TRICARE Choices: At a Glance Flashcards Preview

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Flashcards in TRICARE Choices: At a Glance Deck (10):
1

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

2

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

3

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

4

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)

5

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

6

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).

7

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

8

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.

9

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.

10

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,

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