US military service members and veterans are eligible for several options regarding health insurance. The plans are available to active duty members and veterans that meet coverage requirements set by the Affordable Care Act. They involve the Veterans Healthcare Program, the VA Civilian Health and Management Program, the Spina Bifida Health Care Program, and TRI-CARE. I am going to summarize what you can expect from TRI-CARE.
TRI-CARE provides health insurance for members of the armed forces, including active duty and veterans of the Army, Air Force, Navy, Marine Corps, Coast Guard, and the Commissioned Corps of the US Public Health Service as well is the Commissioned Corps of the National Oceanic and Atmospheric Association as well as their families (Eligibility, 2016.) In addition, former spouses, recipients of the Medal of Honor and their families, and other military members that are registered in the Defense Enrollment Eligibility Reporting System, or DEERS, may receive TRI-CARE benefits. Beneficiaries involve members who are serving currently, are retired, and/or are participating in the National Guard and National Reserve, as well as their family members. The benefits involved in this program depend on the category to which a beneficiary belongs.
There are several programs available within the TRI-CARE program. TRI-CARE Standard is the choice that provides the greatest amount of flexibility to beneficiaries who are eligible. It is known as the “fee for service” option, and provides beneficiaries the chance to receive treatment from any health provider that is authorized by TRI-CARE. This plan is not available for service members who are on active duty, bu rather, t is an option for veterans on around the world (TRI-CARE Standard Overview, 2017.) Veterans and current duty service members who are satisfied with their current health care providers but who may not be in the TRI-CARE network often choose this plan because it allows them to continue with their own providers. In addition, some veterans or current duty active service members and their families may reside in areas where the TRI-CARE network providers are not available, so that this program may be the only available option.
The TRI-CARE Prime Program is a managed-care program available on a global basis to certain service areas. Soldiers on active duty are obligated to enroll in TRI-CARE Prime; family members can opt to enroll or they may use TRI-CARE Standard and Extra. This program provides fewer out-of-pocket expenses than TRI-CARE Standard and Extra, but has less freedom of choice of providers (The TRI-CARE Prime Program, 2017.) For service members or veterans who do not reside in a service area involved in this program, there are extra options, including TRI-CARE Prime Remote, TRI-CARE Prime Overseas, and TRI-CARE Prime Remote Overseas. Enrollees in this program are assigned to see a primary care manager who is responsible for providing the majority of care. Before seeing a specialist, this professional sees the patient first, provides an assessment, and determines what healthcare needs are appropriate. The primary care manager provides and/or coordinates the care, maintains health records, and make referrals to specialists when necessary. Members who opt for this plan must always consult with their primary care manager prior to seeking any sort of medical attention provided by medical facilities and specialists.
TRI-CARE Extra is only available to beneficiaries in the United States, and is not an option for active service duty members. Instead, it is available for family members of active duty members, veterans and their families, family members of active National Guard and Reserved members, survivors, recipients of Medals of Honor, qualified former spouses, and a range of other patients. This program does not require an application, and is available as long as a person is registered in the DEERS directory.
References
Eligibility. (2016, December 1). Retrieved from TRI-CARE: Https://tricare.mil/Plans/Eligibility
The TRI-CARE Prime Program. (n.d.). Retrieved from Military.com: http://www.military.com/benefits/tricare/prime/tricare-prime-overview.html
TRI-CARE Standard Overview. (n.d.). Retrieved from Military.com: http://www.military.com/benefits/tricare/standard/tricare-standard-overview.html
