TRICARE for Military Families | Standard | Extra | Prime

TRICARE is the health care program serving active duty service members, National Guard and Reserve members, retirees, their families, survivors and certain former spouses worldwide. As a major component of the Military Health System, TRICARE brings together the health care resources of the uniformed services and supplements them with networks of civilian health care professionals, institutions, pharmacies and suppliers to provide access to high-quality health care services while maintaining the capability to support military operations.

When it comes to TRICARE, many military families are faced with the decision: choose a TRICARE option with little to no outside costs but with limitations on your healthcare choices imposed by the HMO; or choose another TRICARE program with more flexible choices in healthcare providers, but only covering 80% of your military family's medical expenses.

Some military members can feel like they have to choose between the lowest cost for their healthcare, or more freedom of choice in healthcare providers. There is a way to get both from your TRICARE benefits: you can choose a TRICARE supplement program (TRICARE Supplemental Insurance Program).

Let's Review the TRICARE Basics

TRICARE Standard

No annual enrollment fee to participate in TRICARE STANDARD.
TRICARE STANDARD is the name for the health care option formerly known as CHAMPUS (Civilian Health and Medical Program of the Uniformed Services).

With TRICARE STANDARD, eligible beneficiaries have the greatest flexibility in choosing a health care provider and the government will pay a percentage of the cost. It is chosen most often by individuals and families who have established relationships they wish to maintain with civilian physicians.

TRICARE Standard pays a share of the cost of covered health care services from a non-network civilian health care provider. After the TRICARE deductible has been met, TRICARE Standard will cost share the allowable charges for outpatient services and supplies for active duty families.

With TRICARE Standard you never have to get HMO approvals for seeing specialists; you never need permission before taking your children to see the doctor; no referrals from a primary health care manager are required; and you don't have to go to a military treatment facility.

TRICARE Extra

No annual enrollment fee to participate in TRICARE EXTRA.
TRICARE Extra is a Preferred Provider Organization (PPO). With TRICARE Extra, you choose from a network of civilian doctors and military providers, and receive a discount through cost sharing. You may use TRICARE Extra whenever you want.

TRICARE Prime

Annual enrollment fee of $282.60 per person or $565.20 per family.
TRICARE PRIME is a voluntary "HMO-type" plan where Military Treatment Facilities (MTFs) are the principal source of health care. All active duty service members are automatically enrolled in Prime. You and your family enroll yearly, and receive your medical care from a specified network of civilian and military healthcare providers.

Now, if you want to retain maximum flexibility and choice and still get maximum cost coverage, there is one more option that can take TRICARE Standard to the next level: add a TRICARE supplemental insurance policy to your TRICARE Standard.

TRICARE with a TRICARE Supplement

With a TRICARE supplement program, a trip to the doctor means TRICARE Standard covers 75% of that doctor's fee, while your TRICARE supplemental insurance picks up the remaining 25% - and you're 100% covered. Once you reach the Supplement Plan deductible, there are simply no further costs while your supplemental insurance kicks in to cover your balances.

Supplemental insurance always pays after TRICARE pays. So, after your TRICARE insurance plan pays its portion of the bill, the supplemental insurance pays your provider direct or reimburses you, the TRICARE beneficiary, for out-of-pocket medical expenses you have will have paid to civilian providers to cover their charges.

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