TRICARE is a form of health insurance offered to U.S. service members, their spouses, dependents and children across all 50 states and outside the country. The TRICARE insurance program covers most or all of the health services that qualifying families need, so that they don’t have to obtain their own private insurance plans. It also includes supplemental coverage, such as dental and vision care.
If you are wondering, “what is TRICARE and what does it cover?” you must first understand the eligibility guidelines in Florida. There are several different programs within this form of health insurance, which means you may qualify for more than one program or only one program.
What are the TRICARE requirements in Florida?
In order to meet TRICARE eligibility in Florida, you must be a uniformed military service member, a National Guard or Reserve member, a Medal of Honor recipient or a survivor or former spouse of a service member. You may also receive coverage if you are part of a service member’s immediate family. Furthermore, there are certain other particular circumstances in which you may qualify.
You may want to complete a TRICARE eligibility check before attempting to enroll in any sort of military insurance plan. This involves first making sure that you are enrolled in the Defense Enrollment Eligibility Reporting System (DEERS).
In general, you will automatically meet the DEERS eligibility if you are a military service member. If you are a family member, you must ask for a sponsor to add you to the system. To do so, the sponsor must visit a local ID card office. The sponsor may call the office or go online to schedule an appointment ahead of time.
Once you are registered in the DEERS, you will have access to military insurance.
Who qualifies for TRICARE Prime and other specific TRICARE programs in Florida? Ultimately, it depends on your military status or on your relationship to a military service member. For instance, if you are an active duty service member living in the state, you may qualify for Prime.
On the other hand, if you are a retired reserve member, you may be eligible for the TRICARE Retired Reserve program instead. To qualify, you must be 59 years of age or younger and cannot be enrolled in the Federal Health Benefits (FEHB) program. Additional programs exist for other military service members and their families. To learn more about requirements, download our guide today.
How to Apply for TRICARE in Florida
The TRICARE enrollment process is relatively straightforward. If you are a Florida resident, you must apply for coverage in the east region of the U.S., as TRICARE is separated into three regions.
The application rules for each program are relatively similar, though some are different. In order to sign up for TRICARE Prime, for example, you must first determine whether you are in a Prime service area. These are areas in the U.S. where military health care is available and nearby. If you do not live within a certain number of miles from a service area, you may need to consider a different type of coverage.
Once you know the type of coverage you want and are eligible for, you must choose a military hospital, clinic or network provider. You are required to choose a military hospital or clinic if you live near one. If you do not live nearby, you may select a network provider.
You may complete your TRICARE enrollment online, by phone or by mail. For certain types of coverage, you may be able to enroll all your family members on the same form.
To apply by phone, you may call the TRICARE enrollment number, which will be your regional contractor. To apply by mail, you must mail your enrollment form to the regional contractor’s office. Learn more about the application process and how it changes for different programs with our comprehensive guide.
Learn About TRICARE Costs and Coverage in Florida
TRICARE benefits in Florida may vary depending on your plan and whether you are an active duty service member or family member. If you are an active duty service member, you are not required to pay anything out of pocket for your health care, regardless of your plan.
If you are a family member of an active duty service member, your TRICARE coverage will require you to make certain out-of-pocket payments. As an example, you will pay for care if you use TRICARE Select or visit an out-of-network provider without approval from your insurance.
You must also factor in deductibles and the initial TRICARE payment, if applicable. In other words, some plans require you to make a one-time payment to enroll.
What does TRICARE cover? All programs cover the following services with no additional charge:
- Asthma testing and treatment
- Cardiovascular screening
- Hearing exams
- Infectious disease screening
- Adjunctive dental, if a procedure is deemed medically necessary
- Birth control
- Many forms of mental health care
Depending on your plan, certain types of care may not be covered. Otherwise, they may only be partially covered. You will also pay a higher fee if you go to doctors that are out-of-network. To discover more about how out-of-pocket costs work under TRICARE, download our informative guide.
How to File a TRICARE Claim in Florida
TRICARE claims are more common than you may think, as recipients may need more help with medical payments that were not fully covered under their insurance plans. Other times, patients file claims in order to submit medical bills to TRICARE.
You must fill out a TRICARE claims form in order to submit a claim successfully. Once you fill out the appropriate form, you must obtain a copy of your health provider’s bill, along with important information about your provider and your sponsor. Then, you may submit the claim by mail. You may be able to submit it online in very specific circumstances. Find out more about the claims process by downloading our guide.