TRICARE, the Department of Defense’s health care system for active duty and retired uniformed services members, their families, and survivors, serves over nine million beneficiaries worldwide. TRICARE combines military health care resources and civilian health care providers authorized by TRICARE to receive reimbursement. Authorized civilian providers include:
- Network providers: those who have negotiated discount agreements with TRICARE
- Participating providers: those non-network providers who have agreed to accept TRICARE allowable charges as payment in full
- Non-participating providers: those who do not accept TRICARE allowable charges as payment in full; they may charge patients up to 15% more than the allowed charges, as well as require patients to file their own claims and wait for reimbursement
In military hospitals, clinics, and health care facilities worldwide, active duty service members from any of the seven uniformed services—Army, Air Force, Navy, Marine Corps, Coast Guard, Public Health Service, and the National Oceanic and Atmospheric Administration—have priority for care.
Within the United States, TRICARE is organized into three geographic health care service regions—North, South, and West. Each region is administered by a TRICARE Regional Office, with support from civilian health care contractors who are selected through a competitive procurement process. Each TRICARE region offers the same choices for health care plans and coverage. TRICARE beneficiaries living overseas have fewer options. The TRICARE Web site has links to Web sites for North, South and West regions, plus contact information for TRICARE overseas regions—Pacific, Europe, Canada/Latin America, and Puerto Rico/Virgin Islands.
TRICARE Program Options for Active Duty Family Members
TRICARE offers three health care options to family members of active duty service members living in the US and certain overseas location. They vary according to cost, flexibility, and availability. Family members with special needs may receive care under one of these TRICARE options. TRICARE beneficiary eligibility status is determined by the Services and maintained in the Defense Enrollment Eligibility Reporting System (DEERS).
TRICARE Prime is a managed care option similar to a civilian health maintenance organization. Beneficiaries receive their care from a Military Treatment Facility (MTF), or through the Regional contractor’s provider network. TRICARE Prime is the only option for active duty service members, and it is the only option that requires enrollment by its users. Active duty family members enrolled in TRICARE Prime pay no fees, deductibles, or co-payments for authorized medical services, emergency care MTF care and other care authorized by their Managed Care Support Contractor. Family members living with their active duty service members in locations that are at least 50 miles or one hour from the nearest MTF may enroll in TRICARE Prime Remote for Active Duty Family Members.
TRICARE Extra is a preferred-provider option that allows active duty family members to receive care from the network of providers with whom TRICARE has negotiated discounted costs. Beneficiaries are responsible for paying cost-shares for services after annual deductibles have been met. There are no claims to file, but the choice of providers is limited to those in the network. Active Duty service members cannot use TRICARE Extra, and it is not available overseas.
Formerly known as CHAMPUS, TRICARE Standard is a fee-for-service option that allows active duty family members to receive care from any TRICARE-authorized provider. Beneficiaries are responsible for paying cost-shares after annual deductibles have been met. Cost shares are five percent higher than with TRICARE Extra. However, Standard can be used simultaneously with Extra, and beneficiaries who use a network provider will have their claims adjudicated under Extra. By visiting a non-network provider, they will incur greater out of pocket expenses and may have to file their own claims. TRICARE Standard provides the broadest choice of providers and may be the only option available to family members in some locations. Active duty service members cannot use TRICARE Standard.