Editor’s Note: This article is part of MOAA’s 2023-24 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). A version of the guide appeared in the November 2023 issue of Military Officer magazine.

U.S. Family Health Plan (USFHP) is a TRICARE Prime option available since 1993 in six geographic areas of the U.S. through networks of community-based, not-for-profit health care systems.

Care is provided through large local civilian health care networks of primary care physicians, hospitals, and affiliated specialists. USFHP programs and their service areas are:

• Brighton Marine (800-818-8589) serves Massachusetts, including Cape Cod, Rhode Island, and parts of northern Connecticut.
• CHRISTUS Health (800-678-7347) serves Houston and San Antonio as well as Leesville and Lake Charles, La.
• Martin’s Point Health Care (888-241-4556) serves Maine, New Hampshire, Vermont, upstate and western New York, and parts of Pennsylvania.
• Pacific Medical Center (800-585-5883) serves western Washington, most of central and eastern Washington, northern Idaho, western Oregon, and most of California.
• Vincent Catholic Medical Centers (800-241- 4848) serve New Jersey, western Connecticut, the lower Hudson Valley, and New York City, including Nassau and Suffolk counties.
• Johns Hopkins Health Plans (800-801-9322) serves Maryland, Delaware, Washington, D.C., and parts of Pennsylvania, Virginia, and West Virginia.

Visit this link and enter your ZIP code to see if you reside within the coverage sector of USFHP programs. For Johns Hopkins, use this link. 

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As a TRICARE Prime option, USFHP has no deductible and the same enrollment fees, copays, and catastrophic cap as TRICARE Prime. Instead of a primary care manager, you’ll pick a primary care provider (PCP) or physician. You must go through your PCP for referrals to specialty care.

One common misconception is you cannot access a military treatment facility (MTF) hospital or clinic, including pharmacy services. The exceptions to this limitation are if you have an acute medical emergency and the MTF is the closest to you or if there is an agreement between the USFHP and an MTF that allows USFHP enrollees to be referred to the MTF for specialty care.

This exclusion means you will have pharmacy copays and might want to consider a supplemental plan if you reach the catastrophic cap each year.

What happens if you get sick traveling outside your plan’s coverage area? USFHP covers you for medical emergencies wherever you are. Use the nearest appropriate medical facility, and be sure someone calls your plan or PCP within 24 hours so your provider can confer with the attending doctor.

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Those enrolled continually in a USFHP program on or before Sept. 30, 2012, are “grandfathered” to remain in the program upon turning 65. Those enrolled on or after Oct. 1, 2012, “age out” of TRICARE like all other beneficiaries.

USFHP sends all grandfathered enrollees approaching 65 a letter encouraging enrollment in Medicare Parts A and B. This is to ensure that if later in life you move out of a USFHP coverage area, you won’t incur the lifetime Medicare premium penalty for not enrolling upon turning 65.

If you enroll in Medicare at 65 with USFHP, you pay the Part B premium and USFHP fees and copays stop (except pharmacy copays). Staying with USFHP includes their pharmacy program.