During the three years following a sponsor's death, surviving spouses and children under 21 years of age (23, if enrolled in a full-time course of study in an institution of higher learning) remain eligible for TRICARE Prime without enrollment fees and copayments. Surviving family members may enroll in TRICARE Prime where offered, but lose eligibility for TRICARE Prime Remote for Active Duty Family Members, if enrolled in that program at the time of the sponsor's death. Surviving family members who are not enrolled in TRICARE Prime may use TRICARE Extra or Standard, but are subject to the appropriate active duty cost-shares and annual deductible requirements for each program. During the three-year survivor benefit period, surviving family members are protected from having to pay out-of-pocket expenses of more than $1,000 per fiscal year, for TRICARE allowable charges for covered services.
Surviving family members who choose to live outside the United States should check with the overseas TRICARE Service Center , as their benefits will differ slightly from those available in the United States .
If the survivor reaches age 65 or is disabled and becomes entitled to Medicare Part A, they must purchase Medicare Part B to retain TRICARE coverage. TRICARE survivor status ends if the surviving spouse remarries. Surviving spouse status can not be regained later, even if the surviving spouse later divorces or the new spouse dies.
It is extremely important for survivors to update their TRICARE eligibility in the Defense Enrollment and Eligibility Reporting System. Surviving family members may go to the nearest Uniformed Services identification card facility https://www.dmdc.osd.mil/rsl, or contact the Defense Manpower Data Center Support Office Telephone Center at (800) 538-9552. Surviving spouses must contact the ID card facility in advance to determine the range and scope of available services.
At the end of the three-year survivor benefit period, eligible surviving family members' TRICARE coverage converts to that of retiree family members. Eligible family members may enroll in TRICARE Prime where available, but must pay the same annual enrollment fees and copays as retiree family members. Those who do not enroll in TRICARE Prime convert to retiree family member status under TRICARE Extra or Standard, with the appropriate deductible and cost-share requirements for each program. Beneficiaries remain eligible for TRICARE pharmacy benefits and may enroll in the TRICARE Retiree Dental Program.
The out-of-pocket payment expenses for survivors in retiree family member status are limited to $3,000 per fiscal year, for TRICARE allowable charges for covered services.
The charts below summarize TRICARE Prime, Extra and Standard financial obligations for the three-year survivor benefit period and afterwards.
|Annual Deductible||None||$150/individual or $300/family for E-5 & above; $50/$100 for E-4 & below||$150/individual or $300/family for E-5 & above; $50/100 E-4 below|
|Annual Enrollment Fee||None||None||None|
|Civilian Outpatient Visit||No Cost||15% of negotiated fee||20% of allowed charges for covered service|
|Civilian Inpatient Admission||No Cost||Greater of $25 or $13.90/day||Greater of $25 or $13.90/day|
|Civilian Inpatient Mental Health||No Cost||$20/day||$20/day|
|Civilian Inpatient Skilled Nursing Facility Care||$0 per diem charge per admission||$11/day ($25 minimum) Charge per admission||$11/day ($25 minimum) Charge per admission|
|No separate copayment/cost share for separately billed professional charges|
|Annual Deductible||None||$150/individual or $300/family||$150/individual or $300/family|
|Annual Enrollment Fee||$230/individual $460/family||None||None|
|Civilian Copays||20% of negotiated fee||25% of allowed charges for covered service|
|Outpatient Emergency Care Mental Health Visit||$12 $30 $25 $17 (group visit)|
|Civilian Inpatient Cost Share||$11/day ($25 minimum) Charge per admission||Lesser of $250/day or 25% of negotiated charges plus 20% of negotiated professional fees||Lesser of $512/day or 25% of billed charges plus 25% of allowed professional fees|
|Civilian Inpatient Skilled Nursing Facility Care||$11/day ($25 minimum) charge per admission||$250 per diem copayment or 20% cost share of total charges, whichever is less, institutional services, plus 20% cost share of separately billed professional charges||25% cost share of allowed charges for institutional services, plus 25% cost share of allowable for separately billed professional charges.|
|Civilian Inpatient Mental Health||$40 per day||20% of institutional & negotiated professional fee||Lesser of $169/day or 25% of allowable fees|
Surviving family members who are already enrolled in the TRICARE Dental Program (TDP) at the time of the service member's death remain eligible for dental care under the plan. They pay no dental premiums during the three-year transitional survivor period. If surviving family members are not already enrolled in the TRICARE Dental Program at the time of the service member's death, they are ineligible for the TDP, but may enroll in the TRICARE Retiree Dental Program (TRDP). Under the TRDP, enrollees are responsible for one hundred percent of the premium cost.
Family members who would like to obtain information regarding the loss of a loved one or coping with grief can find information on the Military One Source Website at www.militaryonesource.mil.
For general information about TRICARE, call the toll-free TRICARE information line for your region found at the TRICARE Contact Us web page.