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Military Health Care for Dummies

It has been said (and I completely agree) that one of the most important benefits you have earned as a military family is comprehensive health care coverage. It's a benefit most military families expect and undervalue, until it's no longer available.

Our health care system is not exactly easy to navigate and it can be tremendously overwhelming to decipher, especially if you're a new military spouse. The most valued piece of advice I was ever given in regards to the health care system was to remember that I was the one in charge and responsible for my own health (and that of my family, as well). I remember that every time I think a question is silly, or when I have to spend three hours trying to figure out how to get to the specialist I need to see.

I don't know about you, but I get a huge headache from thumbing through the books and browsing the website trying to understand this system. Let's break it down: TRICARE is the Department of Defense's worldwide health care program for active

duty and retired uniformed servicemembers and their families. TRICARE consists of TRICARE Prime, a managed care option; TRICARE Extra, a preferred provider option; and TRICARE Standard, a fee-for-service option.

NOTE: A family member's key to TRICARE eligibility depends on enrollment in the Defense Enrollment Eligibility Reporting System (DEERS). The DEERS record will indicate the dates of eligibility. All uniformed service sponsors (active, reserve, or retired) should ensure that their family status (marriage, death, divorce, new child, etc.) and residential address are current in DEERS, at all times.

The types of TRICARE are listed below:

TRICARE Standard is a basic health care program offering comprehensive coverage. Enrollment is not necessary, it?s automatic. Additionally, TRICARE Standard is not free. Standard requires that you satisfy a yearly deductible before TRICARE cost sharing begins, and you will be required to pay co-payments or cost shares for outpatient care, medications and inpatient care. For most care, Standard beneficiaries make their own appointments with the provider of their choice. Standard beneficiaries often must file their own paperwork claims.

TRICARE Prime is a managed-care option, similar to a civilian HMO (health maintenance organization). Many active-duty family members choose to enroll in Prime. Prime enrollees receive most health care at the MTF (Military Treatment Facility), where their care is supervised by a primary care manager (PCM). For a servicemember's family this means that they will most likely be assigned to the location on the installation nearest to them. The facilities are usually the installation?s hospital or clinic system. At that location they'll receive a PCM that is responsible for their medical care. From personal experience, the medical practitioners I have seen have been civilian contracted. However, I have seen many active-duty members working in these facilities.

As a Prime enrollee you have priority for appointments at the MTF. Prime enrollees must adhere to certain rules regarding their health care. For example, for specialty care enrollees must receive a referral from their PCM and then get an authorization for care from an outside source if that specific type of care is not available in the installation's medical system. Prime enrollees do not deal with paperwork claims; their claims are filed for them by the provider.

TRICARE Prime Remote is for specific geographic locations, and eligibility is based on residence and/or work address. Members must live and work more than 50 miles or approximately one hour's drive time from the nearest MTF. For more information regarding TRICARE Prime REMOTE visit www.tricare.osd.mil/tpr/.

This may apply to a recruiting, ROTC, or other remote assignment. TRICARE Extra is an option that allows Standard beneficiaries to save money by making civilian doctor appointments with doctors (nurse practitioners, labs, clinics, etc.) who are "participating" providers.

As a new military spouse this can all seem very confusing, so I will simplify it:

  • Have your servicemember ensure your DEERS status is correct.
  • Consider the following questions: How close you are to a MTF? Do you want to choose your own doctor or be assigned a PCM? How often do you visit the doctor? Can your family afford additional medical expenses incurred with co-pay and cost sharing? Does your family have any special medical needs?
  • Visit the TRICARE office nearest you or call the TRICARE service center, discuss with them the answers to the previous questions, and enroll in the TRICARE option that is best for your family.

Most TRICARE Service Centers are located inside the Military Treatment Facility.

To be sure, visit www.military.com/benefits/tricare/tricare-service-centers where they have a wonderful clickable map for you to find your nearest location. Of course, I did not even go into other TRICARE options such as dental, vision, and pharmacy. More information can be accessed on all of the options above as well as the additional programs by visiting the main TRICARE website, www.tricare.osd.mil/.

I know that this is a lot of information to process. Take your time and do your research. Consider every option you know to be available and choose what is best for your family's needs. The most valuable attribute that you have on your side is to not be afraid to ask. Ask questions, questions, and more questions until you feel you?re empowered to make the best decision based on the available resources.

Additional TRICARE Resources:

For additional reserve component questions related to healthcare you can also visit www.dod.mil/ra/ under the 'TRICARE' heading.