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Health Care Plans
TRICARE offers 10 plans, including Prime, Extra and Standard. TRICARE Prime provides the lowest cost coverage and offers benefits for participants under the age of 65. Prime participants receive the majority of their health care services from military health care facilities. The plan does not require enrollment fees and participants pay no health care costs when receiving services from their assigned health care provider. TRICARE Extra is a preferred provider organization plan. Extra participants can receive services within a network of health care providers but must pay deductibles and copayments for services. TRICARE Standard offers fee-for-service coverage, which includes deductibles and copayments, that allows participants to receive services from any health care providers approved by TRICARE. Active duty service members cannot obtain coverage under TRICARE Standard but can select the plan for their family members. As of January 2011, deductibles for TRICARE Standard and Extra cost approximately $150 for individuals and $300 for families. Copayments typically range from $12 to $25.
Depending on the plan selected, TRICARE benefits can include emergency care, ambulance services, dental care, hospital care, maternity services, eye exams and medical exams. Members can also receive certain services for alternative treatments, such as acupuncture. TRICARE also offers special programs to address health issues such as
smoking, alcohol abuse and obesity. TRICARE members with specific medical issues can participate in programs such as clinical trials for cancer patients, chiropractic programs and autism services. Special program can be limited by geographic area or number of enrollees.
TRICARE provides prescription drug benefits with every plan and offers four options for participants to choose from when filling prescriptions: military pharmacy, retail network, home delivery and non-network pharmacy. Participants who fill prescriptions at military pharmacies pay no copayments and those who use home delivery or retail network pharmacies pay between $3 and $22. TRICARE only recommends using non-network pharmacies when other options are not available, as costs are higher.
Each military branch determines eligibility for service members. Upon meeting eligibility requirements, services members are entered into the Defense Enrollment Eligibility Reporting System (DEERS). Members of the service must appear in the DEERS database to qualify for TRICARE. Qualified servicemen must enroll members of their families in order for them to receive benefits too. All active duty military members qualify for TRICARE. Reserve and National Guard members can obtain dental benefits when not on active duty, but typically do not qualify for full TRICARE coverage. When called to duty for over 30 days, Reserve and National Guard members receive benefits under TRICARE Prime.