Sea Legs - Health Care

 


Photo of medical worker taking blood from military member

TRICARE is the military health care program serving active duty members, their families, retirees, survivors and certain former spouses worldwide.

As a major component of the Military Health System, TRICARE brings together the health care resources of the uniformed services and supplements them with networks of civilian health care professionals, institutions, pharmacies and suppliers to provide timely access to high-quality health care services while maintaining the capability to support military operations.
The program is available worldwide. It is managed jointly by the Defense Health Agency (DHA) and regional offices. It is broken down into three regions: TRICARE East, West, and Overseas. Visit www.tricare.mil/About/Regions to find your region.

If you are having any TRICARE-related problems, personnel are available to assist you at:

  • TRICARE East – 1 (800) 444-5445
  • TRICARE West - 1 (844) 866-9378
  • TRICARE Overseas – Country specific Toll-Free numbers

Who is Eligible for TRICARE?
TRICARE is available to active duty members and retirees of the seven uniformed services (Army, Air Force, Coast Guard, the National Oceanic and Atmospheric Administration Commissioned Corps, Navy, Marine Corps and U.S. Public Health Service Commissioned Corps), their family members, survivors and others who are registered in the Defense Enrollment Eligibility Reporting System (DEERS). TRICARE is also available to Reserve members and their families. Benefits will vary depending on the sponsor’s military status.

TRICARE beneficiaries can be divided into two main categories: sponsors and dependents (or family members). Sponsors include active duty members, retired service members and Reserve members. Family members are dependent spouses and children who are registered in DEERS. Other eligible beneficiaries include Medal of Honor recipients and their family members, surviving family members and some former spouses.

Under Federal law, if you are eligible for Medicare Part A, you must have Medicare Part B to remain eligible for TRICARE For Life.

What does TRICARE offer?

TRICARE offers its beneficiaries different options for health care coverage that best suits the needs of the individual. While active duty members are required to be enrolled in TRICARE Prime, family members may choose a different option, depending on circumstances such as where they live, health status and preference of health care providers. TRICARE programs for health care coverage are TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas, TRICARE Select, TRICARE Select Overseas, TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE For Life, TRICARE Young Adult and US Family Health Plan.

All of TRICARE’s health plan options meet the requirements for minimum essential coverage under the Affordable Care Act.

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TRICARE Prime

TRICARE Prime is a managed care option offering the most affordable and comprehensive coverage. It is similar to a civilian Health Maintenance Organization (HMO). You must enroll to participate. TRICARE Prime is available in the United States in designated Prime Service Areas. Check your zip code on the TRICARE website to see if you live in a Prime Service Area.
TRICARE Prime provides comprehensive coverage including:

  • Emergency Care
  • Outpatient Visits
  • Preventive Care (wellness exams, immunizations, etc.)
  • Hospitalization
  • Maternity Care
  • Mental/Behavioral Health
  • Prescriptions

When enrolled, you will also receive enhanced preventive care and vision benefits.

With TRICARE Prime you have an assigned primary care manager (PCM), either at a military hospital or clinic or from the TRICARE network, who provides and directs most of your care. Your PCM will refer you to a specialist for care that he or she cannot provide and coordinate with your regional contractor for authorization, find a specialist in the network and file claims on your behalf.

There are time and distance standards for care including wait times for urgent, routine and specialty care.

Active duty service members and their families have no out-of-pocket costs for any type of care as long as care is received from the PCM or with a referral. All other beneficiaries pay annual enrollment fees and network co-payments.

If you are an active duty member or an activated reservist, you must enroll in TRICARE Prime. All other eligible beneficiaries have the option to enroll or use TRICARE Select. TRICARE Prime offers fewer out-of-pocket costs than TRICARE Select, but less freedom of choice for providers as you must select a provider from the network.

For more information visit: https://tricare.mil/Plans/HealthPlans/Prime

TRICARE Prime is a managed care option.TRICARE Prime Remote

TRICARE Prime Remote is a managed care option that provides the benefits of TRICARE Prime in designated remote locations. You must enroll to participate.

TRICARE Prime Remote is available to the following beneficiaries who live and work in designated remote locations:

  • Active duty service members
  • Active duty family members who live with TRICARE Prime Remote enrolled sponsors
  • Activated Reserve members
  • Family members of activated Reserve members who live with TRICARE Prime Remote enrolled sponsors.
  • Surviving family members of deceased active duty members. TRICARE Prime Remote is not available to surviving spouses three years after the sponsor’s death, but children may remain enrolled.

Once enrolled in TRICARE Prime Remote, you may select a PCM from the TRICARE network. If a network provider is not available, you may select any authorized, non-network provider as your PCM. All other TRICARE Prime rules and conditions apply.

For more information visit: https://tricare.mil/Plans/HealthPlans/TPR.

TRICARE Prime Overseas
TRICARE Prime Overseas is a managed care option for active duty members and their command-sponsored family members living together in non-remote overseas locations. Enrollment is required to participate.

TRICARE Prime Overseas is available to the following beneficiaries:

  • Active duty service members
  • Command-sponsored active duty family members
  • Activated Reserve members
  • Command-sponsored family members of activated Reserve members

For more information visit: https://tricare.mil/Plans/HealthPlans/TPO.

