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Tricare (styled TRICARE) is a health care program of the
United States Department of Defense The United States Department of Defense (DoD, USDOD or DOD) is an executive branch department of the federal government charged with coordinating and supervising all agencies and functions of the government directly related to national sec ...
Military Health System. Tricare provides
civilian Civilians under international humanitarian law are "persons who are not members of the armed forces" and they are not " combatants if they carry arms openly and respect the laws and customs of war". It is slightly different from a non-combatant ...
health benefits for U.S Armed Forces military personnel, military retirees, and their dependents, including some members of the Reserve Component. Tricare is the civilian care component of the Military Health System, although historically it also included health care delivered in military medical treatment facilities. Tricare functions similar to a
single-payer healthcare Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer"). Single-payer systems may contract for healthcare services from ...
system. The Tricare program is managed by the
Defense Health Agency The Defense Health Agency (DHA) is a joint, integrated combat support agency that enables the U.S. Army, U.S. Navy, U.S. Air Force, and U.S. Space Force medical services to provide a medically ready force and ready medical force to Combatant Com ...
(DHA). Before 1 October 2013, it was managed by the Tricare Management Activity (TMA) under the authority of the Assistant Secretary of Defense (Health Affairs). On that date, TMA was disestablished and Tricare responsibility was transferred to the newly established DHA. The
Department of Defense Department of Defence or Department of Defense may refer to: Current departments of defence * Department of Defence (Australia) * Department of National Defence (Canada) * Department of Defence (Ireland) * Department of National Defense (Philipp ...
operates a health care delivery system served approximately 9.4 million beneficiaries in 2018. The Department of Defense's unified medical program represents $50.6 billion or 8% of total FY2019 U.S. military spending. With the exception of active duty service members (who are assigned to the TRICARE Prime option and pay no out-of-pocket costs for TRICARE coverage), Military Health System beneficiaries may have a choice of TRICARE plan options depending upon their status (e.g., active duty family member, retiree, reservist, child under age 26 ineligible for family coverage, Medicare-eligible, etc.) and geographic location.


History

Historically,
health care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health pr ...
for military personnel and their dependents was provided in military medical facilities as promised by the military, and through a referral system, by civilian medical personnel where military physicians were not available in a certain specialty, or when and where overcrowding of a military medical facility occurred. Active duty military personnel always have priority for care in military medical facilities. After
World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the World War II by country, vast majority of the world's countries—including all of the great power ...
and the
Korean War {{Infobox military conflict , conflict = Korean War , partof = the Cold War and the Korean conflict , image = Korean War Montage 2.png , image_size = 300px , caption = Clockwise from top:{ ...
, especially with the growth in the standing forces of the U.S. military due to the
Cold War The Cold War is a term commonly used to refer to a period of geopolitical tension between the United States and the Soviet Union and their respective allies, the Western Bloc and the Eastern Bloc. The term '' cold war'' is used because t ...
, access to care in military facilities became increasingly unavailable for military retirees and the dependents of both active duty and retired military personnel due to resource constraints and growing demands on the system. It was at this time that the concept of "space-available basis" for military retirees and military dependents was first noted. To address this problem,
Congress A congress is a formal meeting of the representatives of different countries, constituent states, organizations, trade unions, political parties, or other groups. The term originated in Late Middle English to denote an encounter (meeting of ...
passed the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966. These acts allowed the
Secretary of Defense A defence minister or minister of defence is a cabinet official position in charge of a ministry of defense, which regulates the armed forces in sovereign states. The role of a defence minister varies considerably from country to country; in so ...
to contract with civilian
health care provider A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often receive ...
s. This civilian health care program became known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) in 1966. In the late 1980s, because of escalating costs, paperwork demands, and general beneficiary dissatisfaction, DoD initiated a series of demonstration projects. Under a program known as the CHAMPUS Reform Initiative (CRI), a contractor provided both health care and administrative-related services, including claims processing. The CRI project was one of the first to introduce managed care features to the CHAMPUS program. Beneficiaries under CRI were offered three choices – a health maintenance organization-like option called Tricare (CHAMPUS) Prime that required enrollment and offered enhanced benefits and low-cost shares, a preferred provider organization-like option called Tricare (CHAMPUS) Extra that required use of network providers in exchange for lower cost shares, and the standard CHAMPUS option that continued the freedom of choice in selecting providers but required higher cost shares and deductibles known as Tricare Standard. Although DOD's initial intent under CRI was to award three competitively bid contracts covering six states, only one bid, made by Foundation Health Corporation (now Health Net) covering
California California is a state in the Western United States, located along the Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the most populous U.S. state and the 3rd largest by area. It is also the m ...
and
Hawaii Hawaii ( ; haw, Hawaii or ) is a state in the Western United States, located in the Pacific Ocean about from the U.S. mainland. It is the only U.S. state outside North America, the only state that is an archipelago, and the only stat ...
, was received. Foundation delivered services under this contract between August 1988 and January 1994. In late 1993, in response to requirements in the DOD Appropriation Act for Fiscal Year 1994, the DoD announced plans for implementing a nationwide managed care program for the MHS that would be completely implemented by May 1997. Under this program, known as Tricare, the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
was divided into 12 health care regions. An administrative organization, the lead agent, was designated for each region and coordinated the health care needs of all military treatment facilities in the region. Under Tricare, seven managed care support contracts were awarded covering DOD's 12 health care regions. Since then, Tricare has undergone several restructuring initiatives, including re-alignment of contract regions,
Base Realignment and Closure Base Realignment and Closure (BRAC) is a process by a United States federal government commission to increase United States Department of Defense efficiency by coordinating the realignment and closure of military installations following the end ...
, and the addition of "Tricare for Life" benefits in 2001 for those who are Medicare-eligible, and "Tricare Reserve Select" in 2005.


