When it comes to healthcare for military families, understanding the available options is crucial. Among the choices within TRICARE Prime, the US Family Health Plan (USFHP) stands out as a unique option. This plan operates through networks of community-based, not-for-profit healthcare systems across six designated service areas in the United States, offering a different approach to healthcare management within the TRICARE framework for eligible beneficiaries and their families.
Who Can Benefit from These Family Plans?
The US Family Health Plan is designed for specific categories of beneficiaries who reside within a USFHP service area. Eligibility extends to a wide range of individuals connected to military service, ensuring comprehensive healthcare options for many family plans. Those eligible include:
- Active Duty Family Members: Providing healthcare coverage as part of their overall family support.
- Retired Service Members and Their Families*: Recognizing the continued healthcare needs after military service.
- Family Members of Activated National Guard and Reserve Members: Supporting families during periods of active duty exceeding 30 days.
- Non-activated National Guard and Reserve Members and Their Families: Offering transitional care through the Transitional Assistance Management Program.
- Retired National Guard and Reserve Members (at age 60) and Their Families*: Extending benefits to those who served in the National Guard and Reserve upon retirement age.
- Survivors: Ensuring continued healthcare access for families who have lost a service member.
- Medal of Honor Recipients and Their Families: Honoring the sacrifices of Medal of Honor recipients with comprehensive healthcare coverage.
- Qualified Former Spouses: Providing healthcare benefits under specific qualifying circumstances.
*Note: For retired service members and their families, and retired National Guard and Reserve members and their families, enrollment fees and network copayments may apply. Active duty family members typically have no enrollment fees or out-of-pocket costs when receiving care from a US Family Health Plan provider.
Service Areas: Where Are These Family Plans Available?
To enroll in the US Family Health Plan, you must reside within one of the six designated service areas. Each area partners with a specific healthcare provider to administer the plan. It’s important to check if your location falls within these areas to determine eligibility for these family plans.
| USFHP Service Area | Designated Provider |
|---|---|
| Maryland, Washington, D.C., Parts of Pennsylvania, Virginia, Delaware, and West Virginia | Johns Hopkins Health Plans – 800-808-7347 – Secure Login Portal – Provider Directory |
| Maine, New Hampshire, Vermont, Upstate and Western New York, Northern and Western Tier of Pennsylvania, Northeastern and Central Ohio | Martin’s Point Health Care |
| Massachusetts (including Cape Cod), Rhode Island, Northern Connecticut | Brighton Marine Health Center – 800-818-8589 – Secure Login Portal – Provider Directory |
| New York City, Long Island, Lower Hudson Valley, New Jersey, Western Connecticut (including New London and Hartford), Eastern Pennsylvania | St. Vincent Catholic Medical Centers – 800-241-4848 – Secure Login Portal – Provider Directory |
| Central Texas, Coastal Bend Texas, Northeast Texas, Southeast Texas, Central Louisiana | CHRISTUS Health – 800-678-7347 – Secure Login Portal – Provider Directory |
| Western Washington State, Most of Central and Eastern Washington State, Northern Idaho, Western Oregon, Most of California | Pacific Medical Centers (PacMed Clinics) – 866-418-7346 – Secure Login Portal – Provider Directory |
How Do These Family Plans Function?
Under the US Family Health Plan, you select a primary care provider (PCP) from the network of private physicians affiliated with the designated not-for-profit healthcare system in your service area. This PCP becomes your central point of contact for all healthcare needs, including prescription drug coverage. Your PCP will coordinate all aspects of your care, including referrals to specialists within the network. This coordinated approach ensures seamless healthcare management for you and your family plans.
Important Note: Enrolling in USFHP means you will receive your healthcare services from the US Family Health Plan network providers. Care is not accessed at military hospitals and clinics or through the standard TRICARE network while enrolled in USFHP. This distinction is key to understanding how these family plans operate differently from standard TRICARE Prime.
Understanding the Costs for Your Family Plans
The cost structure for the US Family Health Plan varies depending on your beneficiary category. It’s important to understand these costs when considering your family plans.
- Active Duty Family Members: Generally, there are no enrollment fees and no out-of-pocket costs for active duty family members when care is received from a US Family Health Plan provider. This makes it a highly cost-effective option for active duty families in the service areas.
- Other Beneficiary Categories: All other eligible beneficiaries typically pay annual enrollment fees and network copayments. The specific amounts can vary, so it’s important to review the detailed cost information for your specific situation.
For more detailed information on specific costs associated with these family plans, you can learn more about USFHP costs.
Is the US Family Health Plan the Right Choice for Your Family?
If you reside within one of the six USFHP service areas, considering the US Family Health Plan is worthwhile. It represents a robust TRICARE Prime option, often offering enhanced coverage and a community-based healthcare approach in each location. For families seeking a coordinated care model with a focus on primary care within a specific network, these family plans can be an excellent choice.
Enrollment Information for Your Family Plans
To enroll in the US Family Health Plan and explore these family plans further, visit US Family Health Plan Enrollment for comprehensive details and the enrollment process.
If you need information on disenrolling or ending your plan coverage, resources are available at Disenrolling From the US Family Health Plan.
Medicare Eligibility and Your Family Plans: Key Considerations
Understanding Medicare eligibility is important when considering the US Family Health Plan, particularly for beneficiaries aged 65 and older.
Enrollment Rules Based on Medicare Eligibility:
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Enrolled Before Oct. 1, 2012: If you were enrolled in the US Family Health Plan before becoming Medicare-eligible (and your USFHP coverage began before October 2012), you generally can remain enrolled as long as there is no break in your coverage. However, enrolling in Medicare Part B when first eligible is strongly recommended to maintain access to other TRICARE benefits should you disenroll or move out of a USFHP service area. Failure to enroll in Part B when initially eligible may result in late enrollment penalties if you decide to enroll later.
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New Enrollments On or After Oct. 1, 2012: For those becoming Medicare-eligible at age 65 and older on or after October 1, 2012, new enrollments in USFHP are not permitted. If you are under 65 and using Medicare due to disability or other reasons, you can continue with the US Family Health Plan until you reach age 65, at which point you will transition to TRICARE For Life.
By understanding the specifics of the US Family Health Plan, including eligibility, service areas, how it works, costs, and Medicare considerations, you can make an informed decision about whether these family plans are the right fit for your family’s healthcare needs within the TRICARE system.
Last Updated: 11/27/2024
