Under normal circumstances, your TRICARE Prime coverage is continuous. You won’t need to reapply each year. But certain events will cause you to be removed from the program, such as a change in status or a failure to pay fees. This is known as disenrollment. Some people may be subject to a temporary bar from reapplication depending on how they get disenrolled. So make sure your account is in good standing to prevent disenrollment unless you in fact, want to leave the program.
Nonpayment of Fees
If you belong to a category of Prime beneficiaries who must pay an enrollment fee and you do not pay it on time, you will be disenrolled. This type of removal from the program comes with a 12-month lockout. That means you won’t be allowed to reapply for Prime during that period.
Change in Sponsor’s Status
A change in the sponsor’s status will result in a beneficiary’s disenrollment. Some changes may be:
If you know a change is coming and that you will still be eligible for Prime in spite of it, you can reapply for enrollment before the date of change. Doing this on time would prevent a lapse in your Prime coverage. You will need to submit your new enrollment application to your TRICARE regional contractor.
Change in Beneficiary’s Status
A change in your status may result in loss of TRICARE Prime benefits. Examples are:
- Getting divorced if a spouse (with exceptions)
- Getting remarried if a surviving spouse
- Turning 21 years old (or 23 years old if enrolled in school) if a child
- Not being enrolled on time if a newborn or newly adopted child
- Becoming eligible for Medicare Part A and not purchasing Part B
Your eligibility status will be shown in your DEERS information. If it says you are ineligible for TRICARE, you will be disenrolled from Prime.
If you decide to withdraw from the TRICARE Prime program, you can ask to be removed from it. This is called voluntary disenrollment. Contact your TRICARE regional contractor to disenroll this way.
Keep in mind you will be subject to a 12-month lockout if you voluntarily leave the Prime program. This means you won’t be able to re-enroll for a year. However this lockout rule does not apply to family members of sponsors with grades E1 to E4.
If you are on active-duty, you cannot voluntarily disenroll. All active-duty service members (ADSM) must use either TRICARE Prime or TRICARE Prime Remote.
Sometimes you lose TRICARE Prime coverage just because your DEERS information is incorrect. If you think you are wrongly listed as ineligible in DEERS, you should update your information. Thereafter always keep it up to date to avoid interruptions in your coverage.