Tricare's options


Enrollment-based Health Plans


Tricare Select

Tricare Select provides a similar benefit to the original CHAMPUS program and is available to retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. Tricare Select is also available to Reservist and their family under the Tricare Reserve Select Component. Under Tricare Select, beneficiaries can use any civilian
health care provider A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often receive ...
that is payable under Tricare regulations. The beneficiary is responsible for payment of an annual
deductible In an insurance policy, the deductible (in British English, the excess) is the amount paid out of pocket by the policy holder before an insurance provider will pay any expenses. In general usage, the term ''deductible'' may be used to describe ...
and coinsurance, and may be responsible for certain other
out-of-pocket expenses An out-of-pocket expense (or out-of-pocket cost, OOP) is the direct payment of money that may or may not be later reimbursed from a third-party source. For example, when operating a vehicle, gasoline, parking fees and tolls are considered out-of ...
. There were no enrollment fees for Tricare Select prior to 2021. As of January 1, 2021 The fees are: *for individuals: $12.50 per month or $150 a year *for families: $25 per month or $300 per year


Tricare Prime

Tricare Prime is a
health maintenance organization In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded heal ...
(HMO) style plan available to active duty personnel, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. Under Tricare Prime, beneficiaries must choose a
primary care physician A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The ter ...
and obtain referrals and authorizations for specialty care. In return for these restrictions, beneficiaries are responsible only for small
copayment A copayment or copay (called a gap in Australian English) is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person e ...
s for each visit (retirees and their families only). There is an annual enrollment fee for Tricare Prime for military retirees and their family members. There is no enrollment fee for active duty military and their family members. The majority of Tricare PRIME enrollees must exclusively use the MTF (Military Treatment Facility) to receive their care, as long as the MTF has capacity. If the MTF does not have capacity, the commander of the MTF notifies the region's contractor and the contractor's provider network is used to supplement the MTF's capacity. If the MTF regains capacity, the MTF reserves the right to move the beneficiaries back to receiving their care at the MTF in a process known as "recapture."


=US Family Health Plan

=
US Family Health Plan The US Family Health Plan (USFHP) is a U.S. Department of Defense-sponsored healthcare plan that serves military family members exclusively. US Family Health Plan operates in six regions, sixteen states, including the District of Columbia. Serv ...
, a Tricare Prime-sponsored health plan option, is made available by nonprofit health care providers in the Northeast U.S., Southeast Texas/Southwest Louisiana, and the Puget Sound region of Washington state.


