TRICARE Program: Overview for Military Members, Retirees, and Families
TRICARE is the Department of Defense health-care program that covers active-duty service members, National Guard and Reserve members, military retirees, and their eligible family members. It combines care at military treatment facilities with a civilian provider network and operates worldwide. Coverage includes inpatient and outpatient services, emergency care, prescription drugs, mental-health services, preventive care, maternity care, and durable medical equipment. Dental and vision benefits are limited or handled through separate programs depending on the plan and beneficiary category.
Eligibility is recorded in the Defense Enrollment Eligibility Reporting System (DEERS). Beneficiaries should keep DEERS information current.
Main TRICARE Plans
| Plan | Primary eligibility | Key features | Cost notes (2026) |
|---|---|---|---|
| TRICARE Prime | Active-duty members and families; retirees and families in Prime service areas | Primary Care Manager (PCM) required; referrals for most specialty care; lowest out-of-pocket costs for many services | Active-duty families: $0 enrollment. Retirees pay annual enrollment fees (Group A or Group B) |
| TRICARE Select | Most non-active-duty beneficiaries | No PCM or referrals required; greater provider choice; higher cost-shares and deductibles | Active-duty families: $0 enrollment. Retirees pay annual enrollment fees (lower for Group A than Group B) |
| TRICARE For Life | Medicare-eligible beneficiaries (usually age 65+) who have Medicare Parts A and B | Acts as secondary payer to Medicare; minimal out-of-pocket costs for services covered by both | No TRICARE enrollment fee; beneficiary must pay Medicare Part B premium |
| TRICARE Reserve Select (TRS) | Selected Reserve members not on active duty orders and their families | Premium-based; similar to Select in structure | Monthly premiums apply (member-only and family rates) |
| TRICARE Retired Reserve (TRR) | Retired Reserve members under age 60 (not yet eligible for retired pay in some cases) and families | Premium-based comprehensive coverage | Higher monthly premiums than TRS |
| TRICARE Young Adult (TYA) | Unmarried adult children ages 21–26 who have aged out of regular TRICARE | Choice of Prime or Select option; premium-based | Monthly premiums are substantial (Prime higher than Select) |
| US Family Health Plan | Eligible beneficiaries in designated service areas | Prime-like managed-care option delivered through specific not-for-profit networks | Follows Prime cost structure in most respects |
Group A vs. Group B status (determined by the sponsor’s initial entry into service before or on/after January 1, 2018) affects retiree enrollment fees, deductibles, and catastrophic caps.
Pharmacy Benefits (2026)
Prescription coverage is administered through military pharmacies, TRICARE Pharmacy Home Delivery, and the retail network (Express Scripts).
Typical 2026 copayments for most non-active-duty beneficiaries (up to the stated supply):
- Military pharmacy (up to 90 days): $0 for covered formulary drugs
- Home delivery (up to 90 days): approximately $14 generic / $44 brand-name formulary / $85 non-formulary
- Retail network (up to 30 days): approximately $16 generic / $48 brand-name formulary / $85 non-formulary
Active-duty service members generally pay $0 at military pharmacies, home delivery, and network retail pharmacies for covered drugs. Non-formulary drugs and non-network pharmacies follow different rules and may require prior authorization or full payment with later claim filing. Confirm current figures on tricare.mil/pharmacycosts, as amounts are adjusted periodically.
Enrollment and Regional Administration
- Active-duty members and their families are generally enrolled in Prime automatically or by direction.
- Other beneficiaries enroll or change plans during TRICARE Open Season (typically mid-November to mid-December) or after a Qualifying Life Event.
- Enrollment is handled through milConnect (Beneficiary Web Enrollment), by phone with the regional contractor, or by form.
Regional contractors (U.S.):
- East: Humana Military
- West: Health Net Federal Services (or current successor)
Overseas coverage is managed under the TRICARE Overseas Program. Contact information and plan-finder tools are available at tricare.mil.
Key Practical Points
- Always verify eligibility and enrollment status in DEERS.
- Prime generally offers lower out-of-pocket costs but requires a PCM and referrals. Select offers flexibility at higher cost-sharing.
- Retirees should understand Group A/B differences and the interaction of TRICARE For Life with Medicare.
- Pharmacy home delivery is usually the lowest-cost option for maintenance medications.
- Catastrophic caps limit annual out-of-pocket spending; amounts differ by plan and Group A/B status.
- Dental coverage is provided separately (e.g., Active Duty Dental Program, TRICARE Dental Program). Vision benefits are limited.
Summary
TRICARE provides comprehensive health coverage for the uniformed-services community through a set of plans tailored to active-duty, Reserve, retiree, and family circumstances. Plan choice, Group A/B status, and use of network vs. non-network providers determine costs. The most reliable sources for current enrollment fees, copayments, deductibles, and catastrophic caps are the official TRICARE website (tricare.mil) and the beneficiary’s regional contractor. Beneficiaries should review their specific plan documents and DEERS record annually or after any change in status.
Related topics on this site include Military Insurance, Servicemembers’ Group Life Insurance, and Veterans’ Group Life Insurance.