Tricare
Tricare is the Department of Defense's worldwide health care program for active duty and retired uniformed services members and their families.
Tricare consists of:
- Tricare Prime, a managed care option
- Tricare Extra, a preferred provider option
- Tricare Standard, a fee-for-service option
- Tricare For Life, available for Medicare-eligible beneficiaries age 65 and over (effective October 1, 2001).
Tricare Prime
Tricare Prime is a managed care option similar to a civilian health maintenance organization (HMO). It is the only Tricare option that requires enrollment. Active duty service members are required to enroll in prime. Active duty family members, retirees and their family members are encouraged, but not required, to enroll in prime. Ask your local Tricare service center (TSC) about the Tricare Prime availability in your area. If you are stationed in a remote area, Tricare Prime Remote may be the option available to you and your family members.
Tricare Prime offers less out-of-pocket costs than any other Tricare option. Active duty members and their families do not pay enrollment fees, annual deductibles or co-payments for care in the Tricare network. Retired service members pay an annual enrollment fee of $230 for an individual or $460 for a family, and minimal co-pays apply for care in the Tricare network. Although prime offers a "point-of-service" option for care received outside of the Tricare Prime network, receiving care from a nonparticipating provider is not encouraged.
Tricare Prime enrollees receive most of their care from military providers or from civilian providers who belong to the Tricare Prime network. Enrollees are assigned a primary care manager (PCM) who manages their care and provides referrals for specialty care. All referrals for specialty care must be arranged by the PCM to avoid point of service charges.
Tricare Prime enrollees are guaranteed certain access standards for care. The chart below describes the access standards for Prime enrollees.
| Time | Urgent Care | Routine Care | Referred/Specialty Care | Wellness/Preventative Care |
|---|---|---|---|---|
| Appointment wait time | Not to exceed 24 hours | Not to exceed 7 days | Not to exceed 4 weeks | Not to exceed 4 weeks |
| Drive time | N/A | Within 30 minutes from home | Within 60 minutes from home | N/A |
| Wait time in office | Not to exceed 30 minutes for non emergency situations | |||
Tricare Extra & Tricare Standard:
Tricare Extra and Tricare Standard are available for all Tricare-eligible beneficiaries who elect not to enroll in Tricare Prime. Active duty service members are not eligible for extra or standard. There is no enrollment required for Tricare Extra or Standard - no annual enrollment fees, no enrollment forms. Beneficiaries are responsible for annual deductibles and cost shares. Beneficiaries may see any Tricare authorized provider they choose, and the government will share the cost with the beneficiaries after deductibles.
Tricare Extra is a preferred provider option (PPO) in which beneficiaries choose a doctor, hospital or other medical provider within the Tricare provider network. Network providers can be located by calling your local Tricare service center or visiting our website.
Tricare Standard is a fee-for-service option. You can see an authorized provider of your choice. People who are happy with coverage from a current civilian provider often choose this option. Having this flexibility means that care generally costs more. See the chart below for the differences between extra and standard.
| Physician | Tricare Extra | Tricare Standard |
|---|---|---|
| Physician / Provider | In network | Not in network, but still an authorized provider |
| Cost share after deductibles | 5% less than Tricare Standard | 20% active duty families 25% retirees and their families plus the difference between |
Tricare For Life and Tricare Plus:
When beneficiaries age 65 and over become eligible for Medicare Part A, they can use Tricare For Life (TFL) if they enroll in Medicare Part B. These beneficiaries are not eligible for Tricare Prime but are eligible to use network and non-network providers under Tricare Extra and Tricare Standard. Under TFL, Tricare acts as a second payer to Medicare for benefits payable by both Medicare and Tricare. Beneficiaries can use an authorized Medicare provider and claims will be automatically sent to Tricare after Medicare pays its portion. There are no enrollment fees for TFL - beneficiaries are only required to pay the Medicare Part B premium. Tricare is first payer for benefits such as pharmacy, which are available only under Tricare.
Some military treatment facilities will have capacity to offer a primary care affiliation program called Tricare Plus. Enrolled beneficiaries have priority access to care at military treatment facilities; however, beneficiaries who choose to use Tricare Extra, Tricare Standard or Tricare For Life may also continue to receive care in a military treatment facility as capacity exists.
For Further Information Regarding Tricare
For more information about any of the Tricare options, please contact your local Tricare service center or visit the Tricare Website.
See Also
- Tricare For Life Fact Sheet
- Tricare Plus Fact Sheet
- Tricare Prime Point-of-Service Option Fact Sheet
- Tricare Regional Managed Care Support Contractors Fact Sheet
- Tricare Prime Remote Website