14.3 TRICARE (The Uniformed Services Health Program)
TRICARE is a health care program designed primarily to provide coverage for active-duty and retired members of the U.S. military, as well as their eligible dependents.
TRICARE offers three primary plan options—Standard, Prime, and TRICARE For Life—which are available based on the member’s service status, such as active duty, National Guard/Reserve, or retired status. For individuals on active duty, enrollment in TRICARE Prime is required, and care received at military medical facilities is provided with no out-of-pocket costs. While dependent coverage is not mandatory, many active-duty service members choose to enroll their dependents in TRICARE Prime for comprehensive coverage.
- TRICARE Standard does not require a monthly premium from the member; however, it includes cost-sharing. Members typically pay a $12 copayment for office visits and approximately 25% of the cost for covered procedures.
- TRICARE Prime requires a monthly premium but offers more comprehensive coverage with limited out-of-pocket costs when care is coordinated through a primary care manager (PCM) or obtained with a TRICARE-approved referral. Members generally pay a $12 copayment for office visits and an $11 per day charge for inpatient hospitalization.
- TRICARE For Life (TFL) functions as secondary coverage for individuals enrolled in Medicare Parts A and B. Medicare serves as the primary payer, while TRICARE For Life covers eligible remaining costs. There are no enrollment fees for TFL; however, members are responsible for paying their Medicare Part B premiums.
Quiz
1. Who is TRICARE primarily designed to cover?
A. Low-income individuals only
B. Active-duty and retired U.S. military members and their dependents
C. Individuals over age 65 only
D. Federal government employees only
Correct Answer: B
Rationale: TRICARE is specifically designed to provide health coverage for active-duty and retired military members and their eligible dependents.
2. Which TRICARE plan is mandatory for active-duty service members?
A. TRICARE Standard
B. TRICARE Prime
C. TRICARE For Life
D. Medicare Advantage
Correct Answer: B
Rationale: Active-duty service members are required to enroll in TRICARE Prime, which provides care with no out-of-pocket costs at military facilities.
3. Which statement best describes TRICARE Standard?
A. It requires a monthly premium with no copayments
B. It requires no premium but includes cost-sharing such as copays and coinsurance
C. It is only available to retirees with Medicare
D. It covers all services with no out-of-pocket costs
Correct Answer: B
Rationale: TRICARE Standard does not have a monthly premium but requires members to share costs, including copays and a percentage of procedures.
4. What is a key requirement for minimizing out-of-pocket costs under TRICARE Prime?
A. Using any provider without referrals
B. Paying all services upfront
C. Coordinating care through a primary care manager or obtaining approved referrals
D. Enrolling in Medicare Part D
Correct Answer: C
Rationale: TRICARE Prime limits out-of-pocket costs when care is managed through a primary care manager or approved referral network.
5. How does TRICARE For Life (TFL) coordinate with Medicare?
A. TFL is the primary payer and Medicare is secondary
B. TFL replaces Medicare entirely
C. Medicare is primary and TFL acts as secondary coverage
D. TFL only covers prescription drugs
Correct Answer: C
Rationale: TRICARE For Life works with Medicare, where Medicare pays first and TFL covers eligible remaining costs, with the member responsible for Part B premiums.