Health care for military personnel and their families isn’t something that gets much coverage in the media, which means that most civilians don’t know very much about it. For military families, though, it’s a big deal. As with almost every other aspect of the military, budget cuts threaten to change the landscape of health insurance for military-affiliated families.
TRICARE has been a benefit for many families and helps keep their medical expenses within budget. TRICARE offers two main plans with 15 different plan variants, making sure to offer plan options that have exactly what you need to get the best, and most affordable, healthcare for yourself and your family.
TRICARE Prime and TRICARE Select offer two different approaches to healthcare. Each plan has its pros and cons, and the following comparison can help you make the best choice for your family.
Active duty military members and their dependents need to enroll in TRICARE Prime. Active duty families pay no enrollment fee, while retirees, their families, and others must pay an enrollment fee ranging from $289 to $350 for individuals, and $578 to $700 for families.
With TRICARE Prime, you can keep coverage costs to a minimum, while using a managed-care system. You aren’t required to pay a co-pay (out of pocket fee) or deductible unless you’re using the point-of-service option. In this case, you'll have a single-person deductible of $300 or a family deductible of $600. If you're active duty, you won't be able to use the point-of-service option.
If you want to use the no out-of-pocket option with TRICARE Prime, you’ll choose from a list of approved or designated providers, similar to a civilian HMO policy, where you can see only providers who are in the plan's network. If you live on or near a base, this usually means going to the local military medical facility. You'll have somewhat limited options with this plan, especially if you or a family member has special medical needs.
TRICARE Prime only offers availability in designated prime service areas, and you can find out which areas qualify by using the Plan Finder on the TRICARE website.
In order to use the no-copay option under Prime, you’ll need an official referral if you need to see a specialist or other preferred provider. So, you’ll have more paperwork and processing on Prime, but the savings may very well be worth it for your family. You just have to prepare yourself for a delay in care while you wait for referrals.
If you need immediate, emergency care, you’ll have to spend a few seconds thinking about your options before you rush out the door. For example, TRICARE separates “emergency” and “urgent” care, and the coverage requirements are different under the plan. A visit to the emergency room for a life-threatening concern only warrants a post-event call to your program contractor. Alternatively, a visit to urgent care for a non-life-threatening but a serious issue (such as a broken ankle) does require a referral.
The TRICARE Prime plan caps your costs, called a catastrophic cap, depending on your military status. For active duty family members, you'll pay a maximum of $1,000, and all others pay a maximum of $3,000 to $3,500.
TRICARE Select gives you the most freedom of choice and flexibility in your options for providers, but it also involves some additional out-of-pocket expenses. You have the choice to use a network provider or out-of-network provider, and you won’t need to get a referral. However, you may still need authorization for certain services, just as you would with most other insurance plans.
You must enroll in this plan, and you may need to pay for some services upfront and then file a claim yourself to get reimbursed. If you choose an in-network provider, they typically file claims for you.
TRICARE Select can be great if you live on or near a base but don’t want to use the local military medical facilities, or someone in your family has special needs. TRICARE Standard’s out-of-network option can also come in handy if you live more than 30 miles from a military medical facility and don’t want to drive long distances to take your children to the doctor. The program is available in all areas of the United States.
You will pay an annual deductible on TRICARE Select, however, the rates are still very affordable compared to civilian insurance options.
For example, for an E4 and below and on active duty or in the Guard/Reserve, your deductible can be $50 per person (but no more than $100 for the whole family). E5 and above can expect $150 per individual (but no more than $300 for the whole family).
You will also be responsible for a percentage or share of certain services. Many preventative services don’t require an out-of-pocket fee, however, you can expect to be responsible for anywhere from $15 to $28 in-network or 20 percent to 25 percent for out-of-network provider visits.
This plan features the same catastrophic cap benefit level as the TRICARE Prime plan.
Making the Right Choice For Your Family
Both plans offer great options for active-duty military personnel and their families. Establish your priorities for health care, and consider your long-term needs to help guide your research. Like any other decision regarding medical care, be sure to communicate directly with your insurance provider to get the most up-to-date information.