TRICARE Eligibility

Your key to TRICARE eligibility depends on your enrollment in the Defense Enrollment Eligibility Reporting System (DEERS). The DEERS record will indicate the dates of eligibility. All uniformed services sponsors (active, reserve or retired) should ensure that their Family status (marriage, death, divorce, new child, etc.) and residential address are current in DEERS at all times. DEERS enrollment and/or updates are completed at uniformed services personnel offices, not TRICARE service centers. For more information about DEERS, contact the Defense Manpower Data Center Support Office (DSO) Telephone Center from 6 a.m. to 5 p.m., Pacific Time, Monday through Friday, at the following toll-free number: 1-800-538-9552.

Beneficiary Categories of Eligible Beneficiaries

Beneficiary Category	Description
Active duty and retired service members	From any of the seven Army, Air Force, Navy, Marine Corps, Coast Guard, Public Health Service, or the National Oceanic & Atmospheric Administration.
Spouses and unmarried children (including stepchildren) of active duty or retired service members Note: Step children lose eligibility after a divorce unless adopted by the sponsor.	Remain eligible even if parents divorce or remarry. Eligibility ends at age 21 unless the child is a full-time student (validation of student status required) then eligibility ends at age 23 or when the full-time student status ends. Eligibility may extend past age 21 if the child is incapable of self-support because of a mental or physical incapacity and the condition existed prior to age 21, or if the condition occurred between the ages of 21 and 23 while the child was a full-time student. Illegitimate children of current or former service members or their spouses may be eligible under certain conditions. Children placed in the custody of a service member or former member, either by a court or by a recognized adoption agency, in anticipation of legal adoption by the member.
Reserve Component members on active duty for more than 30 days – under Federal orders	From any of the seven uniformed services Reserve Component Army, Air Force, Navy, Marine Corps, Coast Guard, Public Health Service, or the National Oceanic & Atmospheric Administration.
Spouses and unmarried children of reserve component service members	Covered while reserve component sponsor is on active duty for more than 30 consecutive days. Covered if reserve sponsor was injured or dies during, or on the way to or from, active-duty training for a period of 30 days or less.
Retired reserve component service members and their Family members	When the retired reserve component service member is eligible for retirement pay (usually at age 60), the member and his/her eligible Family members become TRICARE eligible.
Widows or widowers and unmarried children of deceased active duty or retired service members	Are eligible as Family members of deceased member if sponsor was serving or was ordered to active duty for more than 30 days at time of death. Claims will be cost-shared at the active duty Family member rate for three years after death of active duty sponsor, and thereafter at the retiree rate. Widows or widowers remain eligible until they remarry (loss of benefits remains applicable even if remarriage ends in death or divorce). Children remain eligible until age 21, unless they meet the exceptions above.
Medal of Honor recipients and their Family members	Any service member who has been awarded the Medal of Honor, his/her eligible Family members and widows are eligible for medical and dental benefits under TRICARE.
Certain eligible former spouses of active duty or retired service members	Must not have remarried. (If they remarry, the loss of benefits remains applicable even if remarriage ends in death or divorce) Starting Oct. 1, 2003, eligibility and medical records will be listed under former spouse’s own Social Security Number – not their sponsor’s. Must not be covered by an employer-sponsored health plan. Must not be the former spouse of a North Atlantic Treaty Organization (NATO) or “Partners for Peace” (PFP) nation member. Must meet the requirements of one 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 Feb. 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 Feb. 1, 1983, the former spouse is eligible for TRICARE coverage of health care received on or after Jan. 1, 1985. Eligibility continues as long as the preceding requirements continue to be met.
	Situation 2 Must have been married to the SAME military member or former member for at least 20 years, and at least 15—but less than 20—of those married 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 Jan. 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 Sept. 29, 1988, the former spouse is eligible for care received from the date of the decree until Dec. 31, 1988, or two years from the date of the decree, whichever is later.
	Situation 3 Must have been married to the SAME military member or former member for at least 20 years, and at least 15—but less than 20—of those married 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 Sept. 29, 1988, the former spouse is eligible only for care received for one year from the date of the decree.