Premium-based Health Plans


Tricare Reserve Select (TRS)

Tricare Reserve Select is a premium-based health plan that active status qualified National Guard and Reserve members may purchase. The classification is sometimes referred to as Tricare Reserve Component (RC). It requires a monthly premium and offers coverage similar to Tricare Standard and Extra for the military member and eligible family members. It has a partial premium cost sharing arrangement with DoD similar to civilian private or public sector employer plans, although typically at a lower cost than civilian plans. The program coverage is available worldwide to Selected Reserve (SELRES) members of both the
Title 10 Title 10 of the United States Code outlines the role of armed forces in the United States Code. It provides the legal basis for the roles, missions and organization of each of the services as well as the United States Department of Defense. ...
USC Federal Reserve Components ( Army Reserve, Navy Reserve,
Air Force Reserve The Air Force Reserve Command (AFRC) is a major command (MAJCOM) of the United States Air Force, with its headquarters at Robins Air Force Base, Georgia. It is the federal Air Reserve Component (ARC) of the U.S. Air Force, consisting of commi ...
, Marine Corps Reserve), Title 14 USC Federal Reserve Component (
Coast Guard Reserve The United States Coast Guard Reserve is the reserve component of the United States Coast Guard. It is organized, trained, administered, and supplied under the direction of the Commandant of the Coast Guard through the Assistant Commandant for R ...
) and the Title 32 National Guard (
Army National Guard The Army National Guard (ARNG), in conjunction with the Air National Guard, is an organized militia force and a federal military reserve force of the United States Army. They are simultaneously part of two different organizations: the Army N ...
and
Air National Guard The Air National Guard (ANG), also known as the Air Guard, is a federal military reserve force of the United States Air Force, as well as the air militia of each U.S. state, the District of Columbia, the Commonwealth of Puerto Rico, and the ter ...
) in a drill pay (also known as "paid") status. As of February 2008, retired Reserve Component personnel under the age of 60, actively drilling
Individual Ready Reserve The Individual Ready Reserve (IRR) is a category of the Ready Reserve of the Reserve Component of the Armed Forces of the United States composed of former active duty or reserve military personnel. Its governing statute is codified at . For so ...
(IRR) personnel in a non-paid status, or actively drilling Volunteer Training Unit (VTU) personnel in a non-paid status do not qualify for TRS. IRR and VTU members are eligible for reinstatement under TRS is they return to a SELRES status. Reserve Component personnel who are also Federal civil servants (to include Army Reserve Technicians and Air Reserve Technicians (ART) in the Army Reserve, Army National Guard, Air Force Reserve and Air National Guard) and eligible for the Federal Employee Health Benefit Program (FEHBP) are also excluded from TRS. Retired Reserve Component personnel and eligible dependent family members become eligible Tricare Standard, Tricare Extra or Tricare Prime on the service member's 60th birthday in the same manner as Active Component retirees and their eligible dependents are eligible immediately upon retirement from active service. Qualification questions should be referred to Tricare.


Tricare Reserve Retired (TRR)

Tricare Reserve Retired is a premium-based health plan that qualified retired members of the National Guard and Reserve under the age of 60 may purchase for themselves and eligible family members. Established in 2008 and opened for enrollment in 2010, it is similar to Tricare Reserve Select (TRS), but differs in that there is no premium cost-sharing with DoD as there is with TRS. As such, retired Reserve Component members who elect to purchase TRR must pay the full cost (100%) of the calculated premium plus an additional administrative fee. Payments could range as high as $900.00 a month. Although open to all eligible retired Reserve Component personnel under the age of 60, the program's principal focus is often perceived as being focused on recent Reserve Component retirees who are self-employed or otherwise ineligible for civilian employer provided/subsidized health insurance, especially those who were mobilized for full-time active duty service subsequent to 11 September 2001 in support of Operations
Enduring Freedom Operation Enduring Freedom (OEF) was the official name used synonymously by the U.S. government for both the War in Afghanistan (2001–2014) and the larger-scale Global War on Terrorism. On 7 October 2001, in response to the September 11 at ...
, Iraqi Freedom, New Dawn and/or Noble Eagle. Retired Reserve Component personnel who elect to participate in TRR will exit TRR when the service member reaches age 60 and he/she and their eligible dependent family members become eligible for the same Tricare Standard, Tricare Extra or Tricare Prime options as Active Component retirees and, in the case of Tricare Prime, at the same cost as Active Component retirees. Qualification questions should be referred to Tricare.


