TRICARE is the health care program for members of the military, retirees, and their families. TRICARE provides a wide range of services, such as medical care, prescription medications, and dental and vision coverage. Coverage varies by the type of plan, but most plans meet the minimum essential coverage requirements under the Affordable Care Act.
There are different TRICARE plans, based on whether the service member is active duty or retired, as well as their proximity to a military installation. Below are brief explanations of the main TRICARE plans; costs and deductibles vary.
TRICARE Prime provides health care for those on active duty and their families, and is available in the United States in Prime service areas. TRICARE Prime provides general preventive and vision care. Care is provided by your primary care manager (PCM), who may be either a military or network provider. Patients can be referred to specialists for care that cannot be provided by the PCM. There are no out-of-pocket expenses, network co-pays, point-of-service fees, or enrollment fees for active duty members. However, when family members are added to the plan, out-of-pocket expenses and co-pays may occur.
TRICARE Prime Remote
TRICARE Prime Remote is available in remote United States locations. It can only be used if the sponsor’s home and work addresses are more than 50 miles, or a one-hour drive from a military clinic or hospital. Active duty members and their families are eligible, as well as activated National Guard/Reserve members who have been ordered to active duty for 31 days or more (and their families). Like TRICARE Prime, there is no deductible, and providers will usually file claims. Care is provided by PCMs with referrals to specialists as needed. There are no enrollment fees or co-pays for care from your PCM or referrals; point-of-service fees may be required for care received without a referral.
TRICARE Prime Overseas
TRICARE Prime Overseas is available in overseas areas near military clinics and hospitals. Active duty service members and their command-sponsored family members, as well as activated National Guard and Reserve members and their command-sponsored family members can participate in this program. Most care is provided at a military clinic or hospital by a PCM, but beneficiaries may be referred to specialists if necessary. There are no enrollment fees or co-pays (as long as care is received from the PCM or a referral). Care received without a referral may incur point-of-service fees.
TRICARE Prime Remote Overseas
TRICARE Prime Remote Overseas is available in designated remote locations overseas. These include Eurasia-Africa, Latin America and Canada, and the Pacific. Active duty service members and their command-sponsored family members, and activated National Guard/Reserve members and their families can enroll. Like TRICARE Prime Remote, care comes from a PCM or referrals to specialists. There are no enrollment fees or co-pays, as long as care is provided by a PCM or a referral. Once enrolled in TRICARE Prime Remote Overseas, beneficiaries can have an overseas point of contact enroll them in a plan and schedule their appointments. The TRICARE Area Office can help beneficiaries find a point of contact.
TRICARE Select and TRICARE Select Overseas
TRICARE Select is a self-managed preferred provider network plan. It replaced TRICARE Standard and Extra in 2018. There are two ways to enroll in TRICARE Select: during Open Season (for new enrollments only), or for a Qualifying Life Event (for new enrollment or changes to current plans). TRICARE Select is available for active-duty family members and non-active duty family members. This plan allows beneficiaries to receive care from any network or non-network TRICARE-authorized provider. Referrals are not required, but prior authorization may be necessary for some types of care. With TRICARE Select, patients may have to pay for services up front and file their own claims to be reimbursed. There is no deductible but there is a $1,000 catastrophic cap; however, this can vary depending on sponsor status.
TRICARE Reserve Select
TRICARE Reserve Select is available worldwide. It is a premium-based plan that can be purchased by members of the National Guard and Reserve. The annual deductible varies, and care is provided by authorized providers, both network and non-network. Referrals are not required for specialists, but prior authorization may be required for some care. Claims are filed if care is provided in network, but must be submitted by the patient if the provider is non-network. Depending on the type of provider seen, costs can vary; however, there are fewer out-of-pocket costs with providers in the TRICARE network.
TRICARE for Life
TRICARE for Life serves retired service members and their family members who are enrolled in Medicare. It is available worldwide and provides secondary health insurance for TRICARE beneficiaries who have both Medicare Part A and B. Participants must pay their Medicare Part B premium, but otherwise there are no enrollment fees and minimal out-of-pocket costs. Care is provided by authorized providers and specialists, and military clinics and hospitals if space is available. The maximum out of pocket cost varies, but beneficiaries whose care is covered by both Medicare and TRICARE pay nothing out of pocket.
TRICARE Retired Reserve
TRICARE Retired Reserve is available around the world, and is a premium-based plan.
Enrollment is limited to retired Reserve members who are qualified for non-regular retirement, under the age of 60, and are not enrolled in or eligible for the Federal Employees Health Benefits program, as well as their family members. Care is provided by TRICARE-authorized providers, either network or non-network; co-pays for non-network care are higher. If space is available, beneficiaries may be able to request an appointment at a military clinic or hospital. Beneficiaries pay monthly premiums, an annual deductible, and a percentage of covered services.
TRICARE Young Adult
TRICARE Young Adult is for qualified adult children who are no longer eligible for other TRICARE plans. Beneficiaries must be between the ages of 21 and 26 in order to enroll. Beneficiaries can enroll in either a Prime or Select option. Plan costs are based on whether Prime or Select is chosen, the sponsor’s military status, and where the beneficiary receives care. Costs include monthly premiums in addition to what is paid for covered services.
US Family Health Plan
The US Family Health Plan is an additional option for TRICARE Prime, available through community-based health care systems in six areas of the United States. These include:
- Maryland, Washington D. C., and parts of Virginia, Delaware, Pennsylvania, and West Virginia
- Maine, Vermont, New Hampshire, Upstate and Western New York, and parts of Pennsylvania
- Massachusetts, Rhode Island, Northern Connecticut
- New York City, Long Island, Southern Connecticut, New Jersey and Philadelphia
- Southeast Texas and Southeast Louisiana
- The Puget Sound in Washington State
There is limited eligibility for this plan, but active duty family members, retired service members and their families can participate; full eligibility can be found here. Beneficiaries must enroll, and receive all care from a PCM that they select from a list of physicians who are affiliated with the health system in their area. Beneficiaries are not able to receive care at military hospitals or clinics, or TRICARE network providers under this plan. There is no enrollment fee or out-of-pocket cost for active duty family members, as long as care is from a US Family Health Plan provider. All other beneficiaries pay annual enrollment fees and co-pays.
More information on TRICARE plans and eligibility can be found here.
Heather Maxey works at a non-profit that addresses military ineligibility. She is an Army spouse, and met her husband while working as a Health Educator at Fort Bragg.
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