NAVIGATING TRICARE INSURANCE AND YOUR HEALTHCARE
By Buddy Blouin
The United States Department of Defense (DoD) runs a Military Health System (MHS) under the leadership of the Assistant Secretary of Defense (Health Affairs) known as TRICARE Insurance, a.k.a. TRICARE. This nationalized healthcare system provides for members of the military, Veterans, and families. Because the call of duty knows no bounds, there are many different healthcare plans available worldwide for those who qualify. This means that no matter where you're serving, your comprehensive coverage will be there to help you take care of healthcare costs for you and your family. Get to know more about this incredible healthcare provider and how to best stay covered for what may come.
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What Is TRICARE?TRICARE is an insurance provider that works to be a world-class healthcare system catering to a full range of military operations around the world. The coverage provided is comprehensive coverage that includes healthcare plans, Express Scripts TRICARE (prescriptions), TRICARE dental, and other special programs. Being there for those who serve is a big responsibility, and TRICARE continues to fulfill this role. Serving in the American Armed Forces comes with a wide variety of potential risks to both the mental and physical health of those who serve. This is why TRICARE Insurance is a great option for military members and their families, as they understand the challenges and logistics of providing healthcare coverage to those who serve.
Receiving HealthcareThe MHS has a variety of hospitals and clinics that it operates. Your specific location, provider, and covered services will depend on the plan you enroll in, where you are, and the beneficiary category you fall in, but you can receive healthcare services from these locations. In addition to the 700+ healthcare facilities operated by the MHS, you may also be able to receive care from various providers within the civilian network. Healthcare may also be available through TRICARE-authorized non-network providers, as well.
TRICARE: Find a ProviderIt’s no secret that healthcare is a complex subject, and even as TRICARE Insurance works to streamline and simplify the process, there are many factors to consider. This is especially true when determining TRICARE eligibility. You or your sponsor’s eligibility will be a factor in determining which healthcare plans are right for your needs. Here are the many healthcare plans available under TRICARE Insurance.
TRICARE PlusTRICARE Plus is the main form of coverage offered by the provider. Those who are TRICARE-eligible and not enrolled in a TRICARE Prime Plan, the US Family Health Plan, or a civilian or Medicare Health Maintenance Organization can enroll in this coverage. It’s also available to dependent parents or parents-in-law. Every healthcare facility leader will decide whether or not TRICARE Plus is available, and this healthcare plan is primarily focused on coverage at your local military health facility. Those enrolled pay nothing out of pocket.
TRICARE PrimeWith TRICARE Prime, you'll receive a Primary Care Manager (PCM) in your Prime Service Area. Your PCM is responsible for covering all non-emergent healthcare matters and wellness visits. This plan is available to the following:
- Active-duty service members and their families.
- Retired service members and their families*.
- Activated Guard/Reserve members and their families.
- Non-activated Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program.
- Retired Guard/Reserve members at age 60 and their families*.
- Medal of Honor recipients and their families.
- Qualified former spouses.
TRICARE Prime RemoteTPR provides you with the healthcare you deserve, only remotely. This option can only be used when your sponsor's home and work addresses are more than 50 miles (or one hour's drive time) from a military hospital or clinic. TPR is a great option for those living in more remote areas of the United States.
TRICARE Prime OverseasFor those serving overseas, healthcare is still a necessity, which is where TRICARE Prime Overseas becomes a viable option. Available to active duty, command-sponsored active-duty family members, activated National Guard/Reserve members, and command-sponsored family members of activated National Guard/Reserve members only. Healthcare will come from your PCM or authorized through International SOS to referred specialists.
TRICARE Prime Remote OverseasThis is a remote healthcare option for those living in Eurasia-Africa, Latin America, Canada, or Pacific regions. Available to active duty, command-sponsored active-duty family members, activated National Guard/Reserve members, and command-sponsored family members of activated National Guard/Reserve members only. Healthcare will come from your PCM or authorized through International SOS to referred specialists.
TRICARE SelectTRICARE Select is a self-managed, preferred provider organization (PPO) plan available to those who qualify and are living in the United States. You must be eligible for TRICARE in the Defense Enrollment Eligibility Reporting System (DEERS). Healthcare can come from any TRICARE-authorized provider, and referrals aren’t necessary for most appointments. Pre-authorization may be necessary from your regional contractor for some healthcare services.
