Understanding which coverage option gives you the most value after service.
If you've served in the military, you already know TRICARE. It was your healthcare backbone during active duty reliable, affordable, and largely invisible. You didn't spend hours comparing deductibles or worrying about whether your doctor was in-network. But once you separate from service, the healthcare landscape shifts dramatically. Suddenly, TRICARE's rules change, new options appear, and you're left wondering: should I stick with what I know, or is private insurance actually a better deal?
At Figueroa Family Insurance, our founder Marcos Figueroa faced this exact decision after his own military service. That experience is part of why we built this company to help veterans cut through the confusion and make informed choices. This guide breaks down TRICARE and private insurance side by side so you can see exactly where each one excels and where it falls short.
TRICARE isn't a single plan it's a family of plans, each designed for different circumstances. Understanding which version you're eligible for is the first step in any comparison.
TRICARE Prime is the most comprehensive option. It functions like an HMO, assigning you a primary care manager (PCM) who coordinates all your care. Referrals are required for specialists. For active-duty service members, there's no cost. For retirees and their families, there are modest annual enrollment fees and low copays. The trade-off is limited flexibility you must use the TRICARE network, and out-of-network care is generally not covered except in emergencies.
TRICARE Select operates more like a PPO. You don't need a PCM or referrals, and you can see any TRICARE-authorized provider. Costs are higher than Prime you'll pay deductibles and cost shares but you gain significantly more flexibility in choosing your providers. Select is available to retirees and their family members, as well as certain reserve component members.
TRICARE Standard (now largely rolled into Select) was the original fee-for-service option. If you hear veterans referencing "Standard," they're generally talking about the flexibility that Select now provides.
On the private side, you'll encounter two main categories: ACA marketplace plans and underwritten health plans.
ACA marketplace plans are the plans available through Healthcare.gov. They're guaranteed issue, meaning no one can be denied coverage regardless of health history. If your income qualifies, you may receive subsidies that lower your monthly premiums. However, ACA plans often come with high deductibles, narrow provider networks, and standardized benefits that don't account for individual health profiles.
Underwritten health plans take a different approach. Instead of charging everyone the same rate, they evaluate your individual health profile and reward healthy applicants with lower premiums, lower deductibles, and broader networks. For veterans who maintained the physical standards required during service and many continue those habits after separation underwritten plans can offer dramatically better value.
TRICARE retiree premiums are remarkably low compared to the private market. TRICARE Prime for a retiree family runs roughly $600 to $700 per year in enrollment fees. TRICARE Select costs somewhat more, with annual deductibles on top. By contrast, private insurance premiums range widely ACA plans can run $400 to $800+ per month for a family, while underwritten plans for healthy individuals often come in between $150 and $400 per month with significantly better benefits than comparably priced ACA plans.
If you're eligible for TRICARE retiree coverage, it's hard to beat on cost alone. But if you've separated and lost TRICARE eligibility, underwritten plans frequently outperform ACA plans for healthy veterans.
This is where TRICARE can become limiting. TRICARE Prime restricts you to military treatment facilities and the TRICARE provider network, which can be thin in certain regions especially rural areas. TRICARE Select offers more flexibility, but you're still limited to TRICARE-authorized providers.
Private insurance, particularly underwritten PPO plans, typically offers nationwide networks with tens of thousands of providers. You're not restricted to military facilities, and you can often see specialists without a referral. For veterans who've relocated away from military installations, this broader network access can be the deciding factor.
TRICARE covers a comprehensive range of services preventive care, hospitalization, mental health, prescription drugs, and more. It's a strong benefit package by any standard. However, there are notable gaps. TRICARE dental coverage requires a separate plan (TRICARE Dental Program), and certain services like cosmetic procedures, some alternative therapies, and certain prescription drugs may not be covered.
Private plans vary significantly in coverage scope. ACA plans are required to cover ten essential health benefit categories, so the baseline is solid. Underwritten plans often include dental and vision as add-ons, and many may offer lower copay primary care visits, free preventive screenings, and prescription drug coverage that can rival or exceed TRICARE's formulary.
TRICARE enrollment is tied to your military status and life events. Open enrollment periods exist, and qualifying life events trigger special enrollment windows. If you miss a window, you may have to wait.
ACA plans follow a similar annual open enrollment model, with special enrollment periods for qualifying events like losing military coverage. Underwritten plans, however, have no enrollment windows you can apply any time of year, which gives veterans navigating unpredictable transition timelines a major advantage.
This is the critical distinction. TRICARE is only available to active-duty members, retirees (with 20+ years of service), their dependents, and certain reserve component members. If you served honorably but separated before retirement, you lose TRICARE eligibility after your TAMP coverage (180 days) and CHCBP period (18-36 months) expire. At that point, private insurance isn't just an option it's a necessity.
Private insurance has no service requirements. Anyone can apply for an ACA plan, and underwritten plans are available to anyone who meets the health criteria. For the millions of veterans who served fewer than 20 years, private insurance is the primary path to comprehensive coverage.
Based on our experience advising veterans, private insurance particularly underwritten plans tends to be the stronger option in these scenarios:
TRICARE remains an excellent benefit in certain situations:
There's no universal answer to the TRICARE vs. private insurance question. The right choice depends on your eligibility, health status, family situation, geographic location, and budget. What matters is that you evaluate all your options with clear information not assumptions left over from active duty.
The best coverage isn't the one with the most familiar name. It's the one that actually fits your life today.
If you're a veteran weighing your health insurance options, schedule a free consultation with Figueroa Family Insurance. We'll walk through your specific situation, compare every option available to you, and help you find the coverage that delivers the most protection for the best price.