Military GI - TRICARE Eligibility

TRICARE Eligibility

TRICARE delivers health care, but it does not determine who is and who is not eligible to receive care – the Uniformed Services make that decision. Active duty Soldiers, their family members, retirees and their family members, surviving family members of deceased active or retired Soldiers, and certain former spouses (who meet length-of-marriage rules and other requirements) are eligible for health care.

The Services supply eligibility information to the Defense Enrollment Eligibility Reporting System (DEERS), whose computerized database maintains eligibility information. Sponsors are responsible for ensuring that their family members are properly enrolled in DEERS and that their information is kept up-to-date in DEERS through the unit personnel office. For information about DEERS registration, contact the DEERS Support Office (DSO) Telephone Center at 1-800-538-9552, or for the deaf (TTY/TDD) at 1-866-363-2883. Hours of operation are Monday through Friday from 6:00 a.m. to 3:30 p.m. Pacific time, except federal holidays.

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
Spouses and unmarried children of active duty service members
Uniformed service retirees, their spouses, and unmarried children
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 Congressional Medal of Honor, 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 or retired military who were married to a service member or former member who had performed at least 20 years of creditable service for retirement purposes at the time the divorce or annulment occurred. The former spouse must also meet the following requirements:
- Must not have remarried. Must not be covered by an employer-sponsored health plan.
- Must not be the former spouse of a NATO (or "Partners for Peace" nation) member.
- 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 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 was on or after February 1, 1983, the former spouse is eligible for TRICARE coverage of health care that is received after that date. 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.
  
  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 January 1, 1985, or 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 September 29, 1988, the former spouse is eligible for care received for only one year from the date of the decree. Upon completion of the period of eligibility for TRICARE, explained in Situation 3 above, a former spouse is eligible for the Continued Health Care Benefit Program (CHCBP). Check with your BCAC/HBA/TSC for details.