Editor’s note: This is one in a series of pieces that make up the Military Times 2018 Benefits Guide. Read or download the entire e-book here; for more on the Tricare program, click here.
Tricare Prime: Prime is similar to a health maintenance organization, which has lower out-of-pocket costs but requires enrollees to use network providers and coordinate care through a primary care manager — a doctor, nurse practitioner or medical team. It’s free to active-duty members and families; retirees must pay an annual enrollment fee ($289.08 for an individual, $578.16 for a family in 2018).
Those whose initial period of service began before Jan. 1 are grandfathered in to these rates. Co-payments for medical visits are lower than other programs, and there are no deductibles unless patients get care outside the network.
Tricare Prime Remote: Service members who live and work more than 50 miles or an hour’s drive from the nearest military treatment facility must enroll in Tricare Prime Remote. Family members are eligible if they live with an enrolled service member in a qualifying location, or they may use Tricare Select.
Tricare Prime Overseas/Prime Remote Overseas: Tricare Prime Overseas is a managed-care option for active-duty members and their command-sponsored family members living in nonremote locations. They have assigned primary care managers at a military treatment facility who provide most care and referrals for and coordination of specialty care.
Tricare Prime Remote Overseas is a managed care option in designated remote overseas locations, with most care from an assigned primary care manager in the local provider network, who provides referrals for specialty care. Activated National Guard and Reserve members and their families also may enroll in these options while the sponsor is on active duty; retirees and their families aren’t eligible.
What's covered, what's changed, and how you can move from plan to plan.
Tricare Select: This is a preferred provider plan — authorized doctors, hospitals and other providers are paid a Tricare-allowable charge for each service performed. Costs are higher for out-of-network providers, and certain procedures require pre-authorization. There is no enrollment fee for active-duty families, or for retirees and their families and others whose period of service began before Jan. 1, 2018.
Co-pays vary by status and type of care: An in-network primary care outpatient visit costs retirees and their families $28, for example, while some active-duty family members pay $21 and others — those whose sponsor entered the network in 2018 — pay $15.
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Tricare Reserve Select: Qualified Selected Reserve members can buy Tricare coverage when they are in drilling status — not mobilized. The program offers coverage similar to Tricare Select.
Tricare Retired Reserve: “Gray area” National Guard and Reserve retirees who have accumulated enough service to qualify for military retirement benefits but have not reached the age at which they can begin drawing those benefits (usually age 60) can purchase this insurance, which offers coverage similar to Tricare Select.
Tricare for Life: This wraparound program is for retirees and family members who are eligible for Tricare and Medicare. The provider files the claims with Medicare; Medicare pays its portion and then sends the claim to the Tricare for Life claims processor. Enrollees must enroll in Medicare Part A (free for those who paid Medicare taxes while working) and Part B (monthly premium required) to receive Tricare for Life.
Tricare Young Adult: Unmarried dependent children who do not have private health insurance through an employer may remain in Tricare until age 26 under a parent’s coverage via TYA Select or TYA Prime. Premiums are required for both.
US Family Health Plan: Beneficiaries who live in one of six designated areas, can enroll in this as a Prime option. Those enrolled get all their care, including prescription drugs, from a primary care provider the beneficiary selects, from a network of private doctors affiliated with one of the not-for-profit health care systems in the plan. Beneficiaries don’t get care at military hospitals or clinics, or from Tricare network providers when enrolled in the US Family Health Plan.