TRICARE, the Department of Defense's healthcare program for military families, provides insurance for over 8 million people. It’s for active-duty personnel and their families as well as activated Guard and Reserve personnel, retired military personnel and survivors. There are three levels of coverage, as well as pharmacy benefits, dental benefits and life insurance. TRICARE healthcare benefits are administered in military treatment centers (MTCs), but there are civilian provider options as well.
TRICARE Prime is the main coverage for active-duty military, and the lowest in cost of the three main TRICARE plans. There’s no annual deductible and no annual enrollment fee for military families, although retirees pay an annual individual enrollment fee of $260 or an annual family enrollment fee of $520 (this and all figures here are valid as of June 2012; please check the Tricare website, tricare.mil, for the most updated information). There is no deductible and no cost to see and receive treatment from certified civilian doctors for outpatient visits for treatment received outside of a hospital setting, inpatient hospital admissions, or hospital inpatient mental-health services. The maximum annual out-of-pocket expense is $1000.
TRICARE Prime requires the selection of a primary-care manager who provides and coordinates care, maintains health records and arranges referrals to specialists. The TRICARE Remote option is the TRICARE Prime option for enrollees who are located more than 50 miles from military treatment facilities, allowing them to see other providers. The TRICARE Prime Point of Service option allows enrollees to receive non-emergency services from civilian health care providers with additional deductibles and charges. All of these options allow those covered to see civilian doctors in defined situations: TRICARE Prime enrollees may see civilian doctors in the Preferred Provider Network after seeing their primary care manager; TRICARE Prime Remote enrollees who live more than 50 miles from the nearest military treatment facility may see civilian doctors for healthcare.
TRICARE Standard allows enrollees to see civilian providers. It is not available to active-duty service members who are automatically enrolled in their only option -- TRICARE Prime -- but TRICARE Standard is available to their families and retirees and their families who prefer civilian doctors not in the TRICARE network. There is a $150 individual annual deductible and $300 family annual deductible for grade E-5 and above; $50/$100 for Grade E-4 and below. TRICARE Standard has no annual enrollment fee and charges 20 percent of negotiated fee for civilian outpatient visits and the greater of $25 or $16.30 per day for civilian inpatient admission and civilian inpatient mental health. There is no Primary Care Manager or need to get authorization for specialists. This plan has a catastrophic cap of $1,000 for families of active-duty service members and $3,000 for all other enrollees, limiting what enrollees have to pay for services.
The TRICARE Extra plan has no enrollment requirement or annual enrollment fee. It is not available to active-duty military -- only to family members and retirees and families. It allows enrollees to see certified civilian providers or TRICARE’s Preferred Provider Network (PPN). There are no claims to file for services and treatment. The charges include 15 percent of the negotiated fee for civilian outpatient visits and the greater of $25 or $16.30 per day for civilian inpatient admission and civilian inpatient mental health.
Military sponsors (active duty military and activated National Guard and Reserves, as well as military retirees) should enroll family members in the Defense Enrollment Eligibility Reporting System (DEERS) and get current uniformed services identification cards to access TRICARE benefits. Military sponsors are automatically enrolled in DEERS, and enrollment is mandatory. Other benefits available under TRICARE include the pharmacy program, dental programs, the TRICARE for Life retiree health insurance program, and U.S. Family Health Plan.
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