Which TRICARE Option Is Right for You?
By Douglas J. Gillert
American Forces Press Service
WASHINGTON, June 12, 1998 With TRICARE now up and running worldwide, every eligible DoD health care beneficiary has to answer one question: Which care option is right for me?
The DoD health plan offers three primary choices: Prime, Extra and Standard. Under these exist various other options, but your first choice has to be one of these three. If you're an active duty service member, you are automatically enrolled at no cost in TRICARE Prime. If you're an active duty family member, military retiree or retiree family member, you must enroll to get into Prime. If you don't select the Prime option, you still can use any combination of benefits under Extra and Standard. Neither requires enrollment.
Health care officials said you should consider carefully each option before deciding what's best for you. Factors to consider include costs, services available in your area and other health insurance programs you may already be enrolled in.
Here's an overview of each option:
In this plan, most of your health care, including prescription medicine, comes from a military treatment facility, augmented by a local network of preferred providers. You'll be assigned to a primary care manager -- a physician or group of health care providers who supervise your care.
Your primary care manager will provide all nonemergency medical care and refer you to medical specialists as needed. Active duty family members also can enroll in Prime at no cost, and your copayments are lower than under the other two options. Eligible retirees and their families may enroll in Prime at a cost of $230 a year for one person or $460 for more than one.
Enrollment in Prime limits your choice of who will provide your health care. However, where Prime is available, it provides members distinct advantages of guaranteed appointments, away-from-home coverage and smaller fees per visit (no fee for active duty members) to authorized civilian providers than under Extra or Standard.
You don't enroll in Extra. You have to pay CHAMPUS deductibles, and other CHAMPUS rules apply as well. You must select an authorized civilian network provider and make copayments for care received that equal 15 percent of the negotiated fee.
Advantages to Extra include no enrollment fee, no deductibles when you use the retail pharmacy network and no forms to file. On the downside, you have only a limited choice of providers and you pay deductibles and copayments. You may need a nonavailability statement from the military hospital nearest you before receiving inpatient care in a civilian hospital.
Remember CHAMPUS? This is it, under a new name. CHAMPUS rules and costs apply. You don't enroll for Standard either. Treat the Extra and Standard options as interchangeable and use the one best for you in a given instance.
Standard's advantages are it gives you the broadest choice of providers and it's widely available. However, in addition to the CHAMPUS deductible and copayments, you will be charged for the balance of your medical bill if it exceeds allowable charges and the provider doesn't participate in Standard but agrees to bill Standard for the care provided. As with Extra, you may need a nonavailability statement from the military hospital nearest you before receiving inpatient care in a civilian hospital.
For more in-depth information about TRICARE, visit the TRICARE Service Center in your area, visit the TRICARE home page on the World Wide Web at http://www.ha.osd.mil, or contact the health benefits adviser at any military medical treatment facility.
The following charts outline basic TRICARE costs by option and beneficiary category: