top of page

Your Healthcare Coverage

One of the amazing benefits of being a military spouse is the healthcare! Whether you choose to enroll yourself only, or you include your dependents, the healthcare coverage options can be really quite exceptional - as well as tailored to your specific needs and location!

TRICARE Medical Information

TRICARE is your health care provider. You will need to select a plan specific to you and your family's needs. This health care is only available for spouses and dependents, and this is a benefit that does not come out of their paycheck. Your spouse is not going to have a choice in their medical insurance. But you, as a dependent, have a choice where you can go on either Prime or Select. 

 

Click here to be taken to these benefits

​

  • TRICARE is available two different ways: PRIME or SELECT​

    • TRICARE Prime is your free option, where you are given a Primary Care Manager (that can be changed at any time), there are no out of pocket costs, and referrals are issued by your Primary Care Manager. ​

    • TRICARE Select has out of pocket costs, but you are allowed to see any doctor or specialist without getting a referral from your Primary Care Manager.

​

​​

​

  • For information regarding TRICARE for USCG Reserve members CLICK HERE. ​​​​​​​​

​

TRICARE

Tricare PRIME

TRICARE PRIME
ADVANTAGES

This insurance plan has a Primary Care Manager (PCM), and you see that doctor to get referrals before you can see a specialist.

You can change your Primary Care Manager at any time by contacting TRICARE online or on the phone, and you can also change the specialist you were referred to if there is another doctor in the TRICARE system that takes this insurance. 

The only time you need a referral from your Primary Care Manager is when you want to see a specialist.
​
This may be important if you see a specialist for medical issues you or your dependents already know you have, and there are specific doctors you want to see.

You can always go to an emergency room or urgent care that takes TRICARE; no referral needed.

If you're able to go through your Primary Care Manager for a referral, you pay nothing except pharmacy co-pays. 

These copays are the same on both Prime or Select plans. The red column shows $0 all the way down, and that's what the fees are for TRICARE Prime! 

This plan works really well when you live in an area that has a lot of doctors, and you're able to find a doctor who takes TRICARE easily. 

Remember:
THE COST TO YOU IS ZERO DOLLARS! You can easily add your dependents during a Qualifying Life Event or during open enrollment! 

FOR EXAMPLE ONLY

Current costs may be different.

Please see TRICARE's website for updated costs.

2025 Tricare.jpg
Tricare SELECT

TRICARE SELECT
ADVANTAGES

You have more freedom with this plan!
You can see any specialist who takes TRICARE, without the need of getting a referral from your Primary Care Manager.
You can go to doctors that are in-network, which means those doctors or hospitals or labs have signed a contract with TRICARE. 

ACTUAL COST AND NUMBERS MAY VARY. PLEASE USE THESE COST EXAMPLES TO UNDERSTAND THE PROGRAM and get the current rates and costs from TRICARE directly. There is an annual deductible of $62 -- this amount is annual, not per visit. That means the first time you go to the doctor on this plan, you have $62 out of pocket to pay, then TRICARE will kick in and share the cost with you. If you decide to go to a doctor that is in-network, you pay $18 for that visit.

Hospitalization under this plan could be costly: An in-network hospital visit is a flat $75. You could be in the hospital for two days, twenty days, or two months, and it's still a flat $75, as long as the hospital is in-network.

If you are admitted to a hospital that is out-of-network, that's where the cost could be huge.

Looking at the chart, you see the cost for you is 20% of the hospital stay and services. For this reason, TRICARE created a safety net called a "Catastrophic Cap".

Providers who have not signed a contract with TRICARE are "out-of-network".
 
You have more choice on which providers you see, and you don't have to have those referrals.
 
You can call a specialist and make appointments yourself, and you don't need anyone's permission. But, this freedom comes at a co-pay amount.

If any of those providers are out-of-network, you'd pay 20% of the cost of that visit. 

Catastrophic Cap is where if all of the copays and deductibles for you and all of your dependents add up to $1256, TRICARE will pay 100% for you the rest of the year.

January 1st this slate is wiped clean, and your Catastrophic Cap resets again. Some people can budget $1256 a year for the freedom to see whomever they want to see, and that's why Select is a good option for them. 

EAST OR WEST REGION

Which Region
Am I?

Regardless of the program you choose, Prime or Select, your medical insurance will be broken up into regions. The country is split in half: East and West. For a current map of which region applies to you, please see TRICARE's website.

 

When you live in the "East" region, your TRICARE will be called "TRICARE East". When you are living in the "West" region, your insurance will be called "TRICARE West". You can always log into the website, check doctors in the area, and see if your doctor that you want to see is in-network. This is a great way to check which program you'd like to be enrolled into each time you move with the military, Prime or Select. 

​

The website is very helpful! You can see your referrals, claims, bills, and all doctor information just by logging into your patient portal.

