US Family Health Plan

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VA doctor with patient

One TRICARE Prime option, called the US Family Health Plan is available in 16 states and DC. If you live in New England, the Mid-Atlantic, the Western Gulf Coast or in the Puget Sound area you may be eligible for the plan.

The U.S. Family Health Plan meets the minimum required coverage requirements of the Affordable Care Act.

US Family Health Plan Overview

The U.S. Family Health Plan began as part of the U.S. Public Health Service hospital program. It was made available to military members in 1993.

The program offers several benefits that Tricare does not such as free vision exams and discounts on glasses, contact lenses and laser surgery;  discounts for health clubs and gyms; alternative health care and more.

Who Is Eligible

Anyone who is eligible for Tricare and lives in the designated area is eligible for the plan.

Enrollment

You can enroll in the U.S. Family Health Plan anytime and coverage begins on the first day of the month following receipt of your application, when it is received by the 20th of the month. There's no waiting period for benefits. As with any TRICARE Prime program, when you enroll in the U.S. Family Health Plan, you commit to remaining enrolled for 12 months.

If you move to another region served by the U.S. Family Health Plan, your enrollment can be transferred. If moving outside the plan's service area, you can transfer your enrollment to Tricare Prime, and any enrollment fees paid will be transferred..

Tricare Groups

There are two separate groups of Tricare beneficiaries:

  1. Group A: where the service member entered active duty before 2018
  2. Group B: where the service member entered active duty in 2018 or later

Costs

Active duty family members pay no enrollment fees and no out-of-pocket costs for any care as long as care is received from the U.S. Family Health Plan Provider.

Retirees pay an annual enrollment fee which is the same as the Tricare Prime enrollment fee. For Group A retirees that amount is $300/year for an individual or $600/year for family enrollment. For Group B retirees the fees are $366/year for an individual or $732/year for family enrollment.

Retirees who provide proof of Medicare Part B enrollment will have the fee waived.

U.S.  Family Health Plan Copayments for enrollees who are not Active duty family members
Service Cost
Primary Care $20 
Specialist $31
Ambulance $41
Emergency Room $62
Hospital $156

Catastrophic Cap

The catastrophic cap is the maximum amount you have to pay in any given calendar year.

That amount is $1,000 for Group A active-duty family members or $1,044 for Group B active duty family members. For retirees it is $3,000 for Group A or $3,655 for Group B.

For More Information

For more information, call 800-748-7347, or visit the US Family Health Plan Web site at http://www.usfhp.com.

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