What TIFA covers and who it serves

TRICARE for Individuals and Families (TIFA) is a health insurance option for people with military connections who do not may have access to for other TRICARE plans. It is run by the Department of Defense and covers doctor visits, hospital stays, prescription drugs, and preventive care. The monthly premium, deductible, and out-of-pocket costs vary depending on your sponsor's rank and length of service.

TIFA is open to former spouses of active duty, Reserve, or retired service members; adult children aging out of dependent coverage; and people who lost TRICARE may be able to access through a change in family status. You must have a military ID or a letter from the Department of Defense confirming your connection to the military. Unlike some TRICARE plans, TIFA does not require your sponsor to be on active duty or retired — you can enroll even if your sponsor has left the military, as long as you meet the time-in-service requirements.

Women using TIFA can access maternity care, gynecological services, and preventive screenings like mammograms and cervical cancer screening at no cost before you meet your deductible. Mental health services, including therapy and psychiatric care, are covered at the same rate as other medical services.

Key Takeaways

  • TIFA is a self-paid health insurance plan for military-connected people who do not fit into active duty, retiree, or dependent categories.
  • Monthly premiums range based on your sponsor's rank and years of service, and you pay a yearly deductible before TRICARE begins to share costs.
  • Preventive care for women — including contraception, cancer screenings, and maternity visits — costs nothing before your deductible.
  • You enroll through the TRICARE website or by mail, and coverage can start as soon as the first day of the month after you submit your enrollment.
  • TIFA uses TRICARE's network of military hospitals and civilian providers, so your choice of doctor depends on whether they accept TRICARE.

Who can enroll in TIFA

You can enroll in TIFA if you are a former spouse of a service member and were married for at least 20 years while your sponsor was on active duty, or if you are a former spouse of a retired service member regardless of marriage length. You must also have no other health insurance and not be covered by Medicare or Medicaid.

Adult children can enroll if they aged out of dependent TRICARE coverage (usually at age 21, or 23 if enrolled full-time in college) and do not have coverage through an employer or another source. You must enroll within 90 days of losing dependent status, though you can request a late enrollment if you have a may have access to life event like losing a job or aging off a parent's plan.

People who lost TRICARE coverage because of a divorce, death of a sponsor, or change in duty status can also enroll in TIFA. The Department of Defense website lists the full set of may have access to categories and the documentation you will need to prove your military connection.

Monthly costs and what you pay at the doctor

TIFA premiums are based on your sponsor's rank and years of service. A former spouse of an enlisted service member with fewer than 20 years of service pays less per month than a former spouse of an officer with 30 years of service. The Department of Defense updates these rates each year, usually in January. You can find the current premium table on the TRICARE website by selecting your sponsor's rank and service branch.

Once you enroll, you pay a yearly deductible — the amount you must spend on covered care before TRICARE begins to pay its share. The deductible for TIFA is higher than for active duty family members but lower than for retirees. After you meet your deductible, you typically pay 20 to 25 percent of the cost of most services, and TRICARE pays the rest. Some services, like preventive care and emergency room visits, have different cost-sharing rules.

Preventive services — including annual wellness visits, cancer screenings, contraception, and prenatal care — are covered at no cost to you, even before you meet your deductible. If you need a specialist, you may need a referral from your primary care doctor, depending on whether you choose to use the TRICARE Prime option (which requires a primary care doctor and referrals) or the TRICARE Select option (which does not).

TRICARE Prime versus TRICARE Select under TIFA

TIFA offers two plan structures: TRICARE Prime and TRICARE Select. The main difference is how you access care and what you pay.

With TRICARE Prime, you choose a primary care doctor from the TRICARE network, and that doctor coordinates your care. You need a referral to see a specialist. Your out-of-pocket costs are lower — you pay a small copay for most visits instead of a percentage of the bill. However, Prime requires you to use military hospitals and clinics when they are available, and you must get prior approval for some procedures. Prime premiums are higher than Select.

