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Understanding TRICARE

TRICARE outline

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!

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

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);

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.

Eligible Active Duty, Guard and Reserve Family Members:
Service	TRICARE Prime	TRICARE Extra	TRICARE Standard
Annual Deductible	None	$150/person or $300/fam for E-5 & above $50/$100 for E-4 & below	$150/individual or $300/family for E-5 & above; $50/100 E-4 below
Annual Enrollment Fee	None	None	None
Civilian Outpatient Visit	No Cost	15% of negotiated fee	20% of allowed charges for covered service
Civilian Inpatient Admission	No Cost	Greater of $25 or $13.90/day	Greater of $25 or $13.90/day
Civilian Inpatient Mental Health	No Cost	$20/day	$20/day
Civilian Inpatient Skilled Nursing Facility Care	$0 per diem charge per admission. No separate co-payment/cost-share for separately billed professional charges	$11/day ($25 minimum) Charge per admission	$11/day ($25 minimum) Charge per admission

**Retirees (under 65), Their Family Members, and Others**
Retirees (under 65), Their Family Members, and Others	TRICARE Prime	TRICARE Extra	TRICARE Standard
Annual Deductible	None	$150/individual or $300/family	$150/individual or $300/family
Annual Enrollment Fee	$230/individual $460/family	None	None
Civilian Co-pays	No Cost	20% of negotiated fee	25% of allowed charges for covered service
Outpatient Emergency Care Mental Health Visit	$12 $30 $25 $17 (group visit)	N/A	N/A
Civilian Inpatient Cost Share	$11/day ($25 minimum) Charge per admission	Lesser of $250/day or 25% of negotiated charges plus 20% of negotiated professional fees	Lesser of $512/day or 25% of billed charges plus 25% of allowed professional fees
Civilian Inpatient Skilled Nursing Facility Care	11/day ($25 minimum) charge per admission	$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	25% cost-share of allowed charges for institutional services, plus 25% cost-share of allowable for separately billed professional charges.
Civilian Inpatient Mental Health	$40 per day	20% of institutional & negotiated professional fees	Lesser of $169/day or 25% of allowable fees

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:

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 .

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