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Home Health Care
Inpatient Services (Both MTF and Civilian Facility)


Home Health Care
Same as the Medicare home health care benefit, providing a maximum of 28 hours per week part-time, or 35 hours per week intermittent, skilled nursing care and physical, speech, and occupational therapy. All care must be provided by a participating home health care agency.

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Inpatient Services (Both MTF and Civilian Facility)*
Services Covered  TRICARE Prime**

TRICARE Extra

 TRICARE Standard
Hospitalization(1)(2)(3)
Semiprivate room (and when medically necessary, special care units), general nursing, and hospital service. Includes inpatient physician and surgical services; meals, including special diets; drugs and medications while an inpatient; operating and recovery room; anesthesia; laboratory tests; X-rays and other radiology services; necessary medical supplies and appliances; and blood and blood products. Unlimited services, as medically necessary.  		ADFM:
MTF: No copayment
Civilian: No copayment




Retirees and others:
MTF: $14.35 per day
Civilian: $11 per day or $25 minimum charge per admission, whichever is greater.

(No separate copayment for separately billed professional charges. Catastrophic Cap protection limits do apply.)

ADFM:
MTF: $14.35 per day
Civilian: $14.35 per day or $25 minimum charge per admission, whichever is greater.

Retirees and others:
MTF: $14.35 per day
Civilian: $250 per day or 25% cost-share of the total contracted reimbursement for institutional services, whichever is less, plus 20% cost-share of separately billed professional charges based on the contracted reimbursement.

ADFM:
MTF: $14.35 per day
Civilian care: $14.35 per day or $25 minimum charge per admission, whichever is greater.

Retirees and others:
MTF: $14.35 per day
Civilian: $535 per day or 25% cost share of billed charges, whichever is less, plus 25% cost share of the maximum allowable charge for separately billed professional charges.
Maternity(1)(2)
Hospital and professional services (prenatal, postnatal). Unlimited services, as medically necessary.  		Same as above Same as above  Same as above
Skilled Nursing Facility (SNF) Care(1)(4)
Semiprivate room; regular nursing services; meals including special diets; physical, occupational, and speech therapy; drugs furnished by the facility; and necessary medical supplies and appliances. Unlimited services, as medically necessary.  		Same as above  ADFM:
MTF: $14.35 per day
Civilian: $14.35 per day or $25 minimum charge per admission, whichever is greater.

Retirees and others:
MTF: $14.35 per day
Civilian: Lesser of $250 per day or 20% of the negotiated professional fee for institutional services, plus 20% of the negotiated professional fee.  		ADFM:
$25 per admission or $14.35 per day, whichever is greater.

Retirees and others:
25% cost-share of allowed charges, plus 25% cost-share of the maximum allowable charge for separately billed professional charges. 
While the inpatient rate increases are technically effective October 1, there may be some delay between that date and the time Humana Military receives direction from TMA and is able to implement the change.
* Cost-shares reflecting a dollar amount are subject to change (i.e. $14.35 per day).
** Benefits under TPR and TPRADFM are similar to TRICARE Prime.
1. Cost-share and daily inpatient charges are subject to change at the beginning of each fiscal year (October 1–September 30).
2. TRICARE Standard beneficiaries may pay up to 15 percent above the maximum allowable charge when the provider does not accept assignment (balance billing). See the Glossary for a description of balance billing.
3. TRICARE Standard cost-share for retirees may vary depending on type of treatment or type of hospital.
4. Requires prior authorization for TRICARE Prime, TPR, and TPRADFM.


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Last Reviewed: September 4, 2007