TRICARE for Medically Retired: Benefits and Costs 2026 | TRICARE.com

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## Quick answer If you are medically retired from the military, you and your eligible family members are entitled to the same TRICARE retiree benefits as those who served 20+ years. You generally have the choice between TRICARE Prime and TRICARE Select, and your eligibility for these benefits is lifelong, provided you remain in a retired status (though you must eventually transition to TRICARE For Life upon reaching Medicare eligibility).

Details

Medically retired service members are those placed on the Permanent Disability Retired List (PDRL) or the Temporary Disability Retired List (TDRL). Regardless of your years of service, if you were medically retired, the Department of Defense (DoD) treats your healthcare eligibility the same as a traditional "length-of-service" retiree.

### Plan Options for Medical Retirees Medically retired veterans typically choose between two main paths:

* **TRICARE Prime:** This is a managed care option. You will have a Primary Care Manager (PCM) and require referrals for specialty care. If you live in a Prime Service Area (PSA), this offers the lowest out-of-pocket costs. * **TRICARE Select:** This is a self-managed, preferred provider organization (PPO) plan. You do not need a PCM and can see any TRICARE-authorized provider without a referral. However, you will face higher out-of-pocket costs, including an annual deductible.

### Enrollment and Costs (2026 Rates) Your costs are determined by your "Group" status. Most medical retirees who joined the military before January 1, 2018, are in **Group A**. Those who joined on or after that date are in **Group B**.

* **Enrollment Fees:** For 2026, Group A retirees typically pay an annual enrollment fee for TRICARE Prime (approx. $380–$400 for individuals) or TRICARE Select (approx. $185–$195 for individuals). * **Catastrophic Cap:** This is the most you will pay out-of-pocket for covered services per year. For Group A retirees in 2026, the cap is approximately $4,200–$4,500. * **Pharmacy:** Your prescriptions are managed by **Express Scripts**. You can use Military Pharmacies ($0 copay), Home Delivery, or retail network pharmacies.

### Impact of VA Disability Ratings Many medical retirees also receive care through the Department of Veterans Affairs (VA). You can use both TRICARE and the VA, but they do not "coordinate" benefits. If you see a VA provider for a non-service-connected issue, the VA may bill TRICARE. However, TRICARE cannot pay for care received at a VA facility for a service-connected disability, as the VA is already responsible for that cost.

### TDRL vs. PDRL * **TDRL (Temporary):** You are eligible for retiree health benefits for as long as you are on the TDRL. You will undergo periodic exams (at least every 18 months). If you are eventually removed from the TDRL and not moved to the PDRL, your TRICARE retiree benefits will end. * **PDRL (Permanent):** Your medical retirement is permanent, and your TRICARE eligibility is lifelong.

## Who this affects * **Service Members:** Those on the Permanent Disability Retired List (PDRL) or Temporary Disability Retired List (TDRL). * **Family Members:** Spouses and biological/adopted children of the medically retired member. * **Survivors:** Eligible family members of a deceased medical retiree.

## Sources 1. **TRICARE.mil:** Retiring for Health Reasons (https://www.tricare.mil/LifeEvents/Retiring/MedicalRetirement) 2. **Humana Military (East Region):** Benefit Overview (https://www.humanamilitary.com) 3. **TriWest Healthcare Alliance (West Region):** New Contractor Information (https://www.triwest.com) 4. **Express Scripts:** Pharmacy Benefits (https://militaryrx.express-scripts.com)