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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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Previous Chapter: Appendix D: Program Reviews

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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.

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

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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

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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