Loss of Eligibility
When you lose eligibility for TRICARE, each member of your family will receive a certificate of creditable coverage. The certificate serves as evidence of prior health care coverage under TRICARE, so that you can't be excluded from a new health plan for pre-existing conditions.
Keeping Minimum Essential Coverage
While covered by TRICARE, you have minimum essential coverage under the Affordable Care Act. When you lose TRICARE, you also lose your minimum essential coverage. You need to make some decisions about your health care.
If you don’t have new minimum essential coverage before your TRICARE or transitional benefits end, then you may have to pay a fee to the Internal Revenue Service for each month you don’t have minimum essential coverage.
Reasons You May Lose Eligibility
Eligibility for TRICARE may end for several reasons. This list is not intended to be all inclusive.
Sponsor Separates from Active Duty
When a service member "separates" from active duty, it means he or she "gets out" of the military before retiring. In some cases, the member and family may qualify for transitional health benefits under the Transitional Assistance Management Program.
You Become Entitled to Medicare Part A, but don't Purchase Part B
If you're getting Social Security disability benefits:
- You become entitled to Medicare Part A beginning the 25th month of receiving Social Security disability payments.
- The Social Security Administration notifies you of your Medicare entitlement start date.
- If you don't purchase Medicare Part B when you first become entitled to Medicare Part A, regardless of your age, you'll lose eligibility for TRICARE.
There are some exceptions to this rule, but we recommend that you purchase Part B immediately to avoid any break in TRICARE coverage. >>Learn More
Dependent Child Reaches Age Limit
Children remain eligible for regular TRICARE coverage up to age 21 or age 23 if enrolled in college and the sponsor continues to provide 50% of the child's financial support. After "aging out" at 21 or 23 as described above, dependent adult children may qualify for TRICARE Young Adult until they turn 26 (based on sponsor's eligibility for TRICARE). >>Learn More
In a divorce, the former spouse will lose eligibility for TRICARE unless he or she meet specific requirements to maintain eligibility for TRICARE as a former spouse. >>Learn More
Surviving Spouse, Widow, or Former Spouse Remarries
If a surviving spouse, widow or eligible former spouse remarries, he or she will lose eligibility for TRICARE (unless the marriage is to another TRICARE-eligible sponsor).
DEERS Information Not Kept Up-to-Date
One way you can temporarily lose coverage is to let your information in DEERS lapse. If you lose eligibility due to inaccurate DEERS information, simply update your information and your coverage is restored. >>Learn More
If enrolled in any health plan option, contact your regional contractor to re-enroll as updating DEERS will not automatically re-establish your enrollment.