TRICARE (Medical Coverage)
TRICARE (Medical Coverage).
- TRICARE is the Department of Defense’s health care program – or the military’s equivalent of a medical insurance provider.
- Active Duty Service Member’s are automatically enrolled in the program and receive full medical benefits through a primary care provider at their local military facility.
- Active duty family members and retirees under the age of 65 are also eligible for medical coverage (your family members are eligible from the first day you enter the Army).
- Sponsors must enroll their family members in the program through the local Health Benefits Advisor. (This is an important step – you need to ensure that you have enrolled your family in order for them to receive medical care.)
- There are three TRICARE programs to choose from.
(1) TRICARE Prime.(a) Active duty Soldiers are automatically enrolled in TRICARE Prime (they have no choice), and most sponsors choose this program for their families also.(b) TRICARE Prime is similar to an HMO (Health Maintenance Organization).(c) You and your family members are assigned to a Primary Care Manager (usually in the closest military facility) who will take care of most of your medical needs.(d) He or she will refer you to a specialist if necessary.(e) The great advantage of TRICARE Prime is that almost all of your medical expenses are paid for.(f) However, you must see your Primary Care Manager first for all health care problems.
(2) TRICARE Standard.(a) With TRICARE standard you can choose your own civilian doctor.(b) However, you must pay a yearly deductible (approximately $100 per person) as well as 20% of all medical bills.
(3) TRICARE Extra.(a) Under this plan, you may select from a list of TRICARE-participating civilian doctors.(b) You are responsible for 15% of all medical expenses.
6. Below are a few commonly asked questions about TRICARE.
QUESTION 1: I am a basic training Soldier. My family members are not here with me. How will they get medical care in my hometown?
ANSWER 1: They may enroll in TRICARE Prime if it is available in that area, or they may seek care under TRICARE Extra or TRICARE Standard. The most important step is to talk to the local Health Benefits Advisor to get your family enrolled in your program of choice.
QUESTION 2: What are the costs to enroll my family in TRICARE Prime?
ANSWER 2: There is no cost for active duty family member enrollment in TRICARE Prime. There may be modest payments for in-patient stays at civilian hospitals (around $10 per day) or a cost-share when they are referred to civilian doctors ($6 per visit).
QUESTION 3: If my family and I are away from our local military facility, how do we receive medical care?
ANSWER 3: In an emergency (threat to life, limb, eyesight, or broken bones), simply go to the nearest medical facility (civilian or military). If there is no emergency, contact your primary care manager for approval to see a civilian doctor. This makes it important to keep your Primary Care Manager’s phone number with you when you are on leave or away from your normal military post.