Tricare is the Health insurance program that is used by all seven components of the armed forces. This includes the Army, Navy, Marines, Air Force, Coast Guard, Public Health service, and National Oceanic and Atmospheric Administration. This program was created so that all of these uniformed service members could be provided with network of civilian health care professionals. Overcrowding of military medical facilities pushed this plan to be implemented even more. This grants them better access to health care and provides quality service so that they are able to maintain their health while supporting different military operations.
Tricare was created in 1998. It was developed from the Champus Reform Initiative. (This program existed for more than 30 years) Tricare is administered on a regional basis. The three regions that are covered CONUS include The West Region, The South Region, and the North region. There are also areas covered OCONUS, such as Europe, Canada/Latin America, and Puerto Rico/Virgin Islands. Up until 2005 Tricare had 11 regions. They merged to form the previously mentioned. Each of these regions is headed by a regional director.
This person is responsible for overseeing all health care delivery activities in their specific region. Regional directors work hand in hand with military treatment facility commanders. Tricare’s most important goals are accessibility and affordability. Active duty service members, spouses and unmarried children of active duty service members and, uniformed service retirees, their spouses, and unmarried children are all eligible for Tricare. They must be enrolled in a program called DEERS (defense enrollment and eligibility reporting system) before receiving their sponsorship.
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Most individuals who are 65 years old and eligible for Medicare, parents’ and parents-in law of active duty service members or uniformed TRICARE Services retirees, or of deceased active duty members or retirees, and individuals who are eligible for benefits under the Civilian Health and Medical Program of the Department of Veterans Affairs are not eligible for any form of Tricare. Just like any other form of HMO, Tricare pays only their allowed services. This includes their supplies and procedures. These things are called covered charges.
Covered charges include medical and psychological services and supplies that are considered appropriate care and are generally accepted by qualified professionals to be reasonable and adequate for the diagnosis and treatment of illness, injury, pregnancy, mental disorders, and well- child care. Tricare has something that is referred to as an allowable charge. It would be the equivalent to co-insurance. It is calculated by researching professional providers’ fees for similar services in the past year with certain adjustments for specific locations. Tricare has three choices available for health care.
The three choices are Tricare Standard, Tricare Prime and Tricare Extra. Tricare Standard is your typically fee-for-service plan. Under this type of Tricare enrollees are allowed to choose which provider they are treated by. This is the broadest choice of providers. In many locations Tricare Standard is the only option available. Members who are eligible for Tricare Standard may also use Tricare Extra. Tricare Extra is a preferred provider option. The sponsor chooses a hospital, medical provider or any other physician that is listed in the Tricare Provider Directory.
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There is no annual fee for this type of Tricare. Tricare Prime is health maintenance organization type of managed care option in which MTFS are the principal source of health care. When eligible person’s sign up for this they are assigned TRICARE to a PCM (primary care manager).
They must see this provider or team of providers first for all routine medical care. Tricare and CHAMPVA have many similarities. CHAMPVA is a health care benefits program for depends of veterans. Under this program the CA shares the cost of covered health care services and supplies with eligible beneficiaries.
This program is managed by the VA’s Health Administration Center in Denver, Colorado. Although they both are very similar individuals who are eligible for Tricare are NOT eligible for CHAMPVA. CHAMPVA only provides benefits to eligible family members of veterans who have been declared 100% disabled due to service related injuries, survivors of veterans who died from service connected conditions, and survivors of service members who died in the line of duty who are not otherwise entitled to TRICARE benefits.
Tricare is no different from any other HMO health provider. It is simply something that was established to make the individuals who serve our country have an easier time while trying to obtain certain benefits. Tricare main purpose is to improve overall access to health care beneficiaries, provide faster, more convenient access to civilian health care; create a more efficient way to receive health care; offer enhanced health care services, including preventative care; provides choices for health care and control escalating health care costs.
