TRICARE Choices: At a Glance Flashcards
Tricare is determined by information in DEERS.
Active duty service members (ADSMs)
(Includes National Guard and Reserve members1
activated for more than 30 consecutive days) : are eligible for TRICARE Prime/TRICARE Prime Remote
Active duty family members (ADFMs)2
(Includes family members of National Guard and
Reserve members1 activated for more than 30
consecutive days, and certain survivors): eligible for TRICARE Prime
TRICARE Prime Remote for Active Duty
Family Members (TPRADFM)
TRICARE Standard
TRICARE Extra
TRICARE For Life (ADFMs must have Medicare
Part B to participate in TRICARE For Life)
US Family Health Plan (USFHP)
TRICARE Dental Program
Retired service members and eligible
family members, survivors, Medal of Honor
recipients, former spouses, and others
Note: National Guard and Reserve members who
may have retired from their Service are not eligible
for TRICARE coverage until they reach traditional
retirement age. : eligible for TRICARE Prime
TRICARE Standard
TRICARE Extra
TRICARE For Life (If entitled to premiumfree
Medicare Part A based on age, disability, or
endstage renal disease, the beneficiary must have
Medicare Part B to retain TRICARE eligibility.)
US Family Health Plan
TRICARE Retiree Dental Program
National Guard and Reserve members and
their family members
(Qualified, nonactive duty members of the
Selected Reserve and Individual Ready Reserve): eligible for National Guard and Reserve members and
their family members
(Qualified, nonactive duty members of the
Selected Reserve and Individual Ready Reserve)
TRICARE Prime: • Managedcare or health maintenance organization (HMO) option available in specific geographic area, Enrollment required • Retirees, their families, survivors, and eligible former spouses pay annual enrollment fees • Offers lowest outofpocket costs, • Receive most care from primary care manager (PCM) at a military treatment facility (MTF) or within TRICARE network • PCM referrals required for most specialty care
TRICARE Standard: • Feeforservice option available worldwide, • No enrollment required • No annual enrollment fee or enrollment applications • Annual deductibles and costshares apply1, • Receive care from TRICARE authorized, nonnetwork providers • No referrals required • Some services require prior authorization.
TRICARE Prime Remote (includes TPRADFM): • TRICARE Primelike benefit for active duty families living and working in remote locations, Enrollment required • No annual enrollment fee • Offers same low outofpocket costs as TRICARE Prime, • Receive care from TRICARE network providers (or a TRICAREauthorized provider if network provider is unavailable)
TRICARE For Life (TFL): TRICARE’s Medicare wraparound coverage available to all Medicare eligible TRICARE beneficiaries, regardless of age, provided they have Medicare Part A and Medicare Part B, • No enrollment fees • Must be entitled to premiumfree Medicare Part A and have Medicare Part B, • Receive care from Medicare providers.
TRICARE Extra: Preferred provider option (PPO) in areas with established TRICARE networks, No enrollment required • No annual enrollment fee or enrollment applications • Annual deductibles and discounted costshares apply, Receive care from TRICARE network providers • No referrals required • Some services require prior authorization
Costs for prescriptions are based on
the category under which the drug is classified—formulary
or nonformulary and generic or brand name—and where
the prescription is filled—MTF pharmacy.
You can convert maintenance prescriptions—prescriptions
you take on a regular basis—that you have filled at a
TRICARE retail network pharmacy to the TRICARE Mail
Order Pharmacy via the Member Choice Center (MCC).
The TRICARE Dental Program (TDP) is available to
eligible ADFMs and National Guard and Reserve
members and their eligible family members.
TDP Benefits • Voluntary enrollment •Worldwide, portable coverage • Single and family plans available • Affordable monthly premiums • Lower specialty care costshares for E1–E4 pay grades • Comprehensive coverage for most dental services • 100 percent coverage for preventive and diagnostic services
The TRICARE Retiree Dental Program (TRDP) is
available to retired service members and their eligible
family members, including retired National Guard and
Reserve members.
Authorized providers that are not part of Tricare network of civilian providers may charge beneficiarirs using Tricare Standard up to 15% above the Tricare allowable charge for services.
If you enroll in US Family Health Plan (USFHP) you may not access care at a MTF, including MTF pharmacies.
Active Duty members are not to have MediCare Part B. to remain eligible for Tricare.
Upon sponsor’s retirement, Medicare PtB must be in effect no later than the sponsor’s retirement date to avoid a break in Tricare coverage.
US Family Health Plan (USFHP): TRICARE Prime managedcare option available through networks of communitybased, notforprofit health care systems in six areas of the United States, Enrollment required • Depending on the health care system, enrollment fees may apply,
