TRICARE helps millions of military service members and their families save on medical costs every year. In fact, the TRICARE Prime program alone covers 4.6 million Americans annually. While this federal health coverage program has its disadvantages, it protects service members from the burden of medical bills, many of which may be the direct result of their time in service.
TRICARE insurance is a nationwide coverage plan available to U.S. military personnel and their immediate families. Moreover, coverage is available for servicemen and women living outside of the country. For residents of New York, it is important to understand the different insurance options available and how to qualify for them, so that they can get the most out of their care.
What are the TRICARE requirements in New York?
Your TRICARE eligibility in New York depends on your relationship to the military. Generally, if you are an active duty service member, you will automatically have coverage. As an example, you will receive coverage if you are:
- A uniformed service member.
- A National Guard member.
- A Reserve member.
- A former spouse of a service member.
- A survivor of a service member.
- The child or dependent of a service member.
- A medal of honor recipient.
A TRICARE eligibility check will allow you to determine which type of coverage will suit you best. To check your eligibility, you may complete an online TRICARE questionnaire that asks about your military status or relationship to a military service member. Once you submit this and other basic information about your circumstances, you may identify the programs you are eligible for.
As a New York resident, you may be eligible for TRICARE Prime, TRICARE Select, TRICARE For Life, the U.S. Family Health Plan and more.
It is very important to note that you must have DEERS eligibility in order to qualify for TRICARE. The Defense Enrollment Eligibility Reporting System (DEERS) will automatically register you if you are on active duty. Then, you or your sponsor may enter your family members into the system.
In order to complete this step, you may reach out to the TRICARE eligibility phone number for more information. Otherwise, you may contact your local ID card office to set up an appointment and add your family members to DEERS. To learn more about requirements, download our comprehensive guide.
How to Apply for TRICARE in New York
The TRICARE enrollment process may vary depending on your program of choice. However, all applications are relatively simple. If you live in New York, you will apply for coverage through the east regional office. Generally, you will be asked to complete an enrollment form and submit it online or by mail. Note that certain programs will not allow you to file an online application.
To sign up for TRICARE in New York, you must check your eligibility and then fill out the proper form that corresponds to your desired program. As an example, you may want to enroll in TRICARE Select if you are not on active duty and:
- You live in an area where TRICARE Prime is not available.
- You already have employer-sponsored health insurance, or a different health care plan.
- Your health care provider is out of network and you do not want to switch.
If you under any of these circumstances, you may complete the TRICARE enrollment online, by phone or by email. To gain a better understanding of the application process for different programs, download our guide today.
Learn About TRICARE Costs and Coverage in New York
Your TRICARE benefits and costs for different types of treatments will depend on your coverage. Generally, all forms of care are covered, though you may need to pay a copay, a deductible or an enrollment fee.
Overall, enrollment fees only apply to certain TRICARE programs. For instance, TRICARE Prime recipients are not required to pay an enrollment fee. On the other hand, a single member of TRICARE Reserve Select must pay a monthly fee. This fee increases if the member adds his or her family to the same plan.
Your TRICARE payment is generally higher if you are enrolled in TRICARE for Life, TRICARE Young Adult or TRICARE Retired Reserve. If you are in the Retired Reserve category and cover your family as well, you may have a significantly higher monthly payment. Overall, TRICARE coverage is separated into the following categories:
- Primary care
- Preventative care
- Hospital care and surgery
- Urgent and emergency care
- Mental health and substance abuse
- Medical equipment and supplies
- Tests and X-rays
- Specialty care
What does TRICARE cover? If you are on active duty, you will receive comprehensive coverage and do not have to pay for any form of health care. Other types of care, including clinical preventive services, immunizations, newborn care and hospice care, are almost always covered by every plan.
If you are not on active duty, you may be required to pay a fee for certain forms of care, including maternity care and hospitalization. Discover more about TRICARE coverage with our detailed guide.
How to File a TRICARE Claim in New York
Many recipients of military health insurance file TRICARE claims in New York on an annual basis. However, your provider will typically file a claim on your behalf, particularly if you go to a network provider. However, you may need to file your own claim if you see an out-of-network professional, if you are traveling, or if you have TRICARE for Life and go to a provider that does not participate in Medicare.
In any case, it is important for you to submit your TRICARE claim form as soon as possible. This way, your provider will be paid more quickly, and you may be reimbursed for services that are covered under your plan.
To file a claim, you must fill out the proper claim form. Then, you need to mail the completed form, along with a copy of the medical bill and information about your provider, to the regional office in the east. In certain circumstances, you may be able to submit your claim online.
Note: For certain plans, such as the U.S. Family Health Plan, you may not need to file claims at all.