Navigating through the myriad of healthcare options can be intimidating even to the most seasoned military family. Learn more about the available plans and benefits of Tricare to help you choose the coverage that will best meet your family’s specific medical needs.
Tricare Prime offers low cost, comprehensive coverage to Uniformed Service members, retirees and their families. Available services include doctor visits, emergency care, inpatient and outpatient services, diagnostic testing, prescriptions and access to specialists. This plan operates much like a civilian HMO (Health Management Organization) in that a primary care manager (PCM), or physician, is selected from a listing of network providers and oversees all medical care for the Tricare member. Specialized care may be accessed through a referral from the primary care physician.
Active duty service members are automatically enrolled in Tricare Prime and coverage may be extended to include a spouse and dependent children by enrollment. No enrollment fee or premium is required for active duty service members or their families. In addition, there are no out-of-pocket expenses incurred by the Tricare Prime member provided that medical services are received by in-network providers or through a military treatment facility. This means no co-pays for doctor or hospital visits and free prescriptions.
Enrollment in Tricare Prime is also available to retirees and their spouses and dependent children, as well as eligible ex-spouses of military members. There are some costs associated with enrollment for these Prime members. Annual enrollment is $230 for an individual (ex-spouse or retiree) and $460 for families (current spouse and dependent children). Nominal out-of-pocket expenses do apply for medical services. As of 2010, Prime members (except for active duty and families) are responsible for a $12 co-pay for in-network doctor’s visits and $30 for emergency care.
Health care through Tricare is administered by regional contractors based on your current state of residence. Humana Military Healthcare administers Tricare health services for the southern region of the United States, while Healthnet Federal serves the northern portion of the country. Coverage for Tricare members who reside in the western half of the U.S.is administered by Tri-west Healthcare Alliance. These contractors serve as your point of contact following enrollment in Tricare. The regional contractor can help you change your plan or your physician and provides assistance with services available in your area.
Military members and families must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) prior to enrollment in any Tricare health plan. DEERS is the government’s database of all uniformed service members (including active, reserve, or retired members) and their families. This system is directly related to available military benefits such as Tricare. Incorrect or outdated information regarding the member’s service status or contact information may affect eligibility for Tricare Prime. Keep your information current with DEERS to avoid a lapse in coverage or delays in medical care by contacting or visiting the nearest identification card facility (Pass and ID building).
Tricare Prime Handbook, Tricare