Military Health Insurance
TRICARE BENEFITS
Sorting it Out Before You Need it.
The mission of the Military Health System is to provide quality health support for the full range of military operations, with quality medical care through a network of providers, military treatment facilities, medical clinics and dental clinics worldwide.
TRICARE serves more than 9.2 million eligible beneficiaries worldwide in the Military Health System (MHS).
Do you fully understand your TRICARE benefits? Are you enrolled in the TRICARE coverage plan that best suits your military family's needs? Or are you somewhat confused by all the TRICARE coverage options, co-pays, deductibles, and acronyms?
TRICARE is an enormous military health benefits system, set up to benefit you; but many military servicemembers and their families are understandably unsure about TRICARE, because it is also a very complex health care system.
So if you don't fully understand TRICARE, you're not alone.
TRICARE is a regionally managed health care program for Active Duty, Activated Guard and Reserves, retired members of the uniformed services, their families, and survivors. TRICARE Management Activity, managed by the Defense Department, administers the health care plan for the uniformed services, retirees and their families.
TRICARE brings together the health care resources of the Army, Navy and Air Force, with networks of civilian health care professionals. The goal of TRICARE is to provide better access to high quality healthcare service, maintaining the capability to support military operations.
Active Duty Guard and Reserve are automatically enrolled TRICARE Prime. However military dependents and retirees must choose the TRICARE option that best suits their needs.
TRICARE Prime
TRICARE Extra
TRICARE Standard
Annual Deductible
None
$150/individual or $300/family for E-5 & above; $50/$100 for E-4 & below
$150/individual or $300/family for E-5 & above; $50/100 E-4 below
Annual Enrollment Fee
None
None
None
Civilian Outpatient Visit
No Cost
15% of negotiated fee
20% of allowed charges for covered service
Civilian Inpatient Admission
No Cost
Greater of $25 or $14.35/day
Greater of $25 or $14.35/day
Civilian Inpatient Behavioral Health
No Cost
Greater of $20 per day or $25 per admission
Greater of $20 per day or $25 per admission
Civilian Inpatient Skilled Nursing Facility Care
$0 per diem charge per admission
No separate co-payment/cost-share for separately billed professional charges
$11/day ($25 minimum) Charge per admission
$11/day ($25 minimum) Charge per admission
Military Retirees (under 65), their family, and others
TRICARE Prime
TRICARE Extra
TRICARE Standard
Annual Deductible
None
$150/individual or $300/family
$150/individual or $300/family
Annual Enrollment Fee
$230/individual $460/family
None
None
Civilian Cost Shares
20% of negotiated fee
25% of allowed charges for covered service
Outpatient Emergency Care Mental Health Visit
$12 / $30 / $25
$17 (group visit)
Civilian Inpatient Cost Share
Greater of $11 per day or $25 per admission; no separate copayment for separately billed professional charges
Lesser of $250/day or 25% of negotiated charges plus 20% of negotiated professional fees
Lesser of $535/day or 25% of billed charges plus 25% of allowed professional fees
Civilian Inpatient Skilled Nursing Facility Care
$11/day($25 minimum) charge per admission
$250 per diem cost share or 20% cost share of total charges, whichever is less, institutional services, plus 20% cost share of separately billed professional charges
25% cost-share of allowed charges for institutional services, plus 25% cost-share for separately billed professional charges.
Civilian Inpatient Behavioral Health
$40 per day; no charge for separately billed professional charges
20% of total charge. Plus, 20% of the allowable charge for separately billed professional services
High Volume Hospitals - 25% hospital specific per diem plus 25% allowable for separately billed professional services; Low Volume Hospitals - $175/ day or 25% of billed charges whichever is lower, plus 25% allowable for separately billed services
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