Choosing Your TRICARE Option
The TRICARE health care options are: TRICARE Prime; TRICARE Prime Remote (TPR); TRICARE Extra; TRICARE Standard; TRICARE Reserve Select; TRICARE for Life; TRICARE Young Adult; US Family Health Plan, and TRICARE Overseas. How do you choose the one that's right for you and your family? Do you have a choice? Where will you receive your care?
When making the choice of TRICARE options, consider certain key factors. Eligibility dictates the TRICARE options you and your family members can choose from and thus which option you can select. TRICARE offers an online Plan Wizard that will take you through a set of questions to help you identify TRICARE programs for which you are eligible.
Now that you know which TRICARE options(s) are available for you and your family, you can pick the one that best fits your particular circumstances and lifestyle. We suggest you take these conditions into consideration when choosing a TRICARE program: availability, choice, cost, size of your family (impacts your out-of-pocket costs), and claims.
Availability of Health Care Services
First, look at where you want to receive your health care services. Do you only want to use a military hospital or clinic or do you prefer a civilian provider? If you want to use a military facility, is there one nearby, preferably within a 30-minute drive? Is the military hospital or clinic accepting new Prime enrollees? If not, what are other options? Are TRICARE network providers in your area? Check with your TRICARE contractor to identify civilian providers in their network. Look at what other options would be acceptable.
Choice of Doctors
Do you want the freedom to pick and chose your own primary care and specialty doctors? And, are you willing to pay a little extra for this freedom or to wait a little longer to see the doctor you want to see? Then you probably want to consider the "fee-for-service" type of health care program provided by TRICARE Standard. Remember, if the doctor you see under TRICARE Standard is in the TRICARE network, you will have a lower payment. Is the certainty of getting an appointment important to you? Are you comfortable with having a doctor oversee your care and decide when you need to see a specialist? If so, consider TRICARE Prime.
Cost may be a big concern for you and your family. It's important to know costs vary among the TRICARE options. Depending on the TRICARE option you choose and your beneficiary category, costs can include such things as co-pays, cost shares, services not covered, enrollment fees, and yearly deductibles. There is normally no out-of-pocket cost for beneficiaries when they receive care at a military hospital or clinic. Active duty service members and their families in TRICARE Prime should have no costs using a civilian health care provider if they go through their PCM for all care. Retirees and their families in Prime pay an annual enrollment fee and a small co-pay when using a civilian doctor in the network. TRICARE Standard and Extra users must meet an annual deductible and pay a percentage cost share for each medical visit. National Guard and Reserve members in TRICARE Reserve Select pay premiums and incur the same cost shares and deductibles as active duty families in Standard. Also, pay attention to the timing of the benefit year, which determines your timeframe for yearly deductibles and maximum caps on expenses.
Who files the claims forms can certainly be a concern, especially if you are the one having to fill them out and mail them in after every health care visit. Generally, TRICARE network providers will always submit claims, while some non-network providers will and others won't. If you are making a decision on which TRICARE option to use, based on your continued ability to see a particular doctor, always ask whether they are in the network, whether they will submit the claims, whether you will be required to pay up front and then be reimbursed, and whether they will accept the TRICARE-allowed amount as payment.
Remember, each TRICARE option has its pluses and minuses. To help you weigh those features, use the TRICARE website’s plan comparison tool. Select two options for which you are eligible, look at the features side by side, and pick the one that suits your particular circumstances and lifestyle. Remember, the program you chose today may not fit your needs tomorrow. And, what is good for you may not be the right choice for someone else, even in your own family. TRICARE programs are not the “one-size fits all” type of health care plans. The selection process can be daunting, but when armed with all the right information, it should go smoothly.
Until military families are relieved of the weight of war, we hope you will continue to contribute to their wellbeing.
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