TRICARE Prime Overseas Remote
TRICARE Prime Overseas Remote is a managed care option in designated remote overseas locations for active duty members and their command-sponsored family members.

TRICARE Prime Overseas Remote is available to the following beneficiaries:

  • Active duty service members
  • Command-sponsored active duty family members
  • Activated Reserve members
  • Command-sponsored family members of activated Reserve members

The designated remote locations are:

  • Eurasia-Africa
  • Latin America and Canada
  • Pacific

For more information visit: https://tricare.mil/Plans/HealthPlans/TPRO.

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TRICARE Standard and Extra is a fee-for-service plan available to all non-active duty beneficiaries throughout the United States.TRICARE Select

TRICARE Select is a fee-for-service plan available to all non-active duty beneficiaries throughout the United States. Enrollment is required.

TRICARE Select enrollees may schedule appointments with any TRICARE authorized provider, network or non-network. Referrals are not required, but you may need prior authorization from your regional contractor for some services.
Costs vary based on the sponsor’s military status. After you have met an annual deductible, you are responsible to pay a cost share (or percentage) for covered services.

TRICARE Select Overseas

TRICARE Select Overseas provides comprehensive coverage in all overseas areas. Enrollment is required. Coverage is automatic as long as your information is current in DEERS. For more information visit: https://tricare.mil/Plans/HealthPlans/TSO.

TRICARE Reserve Select
TRICARE Reserve Select is a premium-based plan that qualified Selected Reserve members in the Ready Reserve and their family can purchase. TRICARE Reserve Select is available to the Selected Reserve members of the Ready Reserve (and their families) who meet the following qualifications:

  • Not on active duty orders
  • Not covered under the Transitional Assistance Management Program (TAMP)
  • Not eligible or enrolled in the Federal Employees Health Benefits (FEHB) Program, either under their own eligibility or through another family member.

TRICARE Reserve Select is very similar to the TRICARE Select. Since beneficiaries are required to pay premiums, failure to pay on time may result in
dis-enrollment and possible enrollment lockout.

For more information visit: https://tricare.mil/Plans/HealthPlans/TRS.

TRICARE Retired Reserve

TRICARE Retired Reserve is a premium-based plan that qualified retired Reserve members, their families and survivors can purchase.
TRICARE Retired Reserve is available to the following beneficiaries who are:

  • Retired members of a Reserve component who are qualified for non-regular retirement under 10 USC, Chapter 1223
  • Under the age of 60
  • Not eligible for or enrolled in, the Federal Employees Health Benefits (FEHB) Program

For more information visit: https://tricare.mil/Plans/HealthPlans/TRR.

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TRICARE For Life

TRICARE For Life offers secondary coverage to Medicare for all beneficiaries who have both Medicare Part A and B. TRICARE For Life is available worldwide. Medicare provides coverage in the U.S. and U.S. Territories. In all other overseas locations, TRICARE is the primary payer.

You may visit any authorized provider. Your provider will file your claims with Medicare. Medicare pays its portion and electronically forwards the claim to TRICARE For Life claims processor. TRICARE For Life then pays the provider directly for TRICARE-covered services. For services covered by both Medicare and TRICARE, Medicare pays first and TRICARE For Life pays your remaining coinsurance for TRICARE-covered services. For services covered by TRICARE but not by Medicare, TRICARE For Life pays first and Medicare pays nothing. You must pay the TRICARE fiscal year deductible and cost shares. For service covered by Medicare but not by TRICARE, Medicare pays first and TRICARE For Life pays nothing. You must pay the Medicare deductible and coinsurance. For services not covered by Medicare or TRICARE, Medicare and TRICARE pay nothing and you must pay the entire bill.

You do not pay any enrollment fees, but you must pay Medicare Part B monthly premiums. Your Part B premium is based on your income.

For more information visit: https://tricare.mil/Plans/HealthPlans/TFL.

TRICARE Young Adult
TRICARE Young Adult is a plan that qualified adult children can purchase after eligibility for “regular” TRICARE coverage ends at age 21 (or 23 if enrolled in college).

You may qualify to purchase TRICARE Young Adult if you are:

  • An unmarried, adult child of an eligible sponsor. Eligible sponsors include:
    • Active duty service members
    • Retired service members
    • Activated Reserve members
    • Non-activated Reserve members using TRICARE Reserve Select or Retired Reserve members using TRICARE Retired Reserve
  • At least 21 years of age but not yet 26 years old
    • If enrolled in a full course of study at an approved institution of higher learning and your sponsor provides more than 50 percent of your financial support, your eligibility may not begin until age 23 or upon graduation, whichever comes first.
  • Not eligible to enroll in an employer-sponsored health plan based on your own employment
  • Not otherwise eligible for TRICARE coverage

TRICARE Young Adult provides medical and pharmacy benefits, but dental coverage is excluded. TRICARE Young Adult costs are based on three things:

  • The option you select when you enroll: Prime or Standard
  • Your sponsor’s military status
  • Where the care is received

To participate you are required to pay monthly premiums and then your plan option and sponsor’s military status determine what you pay out-of-pocket for care.