TRICARE Select OverseasSimilar to the Select plan, only for use overseas. You’ll be able to schedule an appointment with any TRICARE-authorized provider located overseas for your healthcare needs.
TRICARE For LifeTRICARE For Life provides Medicare-wraparound coverage for TRICARE-eligible beneficiaries who are enrolled in Medicare Part A and B. While TRICARE Insurance pays first overseas, TRICARE pays after Medicare in the U.S. and its territories. You’ll have to pay your monthly Medicare Part B premiums, which will vary depending on your income and how long you wait to enroll. You’ll be able to receive healthcare where Medicare is accepted. With TRICARE For Life, your healthcare provider will file a claim with Medicare. From there, Medicare pays its portion before sending the bill to TRICARE. Next, TRICARE For Life will pay for the portions covered by TRICARE Insurance.
TRICARE Reserve SelectTRICARE Reserve Select provides a premium level of healthcare coverage for Select Reserve members of the military and their families. Those who have active-duty orders do not qualify. Coverage is available worldwide, and participants must not be under either the Transitional Assistance Management Program or the Federal Employees Health Benefits (FEHB) programs. Though Survivor coverage isn’t affected by FEHB eligibility, members in the Individual Ready Reserve, including Navy Reserve Voluntary Training Units, won’t qualify. Payment depends on whether or not you are using a non-network provider, which means you pay the higher claims and file yourself, or a network provider, which means lower costs and your provider files. You’ll also need to pay a monthly premium, cost share for covered services, and your annual deductible.
TRICARE Retired ReserveThis plan also provides a premium level of healthcare coverage for Select Reserve members of the military and their families, but it's for retired Reserve members under the age of 60 that are not eligible for the FEHB program. Survivors can also receive coverage if their sponsor was covered by TRICARE Retired Reserve when they died, are immediate family members of the deceased sponsor (spouses cannot have remarried), and their TRICARE Retired Reserve coverage would start before the date the deceased sponsor would have turned 60 years old.
TRICARE Young AdultThe TRICARE Young Adult plan is a great option to provide healthcare coverage for adult children. This coverage is available for purchase after eligibility for "regular" TRICARE coverage ends at age 21, or 23 for those enrolled in college. Participants must be no older than age 26 (exceptions due to college may apply), ineligible to enroll in an employer-sponsored health plan through your employment, and not eligible for another type of TRICARE coverage. Both Prime Options and Select Options are available.
US Family Health PlanAvailable in six areas of the U.S., the US Family Health Plan is another TRICARE Prime option available through networks of community-based, not-for-profit healthcare systems. For more information and to determine your best course of action, you can find out which healthcare provider is in charge of your state online on the US Family Health Plan main page. To learn more information and to determine which plan is right for you and your family overall, the TRICARE Plan Provider tool can help.
How Much Is TRICARE Insurance?There are a lot of different things that go into determining the price of your coverage. The TRICARE Compare Cost tool is a valuable resource that can help. Here, you’ll be able to view and compare costs for the healthcare services that are covered, your enrollment, and the premiums for each plan.
Is It Covered?Healthcare is different for everyone. From your coverage needs to ailments and even prescriptions, everyone is a bit different. Both the TRICARE Covered Services tool and the TRICARE Formulary Search tool are great resources for those enrolled in TRICARE Insurance. You can search to see which healthcare services are covered under the “Covered Services” tool. “TRICARE Formulary” helps those with prescription drugs determine if they are covered or not.
TRICARE Regions WorldwideYou could be stationed in the U.S., or you may have to serve in Asia. Maybe Europe? It doesn’t matter. With TRICARE Insurance, you’ll be covered worldwide. In the United States, there are two regions: TRICARE East and TRICARE West. For overseas policyholders, TRICARE Eurasia-Africa, TRICARE Latin America and Canada, and TRICARE Pacific are the regions available. Various partners also help provide benefits around the world, so you’re always covered.
Tricare Patient Portal Is Now MHS GENESISThe TRICARE Online Portal is now known as the MHS GENESIS Patient Portal (MHSG PP). Here, you can view your medical and active-duty dental health records, manage appointments, and exchange messages with your healthcare team from a secure access point online.
Enrolling in TRICARE InsuranceGetting enrolled in TRICARE is simple and can be done in only three easy steps:
- First, you’ll need to confirm your eligibility online or by calling
1 (800) 538-9552.
- Go through and determine the best healthcare plan for your needs.
- Enroll in your healthcare plan of choice if required.
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