals, authorization, and claim processing
  • Education for both the recipients and the providers

Provider: Humana Military, a division of Humana Government Business www.tricare-east.comTRICARE East

Regions Covered: Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island Arsenal area only), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area only), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding the El Paso area), Vermont, Virginia, West Virginia and Wisconsin.

Claims Address

TRICARE East Region Claims
ATTN: New Claims
P.O. Box 7981
Madison, WI 53707-7981

TRICARE East Phone Number: 1-800-444-5445

Login or Register for the TRICARE online patient portal: East Region

To get started, you’ll need:

  • Common Access Card (CAC),
  • DFAS (MyPay) Account, or
  • Premium (Level 2) DoD Self-Service Logon account

TRICARE WEST

Provider: Health Net Federal Services, LLC www.tricare-west.com

Regions Covered: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding the Rock Island Arsenal area), Kansas, Minnesota, Missouri (excluding the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the southwestern corner only, including El Paso), Utah, Washington and Wyoming.

Claims Address

TRICARE West Region Claims
P.O. Box 202112
Florence, SC  29502-2112

TRICARE West Phone Number:  1-844-866-9378

Login or Register for the TRICARE Patient Portal: West Region

TRICARE NORTH AND TRICARE SOUTH

As of January 1, 2018, Tricare North and Tricare South have been consolidated to form Tricare East.

Transitioning and merging Tricare’s regions was undertaken to:

  • Deliver better health care at a lower cost and higher quality
  • Streamline the delays in specialty care appointments
  • Improve the communication between civilian and military providers
  • Facilitate the referrals process

While the West Region has remained intact, the North and South Regions have been combined to form the new East Region.

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1 Comment
  • Janice McLeroy Gaultney
    Posted at 14:20h, 21 October Reply

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