Learn About TRICARE Coverage for Disabled Veterans

Understanding TRICARE: What It Is and Who It Serves

TRICARE is the health insurance program run by the U.S. Department of Defense for military service members, retirees, and their families. For disabled veterans specifically, TRICARE represents one pathway to ongoing health coverage and care. Unlike the Veterans Health Administration (VA), which serves veterans through the Department of Veterans Affairs, TRICARE is a separate system with its own rules, provider networks, and costs.

The program has grown significantly over the decades. As of 2024, TRICARE serves approximately 9.4 million beneficiaries worldwide, including active duty personnel, retirees, survivors, and Reserve and National Guard members. For disabled veterans, TRICARE may offer an alternative or supplement to VA healthcare, depending on their military status and other factors.

TRICARE coverage includes several plan options, each with different cost structures and out-of-pocket expenses. The plans vary in how much you pay in premiums, deductibles, and copayments. Some plans require you to use military treatment facilities (hospitals and clinics run by the Department of Defense), while others allow more flexibility in choosing civilian doctors and hospitals.

One key distinction: TRICARE eligibility often depends on your military service category and retirement status rather than on disability rating alone. A veteran with a service-connected disability rating from the VA may or may not be covered by TRICARE—it depends on whether they retired from the military and other circumstances of their service.

Takeaway: TRICARE is a Department of Defense health program separate from VA benefits. Disabled veterans may have access to TRICARE depending on their military service status, not solely based on their disability rating. Understanding which system applies to your situation is the first step in exploring coverage options.

TRICARE Plans Available to Disabled Veterans and Retirees

TRICARE offers several plan options, and the ones available to you depend on your military status and location. The main plans are TRICARE Prime, TRICARE Select, TRICARE for Life, and TRICARE Young Adult. For disabled veterans who are also military retirees, the most commonly relevant plans are TRICARE Prime and TRICARE Select.

TRICARE Prime functions similarly to a health maintenance organization (HMO). Members choose a primary care manager and must get referrals to see specialists. In 2024, TRICARE Prime costs approximately $0 in premiums for retirees with a service-connected disability rating, though this can vary. Out-of-pocket costs include copayments for office visits (typically $15-$25) and other services. TRICARE Prime requires using military treatment facilities when available, which can mean traveling to a military base clinic or hospital. For disabled veterans living near military bases, this plan often offers the lowest overall costs.

TRICARE Select works more like traditional health insurance, allowing you to visit any civilian doctor or hospital without referrals. In 2024, TRICARE Select costs approximately $311 per year in premiums for retirees. This plan has deductibles ($150-$300 per year depending on individual or family coverage) and then requires you to pay a percentage of the cost for most services (typically 20% after the deductible). TRICARE Select is available worldwide and appeals to veterans who prefer flexibility in choosing providers or who don't live near military facilities.

TRICARE for Life is designed for beneficiaries age 65 and older who are also enrolled in Medicare Part B. This plan works alongside Medicare and typically involves lower out-of-pocket costs. Veterans who turn 65 should review their TRICARE options, as TRICARE for Life may provide better value than continuing with TRICARE Prime or Select.

Takeaway: Disabled veterans who are military retirees can typically choose between TRICARE Prime (HMO-style, lower cost but requires military facilities) and TRICARE Select (more flexibility, higher cost). Reviewing the plan details and comparing costs based on your location and healthcare needs helps identify which option may work best for your situation.

Costs, Premiums, and Out-of-Pocket Expenses

Understanding the true cost of TRICARE coverage requires looking beyond premiums to include deductibles, copayments, and other expenses. For 2024, TRICARE Prime premiums for retirees are $0 annually, but many beneficiaries pay nothing because their premiums were already deducted from military retirement pay throughout retirement. However, TRICARE Prime includes copayments for most services: $15 for an office visit with your primary care manager, $25 for a specialist visit, and varying amounts for mental health visits, urgent care, and emergency room visits.

TRICARE Select premiums are approximately $311 per year for individual coverage and $623 per year for family coverage (as of 2024). After meeting your annual deductible ($150 for individual, $300 for family), you typically pay 20% of the cost of covered services. For example, if a specialist visit costs $200, you would pay 20% ($40) after meeting your deductible. Prescription drugs have separate copayments: $12 for generic medications, $25 for name-brand medications at military treatment facilities, and higher costs at civilian pharmacies.

TRICARE for Life beneficiaries (age 65+) pay no monthly premium if they have a Medicare Supplement insurance plan, or around $163 annually if they have only Original Medicare. Out-of-pocket costs are typically lower than TRICARE Prime or Select, as TRICARE for Life acts as a secondary payer to Medicare.

Cost-sharing can be reduced for beneficiaries with catastrophic healthcare needs. TRICARE has an annual catastrophic cap: once you reach a certain level of out-of-pocket spending, TRICARE covers 100% of remaining costs for the year. In 2024, this cap is approximately $3,500 for individual coverage and $7,000 for family coverage under TRICARE Select, and lower under TRICARE Prime.

Disabled veterans with combat-related special needs may be covered through a separate program called the Comprehensive Nicotine Treatment Program (CNTP) or other specialized plans that have different cost structures.

Takeaway: TRICARE costs vary significantly by plan. TRICARE Prime typically has no premiums for retirees but requires copayments for services. TRICARE Select has annual premiums and deductibles but offers more flexibility. Comparing your expected healthcare costs under each plan helps determine which offers better value for your situation.

Network Providers, Military Facilities, and Finding Care

Where you can receive care depends on which TRICARE plan you have. TRICARE Prime members must use military treatment facilities whenever available. The U.S. military operates hospitals and clinics at bases across the country and worldwide. These facilities employ military physicians and staff and are included at no additional cost under TRICARE Prime. For disabled veterans, military treatment facilities often provide specialized care for service-connected conditions, including mental health services, physical rehabilitation, and prosthetics.

However, military treatment facilities have limited capacity in many areas. If your local military facility cannot provide the care you need within a reasonable timeframe, TRICARE Prime covers civilian providers. Disabled veterans can request referrals to civilian specialists in their local area if military facilities cannot accommodate them. This referral system is built into TRICARE Prime specifically to address capacity issues.

TRICARE Select members can visit any licensed civilian doctor, hospital, or specialist without referrals. However, using civilian providers typically means higher out-of-pocket costs since TRICARE Select has deductibles and coinsurance. The TRICARE Select network includes hundreds of thousands of civilian providers. You can find in-network providers through the TRICARE website or by calling your regional TRICARE office.

For finding mental health care, both TRICARE Prime and Select cover behavioral health services, including therapy and psychiatric care. Many disabled veterans seek mental health treatment for service-related conditions like post-traumatic stress disorder (PTSD). Both military and civilian mental health providers are available depending on your plan. Mental health services typically have lower copayments than other medical services, reflecting the emphasis on mental health support.

Prescription medications are filled through TRICARE's pharmacy program. You can use military pharmacies (available at military treatment facilities), the mail-order pharmacy, or civilian pharmacies in the TRICARE network. Military pharmacies typically offer the lowest copayments.

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