TRICARE Eligibility

TRICARE

TRICARE is a health benefit program for all seven uniformed services: the Army, Navy, Marine Corps, Air Force, Coast Guard, Public Health Service, and the National Oceanic and Atmospheric Administration. To use TRICARE, you must be listed in DEERS as being eligible for military health care benefits. If you don ?t find answers to your eligibility questions in this section, check with your military service personnel office for specific information.

TRICARE-eligible persons include the following:

  • Active duty service members
    Note: Active duty service members and activated National Guard or Reserve Members must enroll in one of the TRICARE Prime options: 
    • TRICARE Prime
    • TRICARE Prime Remote
    • TRICARE Prime Overseas
    • TRICARE Global Remote Overseas 
  • Spouses and unmarried children of active duty service members
  • Uniformed service retirees, their spouses, and unmarried children
  • Medal of Honor (MOH) recipients and/or their families.
  • Un-remarried former spouse and unmarried children of active duty or retired service members who have died Note: Family members of active duty service members who died while on active duty, and who were on active duty for at least 31 days before death, will continue to be treated as active duty family members for TRICARE cost-sharing purposes for 3 years after their active duty sponsor dies.
  • Spouses and unmarried children of reservists and National Guard who are ordered to active duty for more than 30 consecutive days (they are covered only during the reservist's active duty tour) or of reservists and National Guard who die on active duty.
  • Spouses and unmarried children of reservists and National Guard who die as a result of a line of duty condition may be eligible for health care.
  • Persons who have received the MOH, and their family members, who are not otherwise TRICARE eligible. These persons will be able to obtain health care benefits under TRICARE in the same manner as if they were entitled to retired pay.
  • Unmarried children up to age 21 (including stepchildren who are adopted by the sponsor) are still covered by TRICARE even if the spouse gets divorced or remarried. But in the case of a stepchild who was not adopted by the sponsor and the marriage ends in divorce, the stepchild loses eligibility on the date the divorce decree is final. It should be emphasized that stepchildren don ?t have to be adopted by the sponsor to be covered by TRICARE while the sponsor and the mother or father of the stepchildren remains married. A child aged 21 or over may be covered if he or she is severely disabled and the condition existed prior to the child's 21st birthday or, if the condition occurred between the ages of 21 and 23 while the child was enrolled in a full-time course of study in an approved institution of higher learning and is, or was at the time of the sponsor's death, dependent on the sponsor for more than one-half of his or her support. A child may also be covered up to the 23rd birthday if he or she is in school full-time.
  • Children placed in the custody of a service member or former member, by a court of law; or by a recognized adoption agency in anticipation of legal adoption by the member. TRICARE eligibility is effective July 1, 1994, if a court of law places the child. A child placed by a recognized adoption agency is eligible effective October 5, 1994.
  • Children of current or former service members or their spouses born out of wedlock may be eligible for TRICARE benefits under certain conditions. Check with your Beneficiary Counseling and Assistance Coordinator (BCAC)/Health Benefits Adviser (HBA), or TRICARE Service Center (TSC).
  • Certain family members of active duty service members who were court-martialed and separated for spouse or child abuse. The victims of the abuse within the family are eligible for health benefits for the period that the abused family member is receiving "transitional compensation" under Section 1059 of Title 10, U.S. Code. Cost sharing will be the same as for other active duty families.
  • Certain abused spouses, former spouses, and dependent children of service members who were eligible for retirement, but had that eligibility taken away as a result of abuse of the spouse or child. This benefit is effective for medically necessary services and supplies provided under TRICARE Standard (CHAMPUS) on or after October 23, 1992.
  • Spouses and children of North Atlantic Treaty Organization (NATO) and "Partners for Peace" (PFP) nation representatives who are officially accompanying the NATO or PFP nation representatives while stationed in, or passing through, the United States on official business. These family members are eligible for outpatient benefits only (including ambulatory surgery). They are not listed in the DEERS files, and should check with a BCAC/HBA/TSC for assistance before getting care or filing claims. (NATO and PFP family members cannot enroll in TRICARE Prime.)
  • Former spouses of active, retired or former military members may be eligible for TRICARE if they meet the following requirements:
    1. Must not have remarried.  (If remarried, the loss of benefits remains applicable even if the remarriage ends in death or divorce.)
    2. Must not be covered by an employer-sponsored health plan.
    3. Must not be the former spouse of a North Atlantic Treaty Organization or Partners for Peace nation member.
    4. Must meet the requirements of one (not all) of the following three situations:

Situation 1

  • Must have been married to the SAME member or former member for at least 20 years, and at least 20 of those years must have been creditable in determining the member's eligibility for retirement pay.
  • If the date of the final decree of divorce or annulment was on or after February 1, 1983, the former spouse is eligible for TRICARE coverage of health care that is received after the date of the divorce or annulment.
  • If the date of the final decree is before February 1, 1983, the former spouse is eligible for TRICARE coverage of health care received on or after January 1, 1985.

Eligibility continues as long as the preceding requirements continue to be met.

Situation 2

  • Must have been married to the SAME member or former member for at least 20 years, and at least 15, but less than 20, of those years must have been creditable in determining the member's eligibility for retirement pay.
  • If the date of the final decree of divorce or annulment is before April 1, 1985, the former spouse is eligible only for care received on or after January 1, 1985, or the date of the decree, whichever is later.

Eligibility continues as long as the preceding requirements continue to be met.  However, if the date of the final divorce decree or annulment is on or after April 1, 1985, but before September 29, 1988, the former spouse is eligible for care received from the date of the decree until December 31, 1988, or two years from the date of the decree, whichever is later.

Situation 3

  • Must have been married to the SAME member or former member for at least 20 years, and at least 15, but less than 20, of those years must have been creditable in determining the member's eligibility for retirement pay
  • If the date of the final decree of divorce or annulment is on or after September 29, 1988, the former spouse is eligible only for care received for one year from the date of the decree.

Health Plan Options
If you qualify for TRICARE coverage based on the requirements listed above, you're covered with the same benefits as a retired family member.

Visit www.tricare.mil/enrollment/index.cfm for TRICARE Enrollment and Claim Forms.

For general information about TRICARE, call one of the many toll-free TRICARE information lines found at the TRICARE Contact Us web page.

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