TRICARE Offers Choice of Health Care Plans
By Doug Gillert
American Forces Press Service
WASHINGTON, Apr. 3, 1998 While all active duty service members are enrolled automatically in TRICARE Prime, DoD's managed health care plan offers other eligible beneficiaries two alternatives, Standard and Extra.
Also open to family members and retirees, TRICARE Prime provides the most comprehensive benefits at the lowest cost of the three TRICARE options. Prime guarantees timely access to care. Active duty service members and their families don't pay anything, while retirees and their eligible family members pay $230 a year ($460 total per family).
Family members and retirees visiting specialists outside the military treatment facility must pay $6 or $12, depending on their sponsor's rank. They also must pay $11 a day or a minimum fee of $25 for inpatient care in a civilian hospital, and $9.90 a day for inpatient care in a military hospital.
TRICARE Standard is the new name for CHAMPUS. Anyone eligible for military health care is automatically eligible for Standard. There's no enrollment requirement.
Under Standard, you can select any physician who applies for government reimbursement within the terms of the program. TRICARE service centers can tell you if you'll also need the nonavailability statement sometimes required for civilian inpatient care and outpatient procedures.
Standard's greatest benefit is flexibility in the choice health care professionals. On the downside, it potentially is the most expensive of the three TRICARE options and receives the lowest priority for treatment in military hospitals.
With Standard, the government shares the cost of your health care after you pay a deductible. Deductibles range from $50 per person, E-4s and below, to $300 for two or more persons, E-5 and above. After you pay the deductible, Standard pays 80 percent of approved or allowable costs for outpatient care for active duty families, 75 percent for retirees and their families.
However, medical charges that exceed government-established allowable rates for treatment are your responsibility.
While inpatient rates for active duty families are similar to families under TRICARE Prime, retirees using Standard must pay $360 a day for care in a civilian hospital, or 25 percent of the charges, whichever is less. Retirees also must pay 25 percent of the cost for any separately billed physician and professional fees, which can amount to hundreds of dollars a day.
Retirees and active and retired family members can still get seek care in military hospitals on a space-available basis for about $10 a day. But again, TRICARE Prime patients receive first priority for care.
Retirees can cut their health care costs considerably by upgrading from Standard to Extra. The deductibles are the same for Standard and Extra, but after paying the deductible, retirees and their families pay $250 a day for care in a civilian hospital or 25 percent of daily hospital costs, whichever is less.
Under TRICARE Extra, you can choose civilian physicians and specialists from a network of health care providers. This may be a good option if your physician is already a member of the network or if you live a long way from the nearest military hospital.
If you use a preferred provider under Extra, the government will pay an additional 5 percent of medical costs incurred. Health care providers in the network also agree to charge government-approved rates, so you won't be billed for additional costs over allowable rates, as you would be with Standard.
Each of the three TRICARE options -- Prime, Standard and Extra -- provides a basis for managing health care for you and your family. TRICARE officials urge users to consider their needs carefully before selecting an option and then to talk to a TRICARE service center representative for assistance.
More TRICARE information for patients is available on the Internet at www.ha.osd.mil/hmbi2.html.