TRICARE Everywhere: You Got This!
TRICARE is an amazing benefit for military members, retirees and their families. It might be easy to take it for granted, but as time goes by you start to see what an exceptional thing it is: life-long affordable care, easily accessible. Compared to your non-military friends who might struggle with bad health plans, high costs or no coverage at all, TRICARE can be a real blessing!
For years, I have been running a global community of TRICARE users, and I have found that attitudes and comfort level fall roughly into three groups:
Younger military families who are mid-career or earlier. This group is generally well-served by medical services on base; they find access to healthcare to be relatively simple, and don’t give much thought to exactly how the care is delivered.
Late-career military, a year or two from retirement. They are starting to get an uncomfortable feeling that “something” is about to change regarding their health care. They are not exactly sure what or how, but they realize they need to figure it out.
Military retirees. They realize that in many cases, they’ll have to adapt to receiving care off base. They research and find a method that more or less works for them and their family. Some, however, never adjust, and continually find it a struggle to deal with TRICARE, at least until they reach Medicare age.
Obviously, this is an oversimplification and many individuals are far different than described above. But still, these are broad trends I have seen over the years.
There are a lot of myths and misinformation about TRICARE, and we are constantly trying to educate our audience on the facts. Future posts will cover TRICARE plans, benefits and how to use them both in the States and abroad. But for now, we will establish certain ground truth.
Active duty members will always be on Prime or Prime Remote. The military requires servicemembers to be in a managed care plan.
Active duty family members (ADFM) can be in Prime plans, but also have the choice of TRICARE Select or (in some regions) U.S. Family Health Plan (USFHP), a form of Prime.
Prime, Prime Remote, and USFHP are called Managed Care Plans. With these plans, you are assigned a Primary Care Manager (PCM), who you will see first for medical care other than emergencies. The PCM will give referrals to specialists when needed.
All other plans, such as Select, do NOT have a PCM. You choose your own doctor, and TRICARE does not require referrals.
All TRICARE plans work worldwide. When overseas or away from your home area, you can receive urgent or emergency care without a referral on all plans. Furthermore, with non-managed care plans, you can get ALL kinds of covered care anywhere you go.
Obviously, there is more to it than this. For instance, it is important to understand the cost of each plan. Future posts will explain about cost plus we have an excellent video on our YouTube channel which discusses the TRICARE Cost Compare Tool.
Another important aspect to understand is the distinction between network and non-network providers.
Network providers have signed a contract with the TRICARE regional contractor. They agree to accept a negotiated rate for full payment of services, and they file claims, so you don’t have to. Your copayments are generally lower when seeing a network provider.
Non-network providers are TRICARE-authorized providers who have not joined a network. You can visit these providers if you are in a non-managed care plan like Select or TRICARE for Life. You can expect that your copayments will be higher compared to seeing a network provider. You normally will pay in full, and then submit a claim for partial reimbursement.
Retirees living overseas will nearly always receive non-network care and have to file a claim. Network providers are rare overseas, but they do exist if you can find them. Join our Facebook group to chat about your particular needs. Those in Prime plans should avoid seeing non-network providers without a referral (for other than emergencies), or they will incur steep copayments.