Understanding Military Medical Care and TRICARE

Understanding Military Medical Care and TRICAREUnderstanding Military Medical Care and TRICAREMilitary Medicine Depending upon their status, active duty members, retired members, members of the Guard/Reserves, family members, and certain veterans receive free or government subsidized medical and dental care. For the fruchtwein part, this care falls under an overall program known as TRICARE. Beginning in 1988, the military offered service families a choice of ways in which they might use their military health care benefits. Five years of successful operation and high levels of patient satisfaction convinced Defense Department officials that they should extend and improve the concepts of military medicine reform initiative (called CRI - Champus Reform Initiative), as a uniform program nationwide. The new program, known as TRICARE, is now fully in place. In FY 1996, the TRICARE/CHAMPUS budget was more than $3.5 billion, and more than 20 million claims were received. Today, nearly 5.5 mi llion people are eligible for TRICARE benefits. Types of TRICARE When TRICARE was first instituted, there were only three types.Over the past few years, more TRICARE health plan options have been established.Visit the TRICARE website for complete details on all TRICARE plans TRICARE PrimeTRICARE Prime RemoteTRICARE Prime OverseasTRICARE Prime Remote OverseasTRICARE Standard and ExtraTRICARE Standard OverseasTRICARE For LifeTRICARE Reserve SelectTRICARE Retired ReserveTRICARE Young AdultUS Family Health Plan TRICARE Prime This option is similar to an HMO in concept. It requires that one specificallyenrollin the program (active duty membersare enrolledautomatically). Individuals enrolled in TRICARE Prime are assigned to a primary care lieferant (PCP), which is usually the local military medical facility (base hospital). In order to receive specialist care, enrollees must be referred by their PCP. Under this program, there is no enrollment fee or cost-sharing for active duty me mbers and family members of active duty. For retirees (under age 65) and family members of retirees (under age 65), there is an enrollment fee for TRICARE Prime that increases each year.One can get the forms to enroll inTRICARE Prime online. A brand new option under TRICARE Prime is the Point of Service (POS) enrollment option. Normally under TRICARE Prime, you must be referred by the PCP in order to receive any reimbursement for medical care received from anyone other than the PCP. But, if you elect the POS option attimeof enrollment, you can use TRICARE Prime andtotenstilluse the TRICARE Standard or TRICARE Extra options described below. TRICARE Standard and Extra This program gives more flexibility than TRICARE Prime, but could result in addition costs. You do leid need to enroll in advance to use TRICARE Extra. Under this program, you see anyAuthorized TRICARE Provider, present your ID Card and receive medical care. The TRICARE Authorized Providers have a contract with the m ilitary to limit costs to designated amounts. Under TRICARE Extra, active duty family members pay an annual deducible (the year begins every October)See link for costs updates - TRICARE COSTS For retirees and retiree family members (under age 65), the program costs a little more, though the annual deductible is the same. Visit the TRICARE Standard and Extra Costs webpage for all cost details. Under TRICARE Extra, the medical provider fills out the TRICARE Claim Forms for you, and they receive direct payment from TRICARE for their portion. You simply pay them your portion of the costs. TRICARE for Life Until recently, when a retiree or retiree family member reached the age of 65, they were no longer eligible for TRICARE. Instead, they were expected to receive medical care under the provisions of Medicare. This changed in 2001 with the introduction of TRICARE for Life (TFL). Again, there is no need to enroll in advance (except one must be enrolled in Medicare Part B). Additionally , the only charges for this program are the monthly Medicare Part B premiums. Under this program, you see an authorized Medicare Provider and present your ID Card. TRICARE then becomes the second payer and picks up any costs that Medicare doesnt cover. Although Medicare doesnt cover services provided outside of the continental United States, retirees residing in foreign countries can still take advantage of TFL because TRICARE becomes the primary source of health benefits for them. Like those living in the United States, to be eligible overseas retirees must be enrolled in Medicare Part B. TRICARE for Life will provide the same level of coverage afforded retirees under 65 and they will be responsible for the same TRICARE cost shares and deductibles as the under 65 retirees. Since a great number of retirees living overseas did not enroll in Part B because Medicare didnt cover medical care received in foreign countries, some of the military related organizations are pushing for a wai ver of the Part B penalty which entails a 10 percent penalty for each year the individual was eligible for Part B but didnt enroll. However, there is currently nothing in the works that indicates such a waiver is coming. Pharmacy Benefits with TRICARE There are several ways to fill prescription medications through TRICARE Military Pharmacies You may have prescriptions filled (up to a 90-day supply for most medications) at a military treatment facility (MTF) pharmacy free of charge. Please be aware that not all medications are available at MTF pharmacies. Each facility is required to make available the medications listed in thebasic core formally(BCF). The MTF, through their local Pharmacy Therapeutics Committee, may add additional medications to their local formally based on the scope of care at that MTF. TRICARE Mail Order Pharmacy (TMOP) You can order medicationsonline or through the mail. You can receive up to a 90 day supply (for most medications). Generic formular y costs are $0, while the brand name formulary is $20. Non-formulary cost is $49 unless you have a medical necessity. Network Pharmacies Youmay receive up to a 30-day supply of prescription medication from a pharmacy within theTRICARE Pharmacy Network. The cost for generic formulary is $10, and the cost for brand name formulary is $24. Non-formulary is $50 unless you have medical necessity. Non-network Pharmacies The costs for non-network pharmacies are based on where you are, who you are and in some cases, what plan youre using.You may need to pay up front and file a claim for reimbursement. The costs will generally be higher, however, for non-active duty beneficiaries. Active duty service members will receive full reimbursement. For complete details and costs for beneficiaries, visit the TRICARE prescription costs web page. Active Duty/Reserve Dental Care Dental care for active duty, of course, is free through the Military Dental Clinic. TRICARE does, however, offer op tionaldental plansfor family members of active duty and members of the Guard/Reserves and their family members. These programs require a monthly premium. The programs pay the total cost of some dental care, plus cost-share for other dental care.See current rates for dentalThree different dental programs VA Medical Care I run into folks all the time who think that any military retiree or any veteran can get free medical care from the Veterans Administration. bedrngnis true. To receive medical care from the VA, you must be a Veteran (over 180 days of military service), have an honorable discharge and have either a service-connected illness, injury or disability, or you must fall into a certain range of poverty. More information about VA Medical Care is available on theVAs Web Site.