TRICARE Basics
By CWO4 Lewis Tolleson, USCG-Ret., Director; Lt. Col. William A. Pierce, USA-Ret.; and Capt. Bud Schneeweis, USCG-Ret.

What health care plans are available through TRICARE?

There are three TRICARE options for eligible beneficiaries.

TRICARE Prime is a managed care program that integrates military and civilian health care into a single health care system. Prime beneficiaries agree to a one-year enrollment and select a primary care manager to provide or arrange for their health care needs. This program offers additional wellness and preventive care services.

TRICARE Standard is a fee-for-service program that replaced champus. Standard beneficiaries have the greatest choice of civilian providers but at a higher cost. The beneficiary is responsible for a deductible plus copayments. You do not have to be enrolled to participate.

TRICARE Extra is similar to TRICARE Standard but offers discounts to patients when they use TRICARE network providers. This allows beneficiaries to receive their care from civilian network providers at a reduced cost. There are no claim forms to file - just pay your copayment after satisfying the deductible.

You may use a combination of the Extra and Standard programs at any time, depending on whether you choose providers inside or outside the network. You do not have to be enrolled to participate.

What if I choose not to enroll in TRICARE Prime?

Beneficiaries who decide not to enroll in Prime still are eligible for care in military treatment facilities (MTFs) on a space-available basis and will maintain TRICARE Standard eligibility.

Which option is best for me if I don't live close to an MTF?

TRICARE Prime would be the most cost-efficient option for you. If there are no Prime providers in your area, you can use the TRICARE Extra program. If Extra network providers are not in your area, you must use TRICARE Standard. Contact your managed care support contractor to ask about civilian providers.

What is my priority for care at an MTF?

By law, priority for care at an MTF is arranged in the following order:

1. active duty personnel;
2. active duty family members enrolled in TRICARE Prime;
3. retirees, survivors, and their family members enrolled in Prime;
4. active duty family members not enrolled in Prime; and
5. retirees, survivors, and family members not enrolled in Prime.

Nonenrolled people eligible for military health care may be seen at military hospitals and clinics on a space-available basis.

What about benefits for Medicare-eligible beneficiaries age 65 and older?

TRICARE For Life (TFL) covers Medicare-eligible retirees, including retired guardmembers and reservists; Medicare-eligible family members and survivors; and former spouses if they were eligible for TRICARE before age 65. There are no enrollment fees, deductibles, or premiums for TFL. To participate in TFL, you must be eligible for Medicare Part A and enrolled in Medicare Part B. If you are unsure about your eligibility, contact the Defense Manpower Data Center support office at (800) 538-9552.

What happens to non-Medicare-eligible beneficiaries age 65 and older?

Their benefits didn't change when TFL came into effect. They retain their military health coverage and still can enroll in Prime, where it is offered, or use Standard and Extra. They also have TRICARE pharmacy benefits.

What should those under 65 - but eligible for both Medicare and TRICARE - be aware of?

Dual-eligible (Medicare and TRICARE) beneficiaries must enroll in Medicare Part B or they will lose their TRICARE eligibility. If this happens, they still may receive care at MTFs if there is space available.