RegionsPageJan_1_Map.png

​

  • Both Prime and Select are the same for your pharmacy. Your spouse is not paying anything for their prescriptions, but you have a copay for yours and for your dependents. 

​

  • There may be pharmacies that are excluded from TRICARE's plan. This list could change each year and should be referenced on TRICARE's website before you attempt to fill a prescription. 

​

  • Any medication you take routinely, like birth control or heart pills or injections for auto-immune disorders, you may want to look into having these prescriptions delivered to you via mail! Express Scripts is excellent and in most occasions, may be less expensive than filling these prescriptions at your local pharmacy.

​

​

  • Your plan can be switched from Prime to Select, or vice versa, during special circumstances.

​

  • The first time is during a "qualifying life event", like you are going to have a baby, you are moving to a new duty station, you get married or divorced. Any time a qualifying event happens, you can contact TRICARE and get enrolled, or get your plan changed.

​

  • You have 90 days from these qualifying events taking place to get enrolled or make that change -- so -- when you move to a new location and you need to switch from TRICARE East to TRICARE West, or if you want to change your plan from Prime to Select, you have 90 days from that move date. 

​

  • The next time you can enroll is during open enrollment, which is at the end of the calendar year. Open enrollment occurs each fall, beginning on the Monday of the second full week in November to the Monday of the second full week in December. During this time, you can call and make your switch and it will be effective starting January 1st. 

CRITICAL
REMINDERS!

The moment your spouse got off the bus at boot camp, your clock to choose a medical insurance plan began -- and that clock has 90 days for you to make that choice. 

  • That means you have only 30 days (or less) from graduation to pick a plan and ensure that you are registered for your medical insurance. 

​

  • When your spouse gets home from boot camp, life is going to be CRAZY. You'll be packing, they'll be spending time with a few days off to plan for the move, you'll have life happening, and before you know it, your 30 days will be over and you will have missed your window to choose your medical plan. 

​

  • IF YOU ARE NOT REGISTERED FOR MEDICAL INSURANCE BEFORE THIS 90 DAY WINDOW IS UP, YOU WILL LOSE MEDICAL INSURANCE FOR THE REST OF THE YEAR UNLESS YOU HAVE ANOTHER QUALIFYING LIFE EVENT (QLE). Click here for information about QLEs.

​

​

  • Remember, regardless of who is given to you as your Primary Care Doctor, you can change that person any time. The important thing is to get enrolled before your window closes. 

Pharmacy Details

Open Enrollment Details

Dental

Dental Insurance

There is a premium that comes out of your spouse's paycheck for dental insurance. Your spouse's dental care is covered in full, so you will only be paying for you and your family. 

​

Enrolling in Dental Insurance:

  • Click here to see the different dental insurance plans and coverage options: 

  • Your spouse can also register for dental for the family online at work, using their CAC card at the milconnect website. 

  • Registering for dental insurance is on the 20th of the month, so no need to wait for the end of the year, or for a qualifying life event! If you are enrolled by the 20th of the month, it will be effective on the 1st of the next month. You can enroll like this any month of the year on the 20th of the month. 

  • Be sure to check out each plan to see what's covered - this is the most affordable dental program out there, so be sure to figure out your plan and register! 

  • This program is nationwide! That means you can be on vacation anywhere in the country, and if you have a dental emergency, you can check the website for a dentist who takes your insurance out of state, and get in and be seen for immediate relief. It will all be covered. 

Red Toothbrush_edited_edited.png
Vision

Vision Insurance

Your regular medical coverage pays for routine eye exams every year, but it does not pay for glasses or contacts. Vision benefits are excellent and optional for people who have these needs. This does not apply to your spouse; this is only coverage for you and their dependents. Your spouse's glasses are covered through the military in full, and while your spouse can take that prescription to any place in town, they will have to pay out of pocket if they want glasses from a place that isn't their base. 

​

Vision coverage has several different coverage plans, and they are all vastly different and have different pricing plans. You'll want to look online and compare all the vision plans and see what is best for you and your family. 

  • You have 60 days from your spouse's boot camp start date to get your vision coverage registered. 

  • After that window closes, open enrollment is the only other time you can register, and that is at the end of the year. Once you enroll at the end of the year, your vision coverage begins on January 1st. 

  • Use this link HERE to register and check out the different plans

Glasses_edited.jpg

This is a non-federal entity. This non-federal entity is not part of, or endorsed by, the Department of Homeland Security or the United States Coast Guard and it has no governmental status.

This entity exists for informational purposes only

​

Funding for this website was provided by the Coast Guard Foundation. The Coast Guard Foundation partners with the Coast Guard to provide resources to members and families that build resilience and strengthen the entire community. Learn more about the Coast Guard Foundation and its continued efforts to support CG families by clicking HERE.

bottom of page