|
Now that you’ve learned about the programs that are available to you, it’s time to make your decision. The following are some scenarios that may help you.
If you still have questions after reading this section, contact a beneficiary counseling and assistance coordinator (BCAC) at any military treatment facility (MTF), or contact your regional contractor.
Scenario 1: I am an active duty family member with young children. I’m new to the area and don’t know much about the doctors or hospitals here. I want affordable health care that will cover office visits when my children are sick or when they need their immunizations.
Enrolling in TRICARE Prime or TRICARE Prime Remote for Active Duty Family Members (TPRADFM) is probably the best option for you. When you enroll, you’ll select or be assigned a primary care manager (PCM) at an MTF or a network PCM if you are not near an MTF. Your PCM will guide and manage your health care and the health care for your children. When you or your children need specialty care, your PCM will refer you to an appropriate specialist. Note:You can select a different provider as a PCM for each individual family member if you wish.
Your office visits at the MTF will cost you nothing, you’ll have priority access for appointments, and you won’t have to worry about claims or costly deductibles.
Under TRICARE Prime, immunizations are covered under clinical preventive services. As part of TRICARE Prime’s enhanced benefit, you can go to any network provider without a referral for clinical preventive services and pay nothing out of pocket.
Scenario 2: I am a new active duty family member and I have several doctors that I’ve been going to for years. I want to continue seeing these doctors.
Your doctors may be part of the TRICARE network. Visit your regional contractor’s online provider directory and search for your doctors by name. If they are in the TRICARE network, you’ll be able to use the TRICARE Prime or TRICARE Extra option and pay less than you would if you were using TRICARE Standard.
If your doctors are not in the TRICARE Prime network, the TRICARE Prime option may not be the best option for you. Although you’ll pay more in annual deductibles and copayments, TRICARE Standard and TRICARE Extra will allow you the flexibility to see the doctors you want.
Scenario 3: I’m retiring from the military and my daughter is beginning her first year of college in another state.
As a retiree living in a TRICARE Prime service area (PSA), you have the option of re-enrolling yourself and your family members in TRICARE Prime. You will have coverage similar to that which you did as an active duty service member, but you will have to pay an annual enrollment fee and minimal copayments.
For example, if your daughter is attending school in a TRICARE PSA, she can enjoy the benefits of TRICARE Prime while attending school through TRICARE Prime’s split enrollment feature. To use split enrollment, you must notify each family member’s regional contractor of the split enrollment status. The region where enrollment fee payment is made is determined by the sponsor’s TRICARE Prime enrollment location. If the sponsor is not enrolled, the region where payment is made is determined by the next eldest TRICARE Prime family member enrolled. The regional contractors will coordinate enrollment fees and send the statements to the designated payer.
If TRICARE Prime is not offered in yourdaughter’s area, you may want to disenroll her from TRICARE Prime and have her use TRICARE Standard and TRICARE Extra. If she stays in TRICARE Prime, she’ll be using the Prime point of service (POS) option for routine care, which can become very costly.
Scenario 4: My husband is an active duty service member, but I have health insurance through my employer.
Look carefully at your employer-sponsored health plan. If the health plan is a health maintenance organization (HMO), in which you have to use doctors in the plan's network, enrolling in TRICARE Prime may not be your best option. Because TRICARE Prime and your other health insurance both require you to use doctors in a specific network, they may require you to use different providers.
If you use TRICARE Standard and/or TRICARE Extra as a secondary insurance to your employer-sponsored health plan, you can see TRICARE-authorized network or non-network providers and TRICARE will pay its portion for covered services after your employer-sponsored health plan has paid its portion.
Scenario 5: I am 65 and not entitled to premium-free Medicare Part A based on my own work record (Social Security number). Am I eligible for TRICARE?
If applicable, you must file for benefits under your spouse’s (or former spouse’s) Social Security number if he or she is 62 years of age or older.
If your spouse or former spouse is not yet 62,you are eligible for TRICARE benefits. Because you aren’t entitled to premiumfree Part A, you aren’t required to purchase Part B to remain eligible for TRICARE. However, if you expect to become eligible for premium free Medicare Part A on your spouse’s record at a date following your 65th birthday, you may want to enroll in Medicare Part B when first eligible to avoid paying a higher Part B premium. Medicare Part B premiums increase 10 percent for each 12-month period that you could have enrolled, but chose not to.
|