Tricare Young Adult (TYA)

Tricare Young Adult (TYA) is a premium-based health care plan available for purchase by qualified dependents who have aged out of Tricare at age 21, or age 23 for full-time college students. Dependents are eligible if they are unmarried, not eligible for either Tricare coverage or their own employer-sponsored health care coverage, and their sponsor is Tricare eligible.


Medicare-wraparound Coverage


Tricare for Life (TFL)

Tricare for Life (styled TRICARE For Life) was first incorporated as part of the then-seven regional Managed Care Support Contracts of Tricare in May 2001. The benefit was enacted by Congress in response to growing complaints from beneficiaries that as Medicare out of pocket costs increased a benefit was needed to pay these costs in lieu of Tricare retirees being required to purchase Medicare Supplemental Coverage to pay for prescriptions, physician and hospital dispensed drugs, cost shares and deductibles. Before Tricare for Life, Tricare beneficiaries immediately lost Tricare coverage upon attaining Medicare eligibility at age 65, placing them at the same level of coverage as U.S. citizens who had never served full 20 to 30-plus year careers in the armed forces. This included becoming Medicare eligible due to disability. Tricare for Life is designed to pay patient liability after Medicare payments. There is no enrollment necessary for Tricare for Life and to be eligible, members must be Tricare and Medicare Eligible and have purchased
Medicare Part B Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides ...
coverage. An exception to the requirement for Part B coverage exists when the beneficiary that is Medicare eligible is the spouse of an Active Duty Service Member. In some instances Tricare for Life is primary payer when the services are normally a Tricare benefit but not covered by Medicare. This includes drug charges, when Medicare benefit limits are attained and services performed outside the United States or in a
Veterans Affairs Veterans' affairs is an area of public policy concerned with relations between a government and its communities of military veterans. Some jurisdictions have a designated government agency or department, a Department of Veterans' Affairs, Minist ...
facility where Medicare does not pay. TFL does not pay patient liability for services that are not a Tricare benefit even though they may be paid by Medicare, such as chiropractic benefits. The policy limitations applying to Tricare also apply to TFL and must therefore be deemed medically necessary and skilled care. Custodial care therefore is not covered. In 2004 the Tricare for Life benefit was transferred from the individual regional Tricare contractors. Medical claims are processed by the national Tricare Dual Eligible Fiscal Intermediary Contractor (TDEFIC-Wisconsin Physicians Service Insurance Corporation). Pharmacy claims are processed by the Tricare Pharmacy Contractor (Express Scripts) and Overseas TFL claims are processed by the Tricare Overseas Program Contractor (as of September 2010 this will be International SOS using Wisconsin Physicians Service as their Fiscal Intermediary partner). The signing of the National Defense Authorization Act in January 2011 aligned Tricare with the provisions of the 2010 Patient Protection and Affordable Care Act, and led to the creation of TYA. Enrollment began on 1 May 2011.


Program administration

The ultimate responsible organization for administration of Tricare is the
U.S. Department of Defense Military Health System The Military Health System (MHS) is a form of nationalized health care operated within the United States Department of Defense that provides health care to active duty, Reserve component and retired U.S. Military personnel and their dependents. ...
, which organized the Tricare Management Activity (TMA). The Tricare Management Activity contracts with several large health insurance corporations to provide claims processing, customer service and other administrative functions to the Tricare program.


