WHAT IS TRICARE?
TRICARE is a health care program for active duty, family and retired members of all military services. It provides high-quality accessible care, controls patient costs and improves medical readiness. The program is managed by the military and uses civilian contractors throughout the country.
Making a choice— TRICARE Prime, Extra or Standard
All family members and retirees must decide which option is best for them.
TRICARE Standard is the most flexible plan but requires deductibles and cost-shares.
Usually, active-duty families who use TRICARE Prime or Extra will save money compared with what they would spend using TRICARE Standard.
There are no enrollment fees for active-duty families.
For more information, visit www.tricare.mil.
Similar to a civilian HMO plan, TRICARE Prime is the least expensive but most restrictive plan. Under Prime, active-duty family members do not pay copayments when receiving services from a military treatment facility. Additionally, copayments were eliminated except for prescriptions at civilian pharmacies or using the Point of Service option.
For more information about TRICARE benefits or coverage or to enroll in TRICARE Prime, call TRICARE at 877-988-WEST (9378). Hawaii is in TRICARE’s West region. UnitedHealthcare Military & Veterans is the regional contractor providing health care services and network-provider support in the TRICARE West Region.
Customer service is available 8 a.m. to 6 p.m Monday through Friday in the West Region time zone in which you reside. An interactive voice response system is available 24 hours a day offering an automated self-service option for accessing recorded routine TRICARE information, the Healthcare Finder function and the Behavioral Health Crisis Line.
When you enroll, you must designate one clinic or physician as the PCM for each family member. For all non-emergency outpatient services, you must use the PCM.
Enrollment is mandatory for one year, and you see only the physician/clinic you designated upon enrollment. If specialty care is warranted, your PCM physician/clinic must provide you with the referral. You may not use TRICARE Extra, Standard or military clinics for non-emergency care while enrolled in TRICARE Prime.
TRICARE Prime advantages:
- Assigned Primary Care Manager (PCM).
- Always know where to go for initial care. Healthcare Finder can help authorize non-emergency and specialty care when you’re referred outside of the MTF.
- No copayments, except for prescriptions from a civilian pharmacy and when using the TRICARE Prime Point-of-Service option.
- No paperwork. Civilian providers file their payment directly with the contractor.
TRICARE Prime disadvantages:
- One-year commitment (you can change your PCM anytime within the year).
- Must use selected PCM and Prime network care providers for all care, except emergencies.
- Retiree families must pay enrollment fees whether they use care or not.
Under this option, individuals may choose their own care providers. If an authorized network provider is used, a 5 percent discount from the TRICARE Standard cost shares is available. The annual deductibles must be met before cost sharing begins, and other TRICARE Standard rules apply.
TRICARE Extra advantages:
- Less expensive than Standard.
- Lower cost share when using doctors in the TRICARE network of providers.
TRICARE Extra disadvantages:
- More expensive per treatment than TRICARE Prime.
- No PCM to guide patient care.
This is a new name for Standard CHAMPUS. Under this option, individuals decline TRICARE enrollment and continue to pay the deductibles and cost share rules of CHAMPUS. Annual deductibles must be met before Standard will cost-share your claim at 80 percent of the allowable charge.
TRICARE Standard Advantage:
- Unlimited provider choice.
TRICARE Standard disadvantages:
- Most expensive option.
- Must pay a deductible and cost share.
- No PCM to guide patient care.
Detailed information concerning each of these plans is available through every Health Benefits Advisor and by contacting the local TRICARE Service Center or Beneficiary Service Office in the area.
Note: TRICARE is available outside of the 50 states. Be sure to contact the TRICARE region for more information about TRICARE coverage overseas.
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