For more information visit: https://tricare.mil/Plans/HealthPlans/TYA.

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US Family Health Plan

The US Family Health Plan is an additional TRICARE Prime Option available through networks of community-based, not-for-profit health care systems in six areas throughout the United States.

The US Family Health Plan is available to the following beneficiaries who live in a designated US Family Health Plan area:

  • Active duty family members
  • Retired service members and their family (until Medicare eligible)
  • Family members of activated Reserve members
  • Non-activated Reserve members and their families who qualify for care under the Transitional Assistance Management Program
  • Retired Reserve members (age 60 and receiving retired pay) and their families
  • Survivors
  • Medal of Honor recipients and their families
  • Qualified former spouses

The six designated US Family Health Plan Providers and their associated areas are:

  • Johns Hopkins Medicine
    • Maryland
    • Washington, DC
    • Parts of Pennsylvania, Virginia, Delaware and West Virginia
  • Martin’s Point Health Care
    • Maine
    • New Hampshire
    • Vermont
    • Upstate and Western New York
    • Northern Tier of Pennsylvania
  • Brighton Marine Health Center
    • Massachusetts, including Cape Cod
    • Rhode Island
    • Northern Connecticut
  • St. Vincent Catholic Medical Centers
    • New York City
    • Long Island
    • Southern Connecticut
    • New Jersey
    • Philadelphia and area suburbs
  • CHRISTUS Health
    • Southeast Texas
    • Southwest Louisiana
  • Pacific Medical Centers (PACMED Clinics)
    • Puget Sound area of Washington state

Active duty family members pay no enrollment fees and no out-of-pocket costs for any type of care as long as care is received from the US Family Health Plan.

For more information visit: https://tricare.mil/Plans/HealthPlans/USFHP.

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Special Programs

TRICARE offers supplemental programs tailored specifically to beneficiary health concerns or conditions. Some programs have specific eligibility requirements based on beneficiary category, plan or status. Some programs are for specific beneficiary populations while others offer services for specific health conditions. Some programs are limited to a certain number of participants or a certain geographic location. To find out if you are eligible and to learn more, visit www.tricare.mil/Plans/SpecialPrograms.aspx.

TRICARE Pharmacy Benefit
TRICARE’s pharmacy benefit is available to all eligible uniformed service members, retirees and family members, including beneficiaries age 65 and older. The TRICARE Pharmacy Program provides outpatient prescription drugs to more than 9.6 million individuals.

Express Scripts, Inc. (Express Scripts), who administers the TRICARE pharmacy benefit, provides home delivery, retail and specialty pharmacy services.

The TRICARE Pharmacy Program is designed to provide the medications you need, when you need them, in a safe, convenient and cost-effective manner. The program’s three objectives are to:

  • Provide a uniform, effective and efficient benefit: TRICARE provides with several pharmacy options. The TRICARE Pharmacy Program Handbook contains more information on:
    • Military treatment facility pharmacies
    • TRICARE Pharmacy Home Delivery
    • TRICARE retail network pharmacies
    • Non-network retail pharmacies
  • Encourage TRICARE Pharmacy Home Delivery use: TRICARE Pharmacy Home Delivery is the least expensive option when not using a military treatment facility pharmacy. You can receive up to a 90-day supply of maintenance medications delivered directly to your home. The Member Choice Center is available at 1-877- 363-1433 to help you switch prescriptions to the convenient, cost-effective home delivery option.
  • Promote patient safety: All prescriptions dispensed through military treatment facilities, TRICARE Pharmacy Home Delivery and retail network pharmacies are rigorously checked for accuracy and against your TRICARE prescription history for potential drug interactions.

The TRICARE retail pharmacy network includes most of the major national chains, over 100 regional chains and more than 20,000 independent community pharmacies. If you are unsure if your current pharmacy is a TRICARE retail network pharmacy, please ask your pharmacist.

For more information, refer to this TRICARE Pharmacy Program Handbook. You can also visit www.tricare.mil/pharmacy or www.express-scripts.com/TRICARE/ or call 1-877-363-1303.

TRICARE Catastrophic Cap Benefit
The TRICARE catastrophic cap limits the amount of out-of-pocket expenses a family will have to pay for TRICARE-covered medical services. The catastrophic cap is $1,000 total for active duty families and $3,000 per family for all other beneficiaries. After the family meets the catastrophic cap, TRICARE will pay the beneficiaries’ portion of the TRICARE- allowable amount for all covered services for the rest of the fiscal/enrollment year.

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TRICARE Dental ProgramActive duty members are provided no cost dental care through their local Military Treatment Facility.

Dental coverage is separate from TRICARE’s medical coverage. The TDP is a voluntary dental program. The dental benefit is available to eligible active duty family members, National Guard and Reserve members and their family members. Additional information is available on page 25 and at www.tricare.mil/dental/.

The Federal Employee Dental and Vision Insurance Program (FEDVIP)

Family members of active duty service members who are enrolled in a TRICARE Health Plan can enroll in a FEDVIP vision plan.

Additional information is available at https://tricare.benefeds.com/.