TRICARE Prime: This is a health maintenance organization-type managed care program in which retirees are required to pay an annual enrollment fee. Enrollees are assigned a primary care manager, who determines the most appropriate, available source of care—either a military treatment facility or a civilian network provider. Enrollees pay little or no co-payment, and usually are not required to file claims for their care.
TRICARE Extra: This is a preferred provider organization-type program, in which beneficiaries are not required to enroll. They will, however, receive reduced co-payments if they use networks of approved providers.
TRICARE Standard: This is the basic TRICARE health option, for which beneficiaries have annual deductible and cost share requirement.
Retired beneficiaries should contact Health Benefits Advisors/BCACs at MTFs or TRICARE Service Centers for more assistance and to check availability of coverage for the area in which they intend to locate.
The following chart compares the costs associated with each of your TRICARE options:
|
TRICARE
Prime |
TRICARE
Extra |
TRICARE
Standard |
|
|
Annual Deductible
|
None
|
$150/individual or
$300/family |
$150/individual or
$300/family |
|
Annual Enrollment Fee
|
$230/individual $460/family
|
None
|
None
|
|
Civilian Copays
|
20% of negotiated
fee |
25% of allowed charges for covered service
|
|
|
Outpatient
Emergency Care Mental Health Visit |
$12
$30 $25 $17 (group visit) |
||
|
Civilian Inpatient
Cost Share |
$11/day
($25 minimum) Charge per admission |
Lesser of $250/day or 25% of negotiated charges plus 20% of negotiated
professional fees
|
Lesser of $512/day or 25% of billed charges plus 25% of allowed professional
fees
|
|
Civilian Inpatient Skilled Nursing Facility Care
|
$11/day
($25 minimum) charge per admission |
$250 per diem co-payment or 20% cost-share of total charges, whichever is less,
institutional services, plus 20% cost-share of separately billed professional charges
|
25% cost-share of allowed charges for institutional services, plus 25%
cost-share of allowable for separately billed professional charges.
|
|
Civilian Inpatient Mental Health
|
$40 per day
|
20% of institutional & negotiated professional fees
|
Lesser of $169/day or 25% of allowable fees
|
