TRICARE Choices: At a Glance Flashcards

1
Q

Tricare is determined by information in DEERS.

A

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

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2
Q

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

A

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

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3
Q

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)

A
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
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4
Q
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.
A
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)
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5
Q
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.
A
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
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6
Q

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.

A

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).

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7
Q

The TRICARE Dental Program (TDP) is available to
eligible ADFMs and National Guard and Reserve
members and their eligible family members.

A
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
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8
Q

The TRICARE Retiree Dental Program (TRDP) is
available to retired service members and their eligible
family members, including retired National Guard and
Reserve members.

A

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.

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9
Q

If you enroll in US Family Health Plan (USFHP) you may not access care at a MTF, including MTF pharmacies.

A

Active Duty members are not to have MediCare Part B. to remain eligible for Tricare.

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10
Q

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.

A
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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