Special Circumstances for TRICARE Eligibility

Check with your local ID card issuing facility or unit personnel office about eligibility requirements for the following beneficiary categories:

• Certain Family members of active duty service members who were discharged as a result of a court-martial conviction or separated for spouse or child abuse.
• Certain abused spouses, former spouses and dependent children of service members who were eligible for retirement, but were revoked as a result of abuse of the spouse or child.
• Spouses and children of representatives of North Atlantic Treaty Organization (NATO) and “Partners for Peace” (PFP) nations that are signatories to the respective Status of Forces Agreements (SOFAs) with the United States, while stationed in or passing through the U.S. on official business. These Family members are eligible for outpatient benefits only.

Dependent Parents and Parents-in-law

Dependent parents and parents-in-law are eligible for care in a military treatment facility (MTF) and may enroll in TRICARE Plus* based on space/resource availability. TRICARE Plus is a local MTF-based primary care enrollment program that may provide TRICARE-eligible beneficiaries, who are not enrolled in Prime, an opportunity to enroll with their local MTF for primary care services. Dependent parents and parents-in-law are not eligible for TRICARE Prime, Standard, Extra or TRICARE For Life. They may be eligible for the Senior Pharmacy Program if they meet all of the requirements.

Medicare-eligibility and TRICARE

Attaining Medicare eligibility does not mean beneficiaries lose eligibility for TRICARE. See the three examples below of dual Medicare/TRICARE eligibility:

1. Beneficiaries, who become eligible for Medicare Part A on the basis of age and purchase in Medicare Part B, continue to be eligible for TRICARE, secondary to Medicare.
2. Family members of active duty service members who are also eligible for Medicare for any reason retain eligibility for TRICARE Prime, Extra or Standard whether or not they purchase Medicare Part B. However, the purchase of Medicare Part B in this instance is recommended. If they do not enroll in Medicare Part B as soon as they are eligible, the cost of Medicare Part B may increase 10% for each 12-month period that they could have been enrolled but were not. Please contact Medicare for more information on Part B enrollment.
3. Beneficiaries under age 65 who are entitled to Medicare Part A because of disability or end stage renal disease and have purchased in Medicare Part B retain their eligibility for TRICARE Prime, Extra or Standard until they turn 65, when they become only eligible for TRICARE For Life. Beneficiaries should notify their MTF or military personnel office if they become eligible for Medicare due to a disability or end stage renal disease.

Medicare coverage begins on the first day of the month in which beneficiaries become eligible. However, if the 65th birthday falls on the first day of the month, then Medicare Part A eligibility begins on the first day of the preceding month—and eligibility for TRICARE Prime, Extra or Standard ends. If beneficiaries are not eligible for Medicare Part A when they turn 65, a Social Security Administration “Notice of Disallowance” must be submitted to the uniformed services responsible for issuance of identification cards so that a new ID card showing TRICARE eligibility can be issued. Please visit www.medicare.gov or call the Social Security Administration at 1-800-772-1213 (TTY/TDD: 1-800-325-0778) for more information about Medicare Parts A and B.

CHAMPVA

Families of veterans who have a 100 percent, permanent disability, or of veterans who died from a service-connected disability, may be covered by CHAMPVA as long as they are not eligible for TRICARE. Eligible former spouses who when they remarried lost their TRICARE eligibility and whose marriage ended in divorce or death may also be entitled to CHAMPVA. CHAMPVA is administered by the Department of Veterans Affairs. Veterans may contact the Department of Veterans Affairs toll-free, 1-800-827-1000, for information. Details on possible CHAMPVA eligibility for Family members are available from the Veterans Affairs Health Administration Center toll-free at 1-800-733-8387.

Program for Persons With Disabilities

ECHO, a supplemental TRICARE program, provides financial assistance to eligible active duty Family members (ADFMs) who have a qualifying mental or physical disability. The program offers services and supplies beyond the basic TRICARE benefits covered in Prime, Extra and Standard. The ECHO benefit also provides a monthly government cost share of $2,500 per eligible Family member, a $1,500 increase over the Program for Persons with Disabilities’ cost share. Additionally, some beneficiaries may qualify for ECHO Home Health Care (EHHC). EHHC provides medically-necessary skilled services to eligible homebound beneficiaries.

For more information about TRICARE eligibility, beneficiaries may contact their local health benefits adviser or TRICARE service center. You can also visit the TRICARE Web site at www.tricare.osd.mil.

Source: TRICARE Eligibility