Basic structure

Currently, there are three regional Managed Care Support Contractors (MCSCs), a Medicare/Tricare Dual Eligible Fiscal Intermediary Contractor (TDEFIC), and a Tricare Pharmacy contractor, who administers both Mail Order Pharmacy (TMOP) and Retail Pharmacy (TRRx) programs. In addition several administrative contractors provide quality management, auditing, and statistical services.


Dental insurance

TMA contracts and administers dental programs. * United Concordia Dental – as Tricare Dental Program (TDP) * Delta Dental – as Tricare Retiree Dental Program (TRDP)


Health insurance

In 2004, Tricare Management Activity re-aligned the previous twelve regions into three large regions, known as Tricare
North North is one of the four compass points or cardinal directions. It is the opposite of south and is perpendicular to east and west. ''North'' is a noun, adjective, or adverb indicating direction or geography. Etymology The word ''north ...
, Tricare
South South is one of the cardinal directions or compass points. The direction is the opposite of north and is perpendicular to both east and west. Etymology The word ''south'' comes from Old English ''sūþ'', from earlier Proto-Germanic ''*sunþa ...
, and Tricare
West West or Occident is one of the four cardinal directions or points of the compass. It is the opposite direction from east and is the direction in which the Sun sets on the Earth. Etymology The word "west" is a Germanic word passed into some ...
. Services in these regions are provided by: * North – Health Net Federal Services, LLC The North Region includes Connecticut, Delaware, the District of Columbia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, Wisconsin and portions of Iowa (Rock Island Arsenal area), Missouri (St. Louis area) and Tennessee (Ft. Campbell area). * South –
Humana Military Healthcare Services, Inc. Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. In 2021, the company ranked 41 on the Fortune 500 list, which made it the highest ranked (by revenues) company based in Kentucky. It has been the thir ...
The South Region includes Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee (excluding the Ft. Campbell area) and Texas (excluding the El Paso area). * West – United Healthcare The West Region includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the southwestern corner, including El Paso), Utah, Washington and Wyoming. If you have TRICARE insurance, and you or your loved one needs treatment for alcohol or drug abuse, you are eligible for coverage at a wide range of treatment programs. All medical claims are processed ("adjudicated") by the following claims processing sub-contractors: * North, South and West – PGBA, LLC (a subsidiary of BlueCross BlueShield of South Carolina) * Tricare Overseas claims and Tricare for Life –
Wisconsin Physicians Service Wisconsin Physicians Service Insurance Corporation (WPS Health Solutions) is a not-for-profit service insurance corporation based in Madison, Wisconsin. WPS offers health insurance plans for groups and individuals and benefit plan administration ...
Insurance Corporation In 2009, the Tricare Overseas Program contract consolidated the following: * Overseas enrollment * Tricare Overseas claims processing * Three area Tricare Service Center contracts * Tricare Global Remote Overseas (TGRO) * Tricare Puerto Rico Prime In October 2009 International SOS Assistance, Inc. was awarded the contract to provide comprehensive health care support services to the Department of Defense Tricare Overseas Program. Effective January 1, 2018 the Tricare regions were consolidated into two large regions, Tricare East and Tricare West. Services in these regions are provided by: * East –
Humana Military Healthcare Services, Inc. Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. In 2021, the company ranked 41 on the Fortune 500 list, which made it the highest ranked (by revenues) company based in Kentucky. It has been the thir ...
The East Region includes Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, West Virginia, Wisconsin and portions of Iowa (Rock Island Arsenal area), Missouri (St. Louis area) and Texas (excluding the El Paso area).. * West – Health Net Federal Services, LLC The West Region includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the southwestern corner, including El Paso), Utah, Washington and Wyoming.


See also

*
US Family Health Plan The US Family Health Plan (USFHP) is a U.S. Department of Defense-sponsored healthcare plan that serves military family members exclusively. US Family Health Plan operates in six regions, sixteen states, including the District of Columbia. Serv ...
*
Health insurance in the United States Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include ...


References


External links

* {{DEFAULTSORT:Tricare Military medicine in the United States United States Department of Defense 1956 establishments in the United States