With TRICARE Select, you do not choose a primary care doctor and do not need referrals to see specialists. You can see any doctor who accepts TRICARE, and you have more flexibility in choosing providers. Your costs are higher per visit — you pay a percentage of the bill after your deductible — but you have more control over your care path. Select premiums are lower than Prime.

How to enroll and when coverage starts

You can enroll in TIFA online through the TRICARE website, by phone, or by mail. To enroll online, you will need to create a login on the TRICARE portal and provide proof of your military connection — usually a military ID, a discharge document, or a letter from the Department of Defense. The process takes about 15 to 20 minutes.

If you do not have a military ID, you can request a letter from the Defense Enrollment may be able to access Reporting System (DEERS) confirming your may be able to access. This letter can take one to two weeks to arrive by mail. Some TRICARE offices will accept a certified copy of your marriage certificate and your sponsor's discharge papers as temporary proof while you wait for the official letter.

Coverage begins on the first day of the month after your enrollment is processed. If you enroll on the 15th of January, your coverage will start on February 1st. If you miss the important date to enroll within 90 days of a may have access to event, you can still enroll outside the window, but there may be a waiting period or a higher premium for the first few months.

Using TIFA at the doctor and in the hospital

When you see a doctor, bring your TRICARE ID card or a printout of your enrollment confirmation. Not all doctors accept TRICARE, so call ahead to confirm. You can search the TRICARE provider directory on the TRICARE website by entering your zip code and the type of care you need.

At the appointment, you will pay your copay (if you are on Prime) or your coinsurance percentage (if you are on Select) at the time of service. The doctor's office will bill TRICARE for the rest. If you are admitted to a hospital, TRICARE will cover inpatient care at a military hospital at no cost to you; at a civilian hospital, you pay your deductible and coinsurance. Emergency room visits are covered at a higher rate than routine office visits, so the out-of-pocket cost is usually lower.

Prescription drugs are covered through the TRICARE pharmacy benefit. You can fill prescriptions at military pharmacies for free or at civilian pharmacies for a copay. Mail-order prescriptions for maintenance medications (drugs you take regularly) are usually cheaper than filling them at a retail pharmacy.

Changes to your TIFA coverage during the year

You can change your plan — from Prime to Select or vice versa — during the annual open season, which runs from mid-May to mid-June each year. You can also make changes if you have a may have access to life event, such as a move, a change in employment, or a birth or adoption in your family. You must report the change within 90 days of the event.

If your sponsor's rank or years of service change, your premium may change. TRICARE will notify you of any premium changes before they take effect. If you lose your military connection — for example, if your former spouse passes away — your TIFA coverage will end, and you will need to find other insurance. TRICARE will give you at least 30 days' notice before your coverage ends.

Frequently Asked Questions

Can I use TIFA if I am also on my employer's health plan?

No. TIFA requires that you have no other health insurance. If you are offered coverage through an employer, you must decline it or drop it before you can enroll in TIFA. If you gain employer coverage after you enroll in TIFA, you must report it to TRICARE and may lose your TIFA may be able to access.

What happens to my TIFA coverage if my former spouse remarries?

Your coverage does not end if your former spouse remarries. However, if your former spouse passes away, your TIFA coverage will end within 30 days. TRICARE will send you a notice with the end date and information about other coverage options, such as the ACA marketplace.

Do I have to use a military hospital for TIFA?

It depends on your plan. If you choose TRICARE Prime, you must use military hospitals and clinics when they are available in your area. If you choose TRICARE Select, you can see any civilian doctor who accepts TRICARE. Check the TRICARE provider directory to see which military facilities and civilian providers are near you.

Can I enroll in TIFA if I am over 65 and on Medicare?

No. TIFA is not available to people on Medicare. If you are a military-connected person over 65, you may be covered under TRICARE for Life, which works alongside Medicare. Contact TRICARE to learn which plan fits your situation.

How do I learn about I meet the 20-year marriage requirement for former spouses?

The 20 years must be during your sponsor's active duty service. If you were married for 20 years total but only 15 of those years overlapped with active duty, you do not meet the requirement. TRICARE will review your military records and marriage certificate to confirm. You can call TRICARE or submit your documents through the online portal to ask for a information.