You're eligible for TRICARE if you
are:
- On active duty or an activated member
of the National
Guard or Reserve. (Automatically Enrolled)
- A spouse or unmarried child of an active
duty service member.
- A uniformed service retiree, or their
spouse, or unmarried child.
- An un-remarried former spouse and unmarried
children of active duty or retired service
members who have died.
- A spouse or unmarried child of Reservist
and National Guard servicemember who
are ordered to active duty for more than
30 consecutive days.
Click here for more details on TRICARE
Eligibility
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Understanding TRICARE
Do you understand your TRICARE benefits? Do you know if you are enrolled
in the TRICARE coverage plan that best suits your family's needs?
Are you completely confused by all the TRICARE coverage options, co-pays,
deductibles, and acronyms?
If so you are not alone, our surveys have found that most servicemembers
and their families are confused by TRICARE. The fact is, TRICARE is
a enormous and very complex health care system.
We can help clarify many of your questions and concerns. You owe it
to yourself and your family to find out as much as you can about TRICARE
before making any decisions! The following provides a summary of this complex program:
The Facts
TRICARE is a regionally managed health care program for Active Duty,
Activated Guard and Reserves, Retired members of the uniformed services,
their families, and survivors. TRICARE brings together the health
care resources of the Army, Navy and Air Force and supplements them
with networks of civilian health care professionals to provide better
access and high quality service while maintaining the capability to
support military operations.
Active Duty and Guard and Reserve servicemembers are automatically
enrolled TRICARE Prime. However military dependents and retirees must
choose the TRICARE option that best suits their needs.
TRICARE has three main coverage choices for health care:
- TRICARE
Prime - where Military Treatment Facilities (MTFs) are the
principal source of health care.
- TRICARE
Extra - a preferred provider option that saves money; and
- TRICARE
Standard - a fee-for-service option (the original CHAMPUS
program);
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Take Advantage!
If you are required to pay an enrollment fee, you should pay it annually, not quarterly. Under the present billing system, if you pay annually there's less chance of a billing and claims payment problem. Get more insider tips on your benefits with The Military Advantage, a must-have guide for servicemembers, veterans and families.
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Making the Choice
Your main challenge will probably be deciding which TRICARE option,
Prime, Extra or Standard, is best for you. The following tables provide
examples of cost-shares or copayments for families who use civilian
providers and facilities under each of the three TRICARE options.
The listed fees are subject to change.
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Eligible Active Duty, Guard and Reserve Family Members:
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TRICARE
Prime |
TRICARE
Extra |
TRICARE
Standard |
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Annual
Deductible |
None |
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$150/individual
or $300/family for E-5 & above; $50/$100 for E-4 & below
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$150/individual
or $300/family for E-5 & above; $50/100 E-4 below |
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Annual
Enrollment Fee |
None |
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None |
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None |
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Civilian
Outpatient Visit |
No cost |
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15%
of negotiated fee |
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20%
of allowed charges for covered service |
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Civilian
Inpatient Admission |
No cost |
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Greater
of $25 or $13.90/day |
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Greater
of $25 or $13.90/day |
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Civilian
Inpatient Mental Health |
No cost |
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$20/day |
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$20/day |
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Civilian
Inpatient Skilled Nursing Facility Care |
$0 per
diem charge per admission
No separate co-payment/cost-share for separately billed
professional charges |
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$11/day
($25 minimum) Charge per admission |
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$11/day
($25 minimum) Charge per admission |
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Retirees
(under 65), Their Family Members, and Others
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TRICARE
Prime |
TRICARE
Extra |
TRICARE
Standard |
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Annual
Deductible |
None |
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$150/individual
or
$300/family |
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$150/individual
or
$300/family |
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Annual
Enrollment Fee |
$230/individual
$460/family |
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None |
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None |
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Civilian
Co-pays
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20% of
negotiated
fee |
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25%
of allowed charges for covered service |
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Outpatient
Emergency Care
Mental Health Visit |
$12
$30
$25
$17 (group visit) |
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Civilian
Inpatient
Cost Share |
$11/day
($25 minimum) Charge per admission |
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Lesser
of $250/day or 25% of negotiated charges plus 20% of
negotiated professional fees |
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Lesser
of $512/day or 25% of billed charges plus 25% of allowed
professional fees |
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Civilian
Inpatient Skilled Nursing Facility Care |
$11/day
($25 minimum) charge per admission |
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$250
per diem co-payment or 20% cost-share of total charges,
whichever is less, institutional services, plus 20%
cost-share of separately billed professional charges
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25%
cost-share of allowed charges for institutional services,
plus 25% cost-share of allowable for separately billed
professional charges. |
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Civilian
Inpatient Mental Health |
$40 per
day |
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20%
of institutional & negotiated professional fees |
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Lesser
of $169/day or 25% of allowable fees |
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TRICARE has many other programs including
TRICARE for Life, TRICARE Dental, etc... For more information see
our TRICARE
section, or click on the links below to learn more
about:
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Take Advantage! |
 Get more insider tips on your benefits with The Military Advantage, a must-have guide for servicemembers, veterans and families. |
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If you aren't sure whether TRICARE covers a service or supply, contact
your Beneficiary
Counseling and Assistance Coordinator (BCAC), Health
Benefits Advisor (HBA),
TRICARE Support Center (TSC), or your TRICARE contractor. They
can advise you about covered services, but they can't guarantee payment
by TRICARE. If you're enrolled in TRICARE Prime, be sure to see your
Primary Care Manger (PCM) for a referral before getting any type of
civilian specialized medical care.
The applicable Federal laws and 32 CFR Part 199 are the final word
on any TRICARE issue. If any difference exists among this handbook,
what anybody tells you, and the law and regulation, it's the law and
regulation that apply (32 CFR 199 is on the Military Health System/TRICARE
web site at www.tricare.osd.mil.
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TRICARE Important Telephone Numbers
- TRICARE For Life Program 1-888-DOD-LIFE (1-888-363-5433)
- Pharmacy Program 1-877-DoD-MEDS (1-877-363-6337)
- National Mail Order Pharmacy 1-888-DOD-CARE (1-800-903-4680)
- TRICARE Prime Remote 1-888-363-2273
- TRICARE Dental Program 1-800-866-8499
- TRICARE Retiree Dental Program 1-888-838-8737
- Active Duty Claims (Military Medical Support Office)
1-800-876-1131
- For general information about TRICARE, you can call the toll-free
TRICARE information line: 1-877-DoD-MEDS (1-877-363-6337).
Hearing or speech-impaired beneficiaries may call TTY/TDD at 1-877-535-6778.
You can call Monday through Friday 8:00 a.m.-11:00 p.m., Saturday
9:00 a.m.-8:00 p.m. and Sunday 10:00 a.m.-5:30 p.m. (closed on
holidays).
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