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News | Dec. 28, 2022

Know These TRICARE Basics To Make the Most of Your Plan

By TRICARE Communications

A new plan year begins Jan. 1, 2023. Now is a great time to get to know your TRICARE plan—especially if you recently enrolled in TRICARE or changed your plan during open season. Familiarizing yourself with your health plan is key to making the most of your benefits.
 
“Taking time to learn about your TRICARE plan can help you make the best health care decisions for you and your family,” said Debra Fisher, TRICARE Health Plan policy and programs analyst at the Defense Health Agency. “Understanding your plan’s covered services, costs, and eligibility requirements and knowing when you need to take action can help keep your out-of-pocket costs lower and ensure you have no gaps in coverage.”
 
Here are some TRICARE basics to be familiar with.
 
Q: What does TRICARE cover?
A: Generally, TRICARE covers services that are medically necessary and considered proven. This includes preventive care and mental health and substance use disorder care. You can use the TRICARE Covered Services tool to learn if a benefit is covered or not. To check if your prescription drugs are covered, search the TRICARE Formulary.
 
As a reminder, dental coverage is separate from TRICARE’s medical coverage. To have dental coverage, you need to enroll in a dental plan separately based on your beneficiary status or your relationship to the sponsor. Your vision coverage, including eye exams, is based on a few things—who you are, your health plan, and your age. You may be eligible for additional vision coverage through the Federal Employees Dental and Vision Insurance Program.
 
Q: How much does TRICARE cost?
A: Your health care costs may include enrollment fees, premiums, deductibles, copayments, and cost-shares. These costs depend on:
  • Who you are
  • Your beneficiary group
  • Your plan
  • The type of care you receive
  • Where you receive care
 
The TRICARE Compare Cost Tool can help you learn more about costs associated with your health plan. You can also read an overview of 2023 TRICARE costs and fees.
 
Q: Where can I receive care?
A: Where you get care depends on your plan.  
To keep your out-of-pocket costs lower, know your plan’s rules for referrals and authorizations before you make an appointment. If you’re looking for a network or non-network provider, check TRICARE’s provider directories to find a TRICARE-authorized provider in your area.
 
Q: What is a Qualifying Life Event (QLE), and how can one affect my TRICARE eligibility?
A: A QLE is a certain change in your life that makes you eligible to enroll or change your TRICARE plan outside of open season. As outlined in the TRICARE Qualifying Life Events Fact Sheet, QLEs include the following:  
After you experience a QLE, you should update your info in the Defense Enrollment Eligibility Reporting System. Depending on the type of QLE, you may need to or have the option to change your TRICARE plan or enroll in a plan. A QLE for you or a family member opens a 90-day period for all family members to make eligible enrollment changes. Check out TRICARE.mil for the complete list of TRICARE QLEs and more QLE information.
 
Q: How can I learn more about TRICARE?
A: TRICARE.mil has a variety of resources to help you learn more about your benefits, including:  
TRICARE and our partners are here to help you maximize your benefits to support the health and wellbeing of you and your family. If you have questions about your coverage, contact your TRICARE contractor.
 
Would you like the latest TRICARE news sent to you by email? Visit the TRICARE Subscriptions page today, and create your personalized profile to get benefit updates, news, and more.
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