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For Retired Military and Their Families

TRICARE and Your Health Care Choices


Your Health Care Options*

TRICARE Prime

The TRICARE Prime option provides comprehensive health care for both activeduty and retired military, and their families, who choose to enroll. With this option, most health care will be provided by military hospitals and clinics, augmented by contracted civilian health care networks. TRICARE Prime is similar to health maintenance organization (HMO) programs offered by employers across the U.S. It emphasizes keeping you healthy through preventive care and services such as pap smears, mammograms, and prostate screenings, rather than simply treating you when you become ill. Your total health care will be guided by your primary care manager, who may be a military or civilian provider or perhaps a team of health care professionals who work together to monitor and guide your care. As a TRICARE Prime enrollee you can expect to receive medical appointments quickly and easily- usually the same day, if you are sick. To receive health care in TRICARE Prime, you must enroll in the program for one year. Call your nearest TRICARE Service Center for details.

TRICARE Extra

TRICARE Extra is for eligible retired military and their families who want to seek health care from civilian sources; and who are willing to receive care from doctors and specialists from a select network in the local community. In most cases, health care will be more expensive than with TRICARE Prime. However, for choosing from the TRICARE Extra network of doctors and specialists, you will pay a smaller share of the costs as compared to TRICARE Standard. You are not required to enroll in TRICARE.

Extra. You simply select a doctor from the network and make an appointment. You may also seek care at a military hospital or clinic on a space available basis, but most of these appointments will soon be reserved for TRICARE Prime patients. Call your TRICARE Service Center for more details about TRICARE Extra and to obtain information on available network providers.

TRICARE Standard

Eligible retirees and their family members who wish to have civilian doctors provide their outpatient care may do so under the TRICARE Standard option. This option is the same as the current CHAMPUS program. While it provides the widest choice of providers, it is also the most expensive way to receive health care. However, you are not restricted to a particular group of civilian doctors or specialists. They must agree to file the necessary claim forms in most cases. There is no requirement to enroll in TRICARE Standard. And you may still seek care at a military hospital or clinic on a space available basis. However, that space will be used increasingly for TRICARE Prime patients. Contact your TRICARE Service Center for details, procedures and any treatment restrictions.

* Not currently available to those 65 years and older who are Medicare eligible.


Frequently Asked Questions About Your Military Health Care

Who is eligible for TRICARE?
TRICARE is the health benefits program for all the uniformed services. All active duty members and theirfamilies, retirees and their families and survivors who are not eligible for Medicare may participate. Additionally, those individuals under age 65 who are eligible for Medicare because of disability or end-stage kidney disease may participate.

Why change our health care program?
Since 1987, 35 percent of the military hospitals in the U.S. have closed, with a similar reduction in the number of doctors, nurses and medical technicians in military service. The number of beneficiaries is not shrinking nearly as fast, however. DoD medical leaders needed to find a better way to provide health care, one that efficiently combines military and civilian resources into a seamless system to maintain or improve quality, increase access, and control costs for both patients and taxpayers. TRICARE is that better way.

Which health care option is best for me?
There are many variables you must consider. If available where you live, TRICARE Prime offers the most comprehensive care at the lowest cost. While you will be required to pay an enrollment fee to join (see chart), there are no deductibles. Outpatient care authorized at military hospitals and clinics is without charge, and there is only a small copayment for visits to civilian network providers. The TRICARE Service Center has program experts who will help with your decision.

How can I continue going to a military hospital or clinic?
The best way is to join TRICARE Prime and request a primary care manager at a military hospital or clinic. If so assigned, you will be guaranteed access to your primary care manager at that facility for one year. If not enrolled, you may still be seen on a space-available basis, but that space will be used increasingly for TRICARE Prime patients, who have priority over non-enrolled members. You can obtain an enrollment form by contacting a TRICARE Service Center.

If I require hospitalization, can I get into a military hospital?
All eligible persons may request care at a military hospital. Those enrolled in TRICARE Prime have priority, and others will be admitted only on a space-available basis.

Can I change among the three options?
You must enroll in TRICARE Prime for one year, and receive your care for that period in TRICARE Prime. At the end of that year, you may reenroll, or you may leave Prime and receive care under the TRICARE Extra or Standard options. You may switch between Extra and Standard at any time simply by your choice of providers.

What happens if I am a Prime member and get sick while I'm traveling?
Non-emergency care while away from your primary care manager may be covered provided you receive prior approval. Contact your Primary Care Manager or a Health Care Finder by calling the telephone number on the back of your TRICARE Prime card. TRICARE Prime enrollees who require emergency care should always seek that care at the nearest medical facility, military or civilian. There is no charge for emergency care at any military emergency room. Your share of the cost for civilian hospital emergency room use is $30 per visit.

Do I need supplementalinsurance with TRICARE Prime?
The choice to purchase supplemental insurance must be a personal one. Your decision should be based on the factors that apply to you and your family's specific needs, and what you can afford.

Why are Medicare eligibles age 65 and older not eligible for TRICARE?
Medicare was established to provide health care to individuals age 65 and over. DoD would like to continue treating these patients and has sought legislation for several years that would permit Medicare to reimburse military hospitals and clinics which provide such care. Until legislation is received which would permit the reimbursement of funds from the Medicare program, DoD has no budget to provide routine health care to our most senior retirees, except on a space-available basis. You should sign up for Medicare Part B when eligible.

Do I have to be enrolled in TRICARE Prime to get prescriptions filled at military pharmacies?
No. All those eligible for TRICARE, as well as those retirees now on Medicare, currently may take prescriptions to any military pharmacy and have them filled without charge. Remember that this opportunity is limited to medications carried by the Military Treatment Facility. A mail-order pharmacy service is also provided with TRICARE. Non-Medicare eligible retirees and their families pay $8 per prescription for a ninety day supply.

Where can I get more information?
Call the nearest TRICARE Service Center, or contact the health benefits advisor at a military hospital or clinic.


Health Care Cost Comparisons

Retirees and Their Family Members*

  TRICARE Prime TRICARE Extra TRICARE Standard
Military Hospital/
Clinic
Outpatient - $0;
Inpatient-small daily fee
Space available;
same costs as Prime
Space available;
same costs as Prime
Annual
Deductible
None $150 individual/$300 family $150 individual/$300 family
Annual Enrollment
Fees
$230 individual/$460 family None None
Civilian Outpatient
Visit/Emergency Care
$12
$30
20% of negotiated fee 25% of allowable charge**
Civilian
Inpatient Admission
$11/day
($25 minimum)
$250/day or 25% of hospital
charges; plus 20% of prof. fees

$360/day or 25% of hospital
charges; plus 25% of prof. fees

Prescriptions:      
  MTF $0 $0 $0
  Mail Order $8/90 day prescription $8/90 day prescription $8/90 day prescription
  Civilian Network $9/30 day 20%/30 day 25%/30 day
 
* Not currently available to those 65 years and older who are Medicare eligible.

**Call your TRICARE Service Center for full explanation of TRICARE Standard fees.


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