Substance Use Disorders in the U.S. Armed Forces (2013)

Chapter: Appendix E: Features of TRICARE and Related Purchased Care Plans

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Suggested Citation: "Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Appendix E

Features of TRICARE and Related Purchased Care Plans

TRICARE Prime

  • Health maintenance organization
  • Active duty service members automatically enrolled
  • Some other beneficiary groups can choose to enroll
  • Some groups have annual enrollment costs
  • Based on a managed care model with an assigned primary care manager and referrals for specialty care
  • Limited co-payments for some beneficiary groups

TRICARE Standard

  • Fee-for-service for non–active duty beneficiaries
  • Does not require pre-enrollment
  • No annual enrollment costs
  • Beneficiary has most options for provider selection
  • Provider can charge usual fees
  • Benefit is a percentage of billed charges after an annual deductible
  • No referrals, some preauthorization
  • Does not require use of network

TRICARE Prime Remote

  • Similar to TRICARE Prime
  • For beneficiaries 50 miles or an hour’s drive from a military treatment facility
  • Primary care manager selected from TRICARE civilian provider network
  • Referrals for specialty care
  • Limited to active duty service members and their dependents

TRICARE Extra

  • Preferred provider organization
  • Fee-for-service plan for non–active duty beneficiaries
  • Does not require pre-enrollment
  • No annual enrollment costs
  • Beneficiary chooses authorized TRICARE provider
  • Benefit is a percentage of allowable charges after an annual deductible
  • No referrals, some preauthorization
Page 358 Cite Bookmark
Suggested Citation: "Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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TRICARE Prime Overseas

  • Similar to TRICARE Prime when near an overseas military treatment facility
  • Requires enrollment
  • Limited to active duty service members and their Command-sponsored dependents who are living together in a nonremote overseas location (near a military treatment facility)
  • Primary care managers are assigned and make referrals for specialty care

TRICARE for Life

  • Medicare “wraparound”
  • Authorized in 2001 for Medicare beneficiaries who also were eligible for TRICARE benefits (generally retirees and their dependents)
  • Requires Medicare Parts A and B
  • Generally no out-of-pocket expenses

TRICARE Prime Remote Overseas

  • Provides TRICARE-like benefits for active duty service members and their dependents living in remote overseas locations (distant from a military treatment facility)
  • Requires enrollment to participate
  • Divided into Eurasia-Africa, Latin America, and Pacific regions
  • Requires primary care managers who also makes referrals
  • Coordinated by International SOS, a civilian corporation that coordinates overseas health care for DoD

TRICARE Plus

  • New program that allows TRICARE Extra and TRICARE for Life beneficiaries to enroll at a military treatment facility and receive their primary care there
  • No enrollment fees
  • Not all military treatment facilities participate

U.S. Family Health Plan for Non–Active Duty Beneficiaries

  • TRICARE Prime managed care option that evolved from the old Marine Hospital System/Public Health Service Hospitals in the early 1980s
  • Managed by six health care organizations
  • Available to beneficiaries in selected areas of the northeast United States, Washington State, southeast Texas, and southwest Louisiana

TRICARE Young Adult

  • Program for eligible dependents aged 21 (or 23 if enrolled in college full time) to 26 originating in the 2010 Patient Protection and Affordable Care Act

TRICARE Reserve Select

  • Premium-based health plan available to Selected Reserve members of the Ready Reserve (and their dependents) who are not eligible for or enrolled in the Federal Employee Health Benefits program
  • Requires cost sharing
  • No referrals, some preauthorization

Civilian Health and Medical Program of the Uniformed Services

  • Predecessor of TRICARE; began in 1966
  • DoD secretary was authorized to contract with civilian providers to provide health care, primarily to non–active duty beneficiaries
Page 359 Cite Bookmark
Suggested Citation: "Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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TRICARE Reserve Retired

  • For certain retired Reserve members under age 60
  • Premium-based worldwide health plan that may be purchased by qualified Reserve members and survivors
  • Covers member and dependents
  • Provides choice of providers although out-of-pocket costs vary
  • No referrals, some preauthorization

Federal Employee Health Benefits Program

  • Overall health insurance program available to federal civilian employees
  • Includes various options with a number of insurance carriers
  • Premium-based
Page 360 Cite Bookmark
Suggested Citation: "Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Page 357 Cite Bookmark
Suggested Citation: "Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Page 357
Page 358 Cite Bookmark
Suggested Citation: "Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Page 358
Page 359 Cite Bookmark
Suggested Citation: "Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Page 359
Page 360 Cite Bookmark
Suggested Citation: "Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Page 360
Next Chapter: Appendix F: Workforce Standards for Substance Use Disorder (SUD) Care
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