Frequently Asked Questions

Is US Family Health Plan separate from TRICARE or part of TRICARE?

We have a foot in both worlds: we’re a non-governmental organization that provides the TRICARE Prime health benefit. In 1993, US Family Health Plan was created by Congress to manage health care for military beneficiaries in seven service areas across the country. A few years later, when TRICARE (the “triple option” health system) was implemented nationally, the Department of Defense selected US Family Health Plan as a local option for TRICARE Prime. US Family Health Plan is a permanent part of the military health system.

Who is eligible to enroll in US Family Health Plan?

If you’re eligible for military health benefits in the Defense Eligibility and Reporting System (DEERS), you’re eligible to enroll in US Family Health Plan. Military beneficiaries include active-duty family members and survivors, retirees and their families. Active duty personnel are not eligible—they are required to obtain their health care at Military Treatment Facilities (MTFs). For details, click here for the TRICARE Eligibility Fact Sheet.

When can I enroll in US Family Health Plan?

Enrollment is open all year. You can enroll anytime and coverage begins on the first day of the month following receipt of your application—unless you’re transferring from TRICARE Prime in which case coverage begins immediately. There’s no waiting period for benefits.

I just turned 65—do I need Medicare Part B to enroll in US Family Health Plan?

No. Medicare Part B is not a requirement to become a US Family Health Plan member, but we strongly recommend having it. Selecting Medicare Part B as soon as you’re eligible for it provides some significant advantages:

• All enrollment fees are waived for US Family Health Plan members who also have Medicare Part B. This saves an individual $260 a year.
• Medicare Part B will provide coverage for the limited services not covered by US Family Health Plan, such as chiropractic coverage.
• If for any reason you decide to disenroll from US Family Health Plan, you are automatically and immediately covered by Medicare Part B and TRICARE For Life benefits.
• If for any reason you decide to disenroll for US Family Health Plan and you do not carry Medicare Part B, you will need to apply for Medicare Part B before you can access your TRICARE For Life benefits. There are waiting periods and higher costs for not taking Medicare Part B at the time you became eligible.

To protect yourself and your family, we encourage you to take Medicare Part B when it is offered.

What if I have Medicare Part B and my wife doesn’t?

You’re still allowed to join the Plan as a family. For a person with Medicare Part B, it’s free – no enrollment fee and no copays except for prescriptions. For a person who doesn’t have Medicare Part B, there’s an individual annual enrollment fee plus any necessary copayments for his or her care.

What if I want to enroll in US Family Health Plan, but my husband/wife wants to continue to use Medicare?

No problem. But you may find it’s easier to manage appointments, and more affordable, if you enroll in US Family Health Plan as a family.

What if I become suddenly ill when I’m traveling?

US Family Health Plan covers you for medical emergencies wherever you are. Go to the nearest appropriate medical facility and please be sure that someone calls your PCP within 24 hours, so that he or she can confer with the attending doctor. Your costs will be covered for everything above your copayment. Show your US Family Health Plan membership ID card and have the bill sent to the address on the back. Plan members may use Military Treatment Facilities only for medical emergencies if the MTF is the nearest emergency facility to you when you become ill or injured.

What if we move?

If you move within your current Plan’s zip code-defined service area, simply notify the Plan of your new address. If you want to change your primary care provider to accommodate your new address, there’s no problem. Give us a call and we’ll send you a new membership card with your new PCP’s name and phone number.

If you move to one of the other areas across the country where US Family Health Plan is available, we will be happy to help you transfer your enrollment.

If you move to an area where US Family Health Plan is not available, we can give you the information you need to transfer your enrollment to the regional TRICARE Prime program.

May we use a military treatment facility while enrolled in US Family Health Plan?

Not for routine or urgent care. Under US Family Health Plan, you may not use military treatment facilities. The only exceptions to this limitation are: if you have an acute medical emergency and the military treatment facility is closest to you, or if a new member who is pregnant wishes to complete her prenatal care at her previous MTF.

Are prescriptions covered under US Family Health Plan?

Yes. Plan members may take (or have their providers call in) their one-time or urgent care prescriptions to pharmacies in the Plan’s retail pharmacy network, or may use one of the Plan’s on-site pharmacies at Hanscom AFB or Brighton Marine Health Center in Boston. The copays for prescription drugs through the retail pharmacy network are $5 for generic drugs, $12 for brand name drugs, or $25 for non-formulary drugs for up to a 30-day supply. For refills or long-term prescriptions, US Family Health Plan’s mail order pharmacy service enables you to get up to a 90-day supply for the same price or even less than you’d pay for a 30-day supply at a retail pharmacy. In fact, generics are free.

Who decides which drugs are not covered under US Family Health Plan?

The Department of Defense (DoD) reserves the right to determine which drugs are covered under the program. Some examples of medications not covered include; medications for hair restoration, weight loss, smoking cessation, drugs used for cosmetic reasons, such as Retin A (wrinkle cream), and over-the-counter medications.

How does the new POS option work?

The Point of Service Option allows you to see an out-of-network provider for covered health care services without Plan authorization, but you are responsible for paying a deductible and coinsurance charges.

• A deductible is the amount you must pay out of pocket before any coverage is available for unauthorized benefits.
• Coinsurance is a percentage of the covered medical costs you are responsible for paying at the out-of-network level of benefits once the deductible has been met.

When you see an out-of-network provider without a referral from your PCP, your visit is automatically treated as a POS service and billed accordingly.