Q. I'm a surviving spouse using Tricare Standard and planning to move to Ireland in the near future. I'm unsure of exactly what I need to do, if I'll be covered there with Standard or if I need to enroll in Tricare Prime. How do I find a primary care manager there? Can I keep my PCM in the States and just enroll in Express Scripts home delivery to manage my medications? If I need to see a specialist there, what kind of referral do I need? Can my PCM continue to provide me with my ongoing medications?
A. You may have a specific stateside health care provider whom you see on a regular basis, but the fee-for-service Tricare Standard program does not require beneficiaries to establish a "primary care manager" as Tricare Prime does, nor is there a requirement for referrals for specialty care. The Tricare Overseas Program Standard available in overseas locations works the same as stateside Tricare Standard, except that you receive care from host-nation providers or at U.S. military hospitals and clinics (on a space-available basis.)
Basically, you manage your own health care and generally can seek care from any host-nation provider without a referral, although certain services, including mental health care, require prior authorization.
However, beneficiaries who live or travel overseas and see a host-nation provider may have to pay for services up front and then file a claim with the TOP contractor for reimbursement. That's why it's important to try to use participating Tricare network providers, because there may be no limit to the amount that nonparticipating, non-network providers may bill. Beneficiaries are responsible for paying any amount that exceeds the Tricare allowable charge for any particular health care service, in addition to normal deductibles and cost-shares.
Also worth noting: The roster of participating network providers is more robust in some overseas nations than in others. The rosters tend to be largest in nations with a significant U.S. military presence and fairly sizable retiree populations, such as Japan and Germany.
The Tricare Overseas Program Prime, known as TOP Prime, and TOP Prime Remote are not available to retirees or their family members; they are open only to active-duty service members and their families living overseas.
Tricare offers comprehensive prescription drug coverage and several options for filling prescriptions overseas. Beneficiaries may fill prescriptions at U.S. military pharmacies, through Tricare Pharmacy Home Delivery, at Tricare retail network pharmacies, or at host-nation pharmacies. Host-nation pharmacies are considered non-network, so you would have to pay the full cost up front and file claims for reimbursement with the TOP claims processor.
Extensive contacts for beneficiaries who are seeking more information about how Tricare works overseas can be found online at www.tricare-overseas.com.
The most complete reference source is the Tricare Overseas Program Handbook. If you put those four words in an online search engine, a downloadable PDF version of the handbook should show up at the top of the results list.
Email questions to tricarehelp@militarytimes.com. Include "Tricare" in the subject line and do not attach files.
