TRICARE is a federal health insurance plan offered to military service members, veterans and their respective families. It also provides coverage to military personnel stationed outside of the U.S. Despite the fact that certain services are excluded from coverage, TRICARE aims to provide comprehensive health care to all its recipients.
TRICARE insurance is organized into separate programs depending on whether you are an active duty military service member, a veteran or a family member. As a resident of Virginia, it is important to understand the TRICARE programs which you may qualify for, because you will have a better sense of how much your coverage will cost.
What are the TRICARE requirements in Virginia?
In order to meet the TRICARE eligibility requirements in Virginia, you must fall into one of the following main categories:
- Uniformed service members.
- National Guard and Reserve members.
- Spouses, children or dependents of service members.
- Former spouses of service members.
- Survivors of service members.
- Service members who have received the Medal of Honor.
If you are currently on active duty and live in Virginia, you may qualify for TRICARE Prime. However, you must also live in a Prime service area. Service areas are places in the U.S. where Prime coverage is available and accessible.
You may want to use a TRICARE eligibility check to simplify your application process. In general, an eligibility check is a short questionnaire that uses your answers to identify the programs for which you may qualify. These questions typically aim to understand:
- Your relationship to your sponsor.
- Your sponsor’s status in the army.
- Whether you qualify for Medicare Part A or Part B.
- Your state and ZIP code.
As an example, an eligibility check will be able to tell you whether or not your location prohibits you from enrolling in TRICARE Prime.
After filling out the questionnaire, you must check the DEERS eligibility requirements in Virginia, unless you are an active duty military member. In this case, you are automatically registered for the Defense Enrollment Eligibility Reporting System (DEERS).
On the other hand, the family members of military service members typically need to be enrolled by their sponsors. Sponsors must visit a military office that issues ID cards to enroll their families. If the sponsor has recently gotten married, he or she must bring the marriage certificate and the spouse’s birth certificate, photo ID card and other documents.
To learn more about registering for the DEERS and enrolling in TRICARE, download our comprehensive guide.
How to Apply for TRICARE in Virginia
The simplified version of the TRICARE enrollment process in Virginia is as follows:
- Obtain the appropriate enrollment form.
- Fill out the entire form as accurately as possible.
- Send the completed form and an acceptable payment method to proper office.
To sign up for TRICARE online, you must log on to the military health care portal. However, note that one of the following must be true in order for you to access the site:
- You have a Common Access Card (CAC) with an accessible card reader.
- You have a Defense Finance and Account Service (DFAS) account for the program called myPay.
- You are a veteran.
- You are registered in the DEERS.
Keep in mind that you may only apply for TRICARE online for certain programs. Discover more about the application process by downloading our guide today.
Learn About TRICARE Costs and Coverage in Virginia
While TRICARE benefits in Virginia are comprehensive, your program may not pay all of your medical costs in full. This is particularly true if you are the family member, spouse, former spouse or dependent of a military service member. Active duty military personnel and other qualifying groups may never have to pay for health care while their plans are active.
As an example, programs such as TRICARE Retired Reserve, TRICARE for Life and TRICARE Young Adult charge an enrollment fee on a monthly basis. Recipients of these plans may pay a deductible for hospital bills and other types of care as well.
Fortunately, TRICARE coverage is always comprehensive for preventive care, such as check-ups, immunizations and newborn care. You may receive comprehensive coverage for other types of care under the following categories:
- Primary care
- Surgery, urgent care and emergency care
- Mental health and substance abuse
- Medical equipment and supplies
- Tests and x-rays
- Dental and vision
Your monthly TRICARE payment will also increase or decrease depending on the number of people in your family and whether you fall into group A or group B. You are in group A if you entered uniformed service before January 1, 2018. You are in group B if you entered the military after January 1, 2018. Discover other factors that may affect your monthly costs by downloading our guide.
How to File a TRICARE Claim in Virginia
Normally, Virginia TRICARE claims are completed by your regular provider and submitted to your regional contractor. If you need immediate medical care and are not close enough to your provider, you may choose to visit an out-of-network hospital or clinic. In this case, you may need to file your own claim.
Remember to fill out your TRICARE claim form as soon as possible, so that you will be reimbursed for any care that is covered under your plan. Then, mail out the completed form along with information about the provider you visited.
Certain plans, such as the U.S. Family Health Plan, do not require you to file any medical claims. Learn more about claim exceptions and the reimbursement process from our detailed guide